Co-amilozide 2.5mg/25mg tablets

BackgroundBy entering collecting duct principal cells via the epithelial sodium channel (ENaC), lithium is capable of inducing vasopressin insensitivity, resulting in excessive urine production, nephrogenic diabetes insipidus (NDI) and potential for other long-term forms of renal dysfunction. ENaC inhibitors (ENaC-I) such as amiloride have been shown in animal models to minimise this adverse effect, and while ENaC-I are often considered an effective strategy, the literature on ENaC-I for lithium-related polyuria has not yet been synthesised despite the importance of this topic. This review aimed to identify all published evidence for adjunctive use of an ENaC-I for lithium-related polyuria to estimate its effectiveness while also exploring potential moderators of effectiveness.MethodThe systematic search covered databases MEDLINE, EMBASE and PsycINFO complemented by handsearches, aiming to identify all studies of ENaC-I interventions in lithium-treated patients with pre- and post-ENaC-I polyuria as outcomes.Results10 studies totalling 25 participants were eligible for inclusion and were synthesised narratively. Amiloride was the ENaC-I used in 24/25 participants, and triamterene in the other. 8/10 publications were single case reports, 4 of which presented substantial confounding issues. Clear improvements to polyuria were demonstrated in most papers, including the two larger studies.ConclusionsAlthough it appears very likely that ENaC inhibitors help ameliorate polyuria in lithium-treated patients, the quantity and quality of evidence is low. Heterogeneity in patient characteristics, intervention characteristics and study designs limit conclusions regarding the contribution of factors likely to influence ENaC-I effectiveness for lithium-induced polyuria. Besides, adverse effects require further exploration.

Abstract licence: CC BY

BackgroundHypertension is among the leading causes of cardiovascular diseases, including myocardial infarction (MI), stroke, and heart failure. The thiazide diuretics of chlorthalidone and hydrochlorothiazide are commonly prescribed in the control of blood pressure. Although they are effective, there has been debate regarding their relative efficacy and safety, particularly with respect to cardiovascular events.AimTo determine the relative efficacy and safety of hydrochlorothiazide vs chlorthalidone in the treatment of primary hypertension treatment in adults, isolation of their effects on systolic and diastolic blood pressure, MI, stroke, heart failure, and hypokalemia.MethodsPubMed and Google Scholar databases were searched for comparative studies of hydrochlorothiazide vs chlorthalidone in patients with hypertension. The inclusion criteria were randomized controlled trials, cohort studies, and clinical studies in the English language from 2005 to 2025. Eleven studies were ultimately included for meta-analysis. Statistical analysis was performed using a random-effects model, and heterogeneity was tested by I 2 statistics.ResultsChlorthalidone was associated with greater reductions in systolic blood pressure [mean difference: 5.18 mmHg, 95% confidence interval (CI): 4.28-6.08] and diastolic blood pressure (2.91 mmHg, 95%CI: 1.96-3.87) compared to hydrochlorothiazide. Interestingly, chlorthalidone also demonstrated superior nocturnal blood pressure control (P = 0.0002). In terms of cardiovascular outcomes, chlorthalidone showed a potential significant (P = 0.052) reduction in the risk of MI (relative risk: 1.30, 95%CI: 1.00-1.70); however, there were no differences in stroke or all-cause mortality between the two medications. A safety analysis revealed a significantly lower risk of hypokalemia associated with hydrochlorothiazide (relative risk: 0.52, 95%CI: 0.38-0.72). Both medications had similar safety profiles regarding heart failure and rates of hospitalization.ConclusionThe present meta-analysis suggests that chlorthalidone is more effective than hydrochlorothiazide in reducing both systolic and diastolic blood pressure, particularly at night. Although both drugs share comparable cardiovascular event safety profiles, chlorthalidone carries a higher risk of inducing hypokalemia. These findings emphasize the need for individualized treatment strategies in the management of hypertension based on the varying efficacy and safety profiles of chlorthalidone and hydrochlorothiazide.

Abstract licence: CC BY-NC