Indapamide

Indapamide is an oral antihypertensive agent related to thiazide diuretics. It inhibits sodium reabsorption in the proximal segment of the distal tubule, increasing sodium and chloride excretion and urine output. It lowers blood pressure through reduction of cardiac hypertrophy, reduction of arterial wall thickening, and stimulation of vasodilator eicosanoid formation via free radical scavenging.

• Essential hypertension
• Salt and fluid retention associated with congestive heart failure

Adult Dose (Oral):

• Hypertension: 1.25-2.5 mg once daily (alone or with other antihypertensives)
• Edema: 2.5 mg once daily, increased to 5 mg daily after 1 week if needed
• Take in the morning (to avoid nighttime urination)

Child Dose: Safety & efficacy not established

Common Side Effects:

• Dizziness
• Headache
• Fatigue
• Nausea
• Gastrointestinal symptoms
• Muscle cramp

Others: Anorexia, vomiting, constipation, diarrhea, postural hypotension, electrolyte imbalances (hypochloremic alkalosis, hyponatremia, hypokalemia, hyperuricemia), hypersensitivity reactions (skin rashes, cholestatic jaundice, blood dyscrasias)

Precautions:

• Indapamide may decrease alertness and affect vision; do not drive if symptoms occur
• Take in the morning to avoid nighttime urination
• Avoid alcohol (may increase dizziness)
• May cause sudden drop of sodium level; avoid low sodium diet
• Monitor blood pressure; notify doctor if it does not lower down
• Notify doctor if dizziness, tiredness, or muscle weakness persists
• Caution in disturbed water/electrolyte balance, diabetes, gout and kidney problems
• Monitoring of potassium and uric acid serum levels recommended

Contraindications:

• Anuria
• Severe hepatic impairment
• Serious liver disease
• Hypokalemia
• Allergy to indapamide or sulphonamides
• Renal failure

Drug Interactions:

• Additive effect with other antihypertensives and diuretics
• Increased chance of hypokalemia with corticosteroids, corticotropin and amphotericin
• Increased risk of lithium toxicity (Potentially Fatal)
• Hypokalemia enhances digitalis toxicity with cardiac glycosides
• May decrease arterial responsiveness to norepinephrine

Food Interactions: Indapamide may cause excessive drowsiness with alcohol.

Use in Pregnancy: Generally considered safe; animal studies show low or no adverse effects; limited human studies; not recommended during pregnancy.

Use in Lactation: Probably safe; limited data suggests drug does not represent significant risk to baby; mothers taking indapamide should not breastfeed.

Renal Impairment: Caution in severe kidney disease; dose adjustment may be needed; effective in renal impairment but diuretic effect reduced.

Hepatic Impairment: Caution in liver disease; dose adjustment may be needed; contraindicated in severe liver disease.

Overdose: Electrolyte depletion (hyponatremia, hypokalemia), nausea, vomiting, dizziness, hypotension; symptomatic and supportive treatment; gastric lavage should be considered.