Formulary
Indapamide: Indications, Dosing, Side Effects and Interactions
Indapamide is a thiazide-like diuretic with antihypertensive effects.
MedNext Academy | 3 min read
Indapamide: Indications, Dosing, Side Effects and Interactions
Indapamide is a thiazide-like diuretic with antihypertensive effects.
Drug action
Indapamide is a thiazide-like diuretic with antihypertensive effects. At lower doses, vasodilatation is more prominent than diuresis; the diuretic effect becomes more apparent with higher doses.
Indications and dose
**Essential hypertension**
- **Adult** (By Mouth Using Immediate-Release Medicines): 2.5 mg daily, dose to be taken in the morning.
- **Adult** (By Mouth Using Modified-Release Medicines): 1.5 mg daily, dose to be taken preferably in the morning.
Cautions
For all thiazides and related diuretics Diabetes; gout; risk of hypokalaemia; systemic lupus erythematosus Cautions, further information Existing conditions Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Potassium loss Hypokalaemia can occur with thiazides and related diuretics. Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics avoids the need to take potassium supplements. In hepatic impairment, hypokalaemia caused by diuretics can precipitate encephalopathy. Elderly Lower initial doses of diuretics may be necessary in the elderly because they are particularly susceptible to the side-effects. The dose should then be adjusted according to renal function. M Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with current significant hypokalaemia (serum potassium less than 3 mmol/L), hyponatraemia (serum sodium less than 130 mmol/L), or hypercalcaemia (corrected serum calcium greater than 2.65 mmol/L)-contra-indicated; hypokalaemia, hyponatraemia, and hypercalcaemia can be precipitated by a thiazide diuretic with a history of gout (gout can be precipitated by a thiazide diuretic) Cautions For indapamide Acute porphyrias
Contraindications
For all thiazides and related diuretics Addison's disease; hypercalcaemia; hyponatraemia; refractory hypokalaemia; symptomatic hyperuricaemia
Side effects
For all thiazides and related diuretics Common or very common Alkalosis hypochloraemic; constipation; diarrhoea; dizziness; electrolyte imbalance; erectile dysfunction; fatigue; headache; hyperglycaemia; hyperuricaemia; nausea; postural hypotension; skin reactions; vomiting Uncommon Agranulocytosis; aplastic anaemia; leucopenia; pancreatitis; photosensitivity reaction; thrombocytopenia Rare or very rare Paraesthesia Side-effects For indapamide Common or very common Hypersensitivity Rare or very rare Angioedema; arrhythmias; dry mouth; haemolytic anaemia; hepatic disorders; renal failure; severe cutaneous adverse reactions (SCARs); vertigo Frequency not known Hepatic encephalopathy; QT interval prolongation; rhabdomyolysis; syncope; systemic lupus erythematosus exacerbated; vision disorders
Interactions
**Other interactions (13):**
- Combinations that are not recommended Lithium Increased plasma lithium with signs of overdosage, as with a salt-free diet (decreased urinary lithium excretion).
- However, if the use of diuretics is necessary, careful monitoring of plasma lithium and dose adjustment are required.
- Combinations requiring precautions for use Torsades de pointes-inducing drugs (such as but not limited to): class Ia antiarrhythmics agents ( e.g.quinidine, hydroquinidine, disopyramide), class...
- N.S.A.I.Ds (systemic route) including COX-2 selective inhibitors, high dose acetylsalicylic acid ( 3 g/day) Possible reduction in the antihypertensive effect of indapamide.
- Other compounds causing hypokalaemia: amphotericin B (IV), gluco- and mineralo-corticoids (systemic route), tetracosactide, stimulant laxatives Increased risk of hypokalaemia (additive effect).
- Baclofen Increased antihypertensive effect.
Pregnancy
For all thiazides and related diuretics Thiazides and related diuretics should not be used to treat gestational hypertension. They may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported.
Breast feeding
Present in milk-manufacturer advises avoid.
Hepatic impairment
For all thiazides and related diuretics In general, manufacturer advises caution in mild to moderate impairment; avoid in severe impairment.
Renal impairment
For all thiazides and related diuretics In general, manufacturers advise caution in mild to moderate impairment (risk of electrolyte imbalance and reduced renal function); avoid in severe impairment (ineffective if creatinine clearance less than 30 mL/minute). See Prescribing in renal impairment .
Medicinal forms
Suspension,Tablet,Tablet
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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