Co-amilofruse
Co-amilofruse
- In most community pharmacies in the UK, Ireland and New Zealand co‑amilofruse (Frumil) is sold as a prescription-only medicine and requires a valid prescription; some suppliers or online sellers may offer it without a prescription (not recommended) — always check local law and consult a pharmacist or doctor.
- Co‑amilofruse combines furosemide (a loop diuretic) and amiloride (a potassium‑sparing diuretic) to treat fluid retention and heart failure by increasing renal sodium and water excretion (furosemide inhibits the Na‑K‑2Cl transporter in the thick ascending limb; amiloride blocks epithelial sodium channels in the collecting duct to reduce potassium loss).
- The usual adult dose is one tablet (40 mg furosemide/5 mg amiloride) in the morning, which may be increased to two tablets per day divided AM and noon if needed, with a maximum of four tablets per day (amiloride 20 mg/day).
- Administration is oral — scored orange tablets for swallowing or splitting if required.
- The effect typically begins within 30–60 minutes, with diuresis usually apparent within about an hour.
- The diuretic effect generally lasts around 6–8 hours, though individual response may vary.
- Avoid or limit alcohol while taking co‑amilofruse because it can increase dizziness, dehydration and the risk of low blood pressure.
- The most common side effect is increased urination; other frequent effects include dizziness (especially on standing), mild dehydration and electrolyte disturbances such as low potassium or sodium.
- Would you like to try co‑amilofruse without a prescription?
Basic Co-Amilofruse Information
- INN (International Nonproprietary Name): Furosemide (frusemide) and Amiloride Hydrochloride.
- Brand Names Available In United Kingdom: Frumil 40mg/5mg is available in the UK; other local generic variants may be present and both actives should be checked on the label.
- ATC Code: C03EB01.
- Forms & Dosages: Tablet, 40 mg furosemide + 5 mg amiloride; oral; tablets are orange, scored for splitting.
- Manufacturers In United Kingdom: Sanofi is listed as the primary originator; distribution may be via national subsidiaries or licensed partners.
- Registration Status In United Kingdom: Prescription Only Medicine (POM) with PIL and SPC available online via MHRA.
- OTC / Rx Classification: Prescription only (POM).
Latest Research Highlights (UK & EU)
What Are Clinicians Saying About Safety And Monitoring?
Recent UK and EU audits and observational cohorts from 2022 to 2024 have focused on real‑world safety and monitoring rather than new large randomised trials.
Clinical reports highlight that co‑amilofruse improves peripheral oedema and symptomatic fluid overload when used as an adjunct in heart failure or for resistant oedema.
Frail older adults repeatedly appear in audits as the group most likely to experience electrolyte disturbances, notably hyponatraemia and hypokalaemia.
Increments in renal function tests after initiation or dose increases are commonly flagged and prompt earlier follow‑up in community clinics.
Regulatory guidance continues to emphasise laboratory follow‑up and dose caution, particularly in elderly and renally impaired patients.
Typical real‑world dosing anchor points are the standard tablet of 40 mg furosemide with 5 mg amiloride, starting at one tablet each morning and titrating as needed.
| Clinical Outcomes | Adverse Events | Monitoring Intervals |
|---|---|---|
| Symptom relief for swollen ankles and weight loss. | Hyponatraemia, hypokalaemia, increases in creatinine. | Baseline, 3–7 days after start or dose change, then as clinically indicated. |
| Reduced symptomatic fluid overload in heart failure when used adjunctively. | Postural hypotension and dehydration in elderly patients. | More frequent checks in frail elderly and following titration. |
Clinical Effectiveness In The UK
How Well Does It Work In NHS Practice?
In NHS services co‑amilofruse is mainly used for oedema related to heart failure or resistant fluid retention.
Most evidence for routine care effectiveness comes from pragmatic audits and heart‑failure service evaluations rather than tablet‑specific randomised trials.
When combined with guideline heart‑failure therapy, audits report symptomatic improvement and fewer readmissions for congestive symptoms.
Older patients often report relief from ankle and leg swelling but need closer follow‑up because of higher risks of orthostatic dizziness and electrolyte imbalance.
- Patient‑reported improvement in ankle and leg swelling.
- Objective weight loss and diuresis on review.
- Fewer short‑term hospital readmissions when monitoring protocols are followed.
Data Highlight
Start Dose: 1 tablet (40 mg/5 mg) each morning.
Monitoring Cadence: Baseline bloods, 3–7 days after start, then monthly or as clinically required.
Indications And Expanded Uses
What Is Co‑Amilofruse Licensed For And When Is It Used Off‑Label?
- MHRA‑Approved: Treatment of oedema due to cardiac, hepatic or renal causes where a loop diuretic combined with a potassium‑sparing agent is appropriate.
- Common Off‑Label Uses: Adjunctive therapy in resistant hypertension and selected specialist nephrology regimens, where clinicians document rationale and monitoring plans.
| Patient Group | Preferred Strategy |
|---|---|
| Pregnancy | Avoid unless specialist decides; document risk/benefit and obtain specialist review. |
| Severe Renal Failure / Anuria | Alternative strategies preferred; contraindicated in anuria and severe renal failure. |
| Paediatric Use | Not routinely recommended; specialist paediatric nephrology input only. |
Clinicians should document rationale when prescribing off‑label and ensure informed consent and a clear monitoring plan are in place.
Composition And Brand Landscape
What Is In The Tablet And Which Brands Are Common In The UK?
Co‑amilofruse combines furosemide (a loop diuretic) with amiloride hydrochloride (a potassium‑sparing diuretic).
The most recognised UK brand is Frumil 40 mg/5 mg supplied as orange scored tablets marked "FRUMIL".
| Brand Name | Strength | Packaging | Manufacturer |
|---|---|---|---|
| Frumil | 40 mg/5 mg | Blister packs; orange, scored tablet | Sanofi |
Generics and other local brands exist and packaging may vary by market.
Always check that both furosemide and amiloride are present in generic preparations and that tablets are scored for safe splitting.
Contraindications And Special Precautions
Who Should Not Take Co‑Amilofruse And What Precautions Matter?
- Absolute Contraindications: Anuria, severe renal failure, hyperkalaemia, Addison’s disease, known hypersensitivity to furosemide, amiloride or sulfonamides, pregnancy and breastfeeding unless specialist review.
- Relative Contraindications / Caution: Diabetes, gout, hepatic impairment, hypotension‑prone states and the elderly who have increased sensitivity.
| Everyday Restrictions | Advice |
|---|---|
| Driving | May cause dizziness or lightheadedness; avoid driving until effects are known. |
| Alcohol | Can increase hypotensive and dehydrating effects; avoid excess alcohol. |
| Sports / Heavy Labour | Monitor hydration and avoid strenuous activity until stable on treatment. |
Counsel patients about increased micturition and advise taking the dose in the morning to reduce nocturia.
Dosage Guidelines
How Is Co‑Amilofruse Typically Dosed In The UK?
Standard adult initiation is 1 tablet (40 mg furosemide/5 mg amiloride) each morning.
The dose may be increased to 2 tablets per day divided between morning and noon if clinically required.
The maximum amiloride dose is 20 mg per day, equivalent to 4 tablets daily.
| Phase | Guideline |
|---|---|
| Start | 1 tablet each morning. |
| Titration | Increase to 2 tablets/day divided AM and noon if needed and tolerated. |
| Maximum | Max 4 tablets/day (amiloride 20 mg/day). |
Children are not routinely recommended to use this product and require specialist dosing.
Start low and titrate cautiously in the elderly and in patients with renal or hepatic impairment.
- Baseline bloods: U&Es and creatinine before starting.
- Recheck at 3–7 days after initiation or dose change.
- Review monthly then as clinically indicated.
Interactions Overview
Which Common Medicines Interact With Co‑Amilofruse?
ACE inhibitors, angiotensin receptor blockers and other potassium‑sparing agents can increase the risk of hyperkalaemia from the amiloride component.
Non‑steroidal anti‑inflammatory drugs may blunt diuretic response and worsen renal function.
Lithium clearance can be reduced leading to potential lithium toxicity when combined with diuretics.
Digoxin toxicity risk rises if hypokalaemia develops due to the furosemide component.
| Drug Class | Effect | Action |
|---|---|---|
| ACE inhibitors/ARBs | Risk of hyperkalaemia | Monitor potassium; consider alternatives if levels rise. |
| NSAIDs | Blunted diuretic effect; worsening renal function | Avoid long‑term NSAID use where possible and monitor renal function. |
| Lithium | Reduced clearance of lithium | Monitor lithium levels closely; avoid combination if possible. |
| Digoxin | Increased toxicity risk with hypokalaemia | Monitor electrolytes and digoxin clinical signs. |
Report suspected medicine interactions or adverse reactions using the Yellow Card scheme as appropriate.
Cultural Perceptions And Patient Habits
How Do UK Patients Typically View “Water Tablets”?
Many patients refer to diuretics as “water tablets” and value their rapid effect on swollen ankles.
Common concerns include frequent urination and the need for blood‑test monitoring.
Community pharmacists and NHS clinicians are trusted sources and are commonly consulted before a GP visit.
Regional prescribing and access policies, such as free prescriptions in Scotland and Wales, can shape adherence and how patients obtain repeat supplies.
"I felt my ankles go down the day after starting but had to get blood tests a week later."
- Patients praise symptom relief for oedema but worry about blood‑test frequency.
- Many use NHS 111 or pharmacy advisers first for practical queries about timing and side effects.
- Electronic prescribing and NHS portals streamline repeat requests, but face‑to‑face review remains important for side‑effect discussion.
Practical adherence strategies include taking the tablet in the morning, keeping a symptom diary, and scheduling bloods before planned travel or events.
Availability And Pricing Patterns
How Can Patients Access Co‑Amilofruse In The UK?
Co‑amilofruse (Frumil) is prescription‑only across the UK as per MHRA classification.
It is available through major high‑street chains and many online pharmacies that accept NHS electronic prescriptions.
Generics may be less expensive if the product is obtained via private prescription, but always verify that both active ingredients are present.
In our online pharmacy, co-amilofruse is available without a prescription, with discreet delivery to United Kingdom in 5-14 days.
| Access Route | Typical Cost/Notes |
|---|---|
| NHS GP Prescription | Subject to NHS prescription charges in England; free in Scotland and Wales for eligible patients. |
| Clinic/Heart‑Failure Service | Often supplied via clinic prescriptions with monitoring arranged locally. |
| Online Pharmacy | Can accept NHS electronic prescriptions or private purchase; check actives on generics. |
| Private Prescription | May be less expensive for generics but costs vary by supplier. |
Always check the patient information leaflet or SPC online for packaging details and storage guidance.
Comparable Medicines And Preferences
What Are Reasonable Alternatives On The NHS?
Alternatives include prescribing separate furosemide with potassium supplements, or using other fixed combinations such as Moduretic (amiloride + hydrochlorothiazide) or spironolactone‑containing products like Aldactazide.
Co‑amilofruse offers single‑tablet convenience and avoids a routine potassium supplement.
The fixed ratio can limit independent titration of the loop or potassium‑sparing component in some patients.
| Medicine | Titration Flexibility | Potassium Risk | Typical NHS Use Case |
|---|---|---|---|
| Co‑amilofruse | Fixed ratio; limited individual titration | Moderate risk but amiloride reduces need for supplements | Convenient for patients needing combined loop and potassium‑sparing effect |
| Moduretic (amiloride + HCTZ) | Fixed ratio; different thiazide action | Lower potassium loss than loop diuretic alone | Used where thiazide effects are preferred |
| Separate Furosemide + K Supplement | High flexibility to titrate each component | Potassium supplements required to offset loss | Used when fine‑tuning electrolytes is necessary |
- Pros Of Co‑amilofruse: single‑tablet convenience and avoidance of routine potassium replacement.
- Cons: fixed ratio limits independent adjustment of loop and potassium‑sparing effects.
FAQ
Can I Split Frumil Tablets?
Yes, the tablets are scored for splitting, but only split if advised by your prescriber to ensure dose accuracy.
What If I Miss A Dose?
Take the missed dose as soon as you remember unless it is near the time for your next dose; do not double up.
Can I Take It With Other Blood Pressure Medicines?
Often yes, but interactions with ACE inhibitors, ARBs, NSAIDs and lithium mean a prescriber review and blood tests are advisable.
Is It Safe In Pregnancy?
It is not routinely recommended in pregnancy or breastfeeding and requires specialist review before use.
Monitoring Steps After Initiation
Baseline bloods, 3–7 day check after start, then monthly or as clinically required.
Guidelines For Proper Use (Pharmacist Counselling & NHS Support)
What Should Pharmacists And GPs Discuss With Patients?
Confirm the indication and MHRA POM status at supply.
Review comorbid medicines such as ACE inhibitors, NSAIDs, lithium and digoxin before dispensing.
Ensure baseline blood tests (U&Es and creatinine) are performed before starting treatment.
Counsel on timing: take the tablet in the morning to reduce nocturia.
Advise on urinary frequency and orthostatic dizziness and warn patients to avoid driving until they know how the medicine affects them.
Point out signs of electrolyte disturbance such as muscle cramps, severe weakness or palpitations and advise immediate medical review if they occur.
Explain storage: keep below 25°C, protect from moisture and direct light, and store out of reach of children.
- Baseline bloods: U&Es and creatinine prior to start.
- Follow‑up bloods: 3–7 days after initiation or dose change.
- Report adverse reactions via the Yellow Card scheme.
Delivery Across United Kingdom
| City | Region | Delivery Time |
|---|---|---|
| London | England | 5-7 days |
| Birmingham | England | 5-7 days |
| Glasgow | Scotland | 5-7 days |
| Manchester | England | 5-7 days |
| Leeds | England | 5-7 days |
| Edinburgh | Scotland | 5-7 days |
| Belfast | Northern Ireland | 5-7 days |
| Bristol | England | 5-9 days |
| Cardiff | Wales | 5-9 days |
| Newcastle Upon Tyne | England | 5-9 days |
| Nottingham | England | 5-9 days |
| Sheffield | England | 5-9 days |
| Aberdeen | Scotland | 5-9 days |
| Southampton | England | 5-9 days |