We have compared the pharmacological properties of the human placental brush-border membrane Na(+)-H+ exchanger with those of the rabbit renal brush-border membrane Na(+)-H+ exchanger. The exchanger activity in both preparations was inhibited by cimetidine, clonidine, and harmaline. Cimetidine was found to be 4-5 times more potent than clonidine in inhibiting the placental Na+-H+ exchanger. However, the order of potency was reversed for the renal exchanger, in which case clonidine was 3-4 times more potent than cimetidine as an inhibitor. There was, however, no difference between the potencies of harmaline to inhibit the two exchangers. When amiloride and four of its analogs were tested as inhibitors, the Na(+)-H+ exchanger of the placental brush-border membrane exhibited greater sensitivity to inhibition by all of these compounds than the Na(+)-H+ exchanger of the renal brush-border membrane. The difference between the two exchangers was more prominent with the 5-amino-substituted amiloride derivatives than with amiloride. The greatest difference between the Ki values was for dimethylamiloride (the kidney/placenta ratio was 185), followed by ethylisopropyl amiloride, hexamethylene amiloride, and t-butyl amiloride. These results indicate that the two Na+-H+ exchangers are pharmacologically distinct.