Interactions with herbs
Ginkgo Biloba
Licorice
  Interactions with supplements
Calcium
Vitamin D
Look Up > Drugs > Indapamide
Indapamide
Pronunciation
U.S. Brand Names
Generic Available
Canadian Brand Names
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Monitoring Parameters
Cardiovascular Considerations
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms

Pronunciation
(in DAP a mide)

U.S. Brand Names
Lozol®

Generic Available

No


Canadian Brand Names
Apo®-Indapadmide; Lozide®

Pharmacological Index

Diuretic, Thiazide


Use

Management of mild to moderate hypertension; treatment of edema in congestive heart failure and nephrotic syndrome


Pregnancy Risk Factor

B (Per manufacturer); D (based on expert analysis)


Contraindications

Hypersensitivity to indapamide or any component, thiazides, or sulfonamide-derived drugs; anuria; renal decompensation; pregnancy (based on expert analysis)


Warnings/Precautions

Use with caution in severe renal disease. Electrolyte disturbances (hypokalemia, hypochloremic alkalosis, hyponatremia) can occur. Use with caution in severe hepatic dysfunction; hepatic encephalopathy can be caused by electrolyte disturbances. Gout can be precipitate in certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure. Cautious use in diabetics; may see a change in glucose control. I.V. use is generally not recommended (but is available). Hypersensitivity reactions can occur. Can cause SLE exacerbation or activation. Use with caution in patients with moderate or high cholesterol concentrations. Photosensitization may occur. Correct hypokalemia before initiating therapy.


Adverse Reactions

1% to 10%:

Cardiovascular: Orthostatic hypotension, palpitations, flushing

Central nervous system: Dizziness, lightheadedness, vertigo, headache, weakness, restlessness, drowsiness, fatigue, lethargy, malaise, lassitude, anxiety, agitation, depression, nervousness

Gastrointestinal: Anorexia, gastric irritation, nausea, vomiting, abdominal pain, cramping, bloating, diarrhea, constipation, dry mouth, weight loss

Genitourinary: Nocturia, frequent urination, polyuria

Neuromuscular & skeletal: Muscle cramps, spasm

Ocular: Blurred vision

Respiratory: Rhinorrhea

<1% (Limited to important or life-threatening symptoms): Purpura, necrotizing angiitis, vasculitis, cutaneous vasculitis, impotency, reduced libido, hyperglycemia, glycosuria, hyperuricemia


Overdosage/Toxicology

Symptoms of overdose include lethargy, diuresis, hypermotility, confusion, muscle weakness

Following GI decontamination, therapy is supportive with I.V. fluids, electrolytes, and I.V. pressors if needed


Drug Interactions

Angiotensin-converting enzyme inhibitors: Increased hypotension if aggressively diuresed with a thiazide diuretic.

Beta-blockers increase hyperglycemic effects in Type 2 diabetes mellitus.

Cyclosporine and thiazides can increase the risk of gout or renal toxicity; avoid concurrent use.

Digoxin toxicity can be exacerbated if a thiazide induces hypokalemia or hypomagnesemia.

Lithium toxicity can occur by reducing renal excretion of lithium; monitor lithium concentration and adjust as needed.

Neuromuscular blocking agents can prolong blockade; monitor serum potassium and neuromuscular status.

NSAIDs can decrease the efficacy of thiazides reducing the diuretic and antihypertensive effects.


Mechanism of Action

Diuretic effect is localized at the proximal segment of the distal tubule of the nephron; it does not appear to have significant effect on glomerular filtration rate nor renal blood flow; like other diuretics, it enhances sodium, chloride, and water excretion by interfering with the transport of sodium ions across the renal tubular epithelium


Pharmacodynamics/Kinetics

Onset of action: 1-2 hours

Duration: Up to 36 hours

Absorption: Completely from GI tract

Plasma protein binding: 71% to 79%

Metabolism: Extensively in the liver

Half-life: 14-18 hours

Time to peak serum concentration: 2-2.5 hours

Elimination: ~60% of dose excreted in urine within 48 hours, ~16% to 23% excreted via bile in feces


Usual Dosage

Adults: Oral:

Hypertension: 1.25 mg in the morning, may increase to 5 mg/day by increments of 1.25-2.5 mg; consider adding another antihypertensive and decreasing the dose if response is not adequate


Dietary Considerations

May be administered with food or milk to decrease GI adverse effects


Monitoring Parameters

Blood pressure (both standing and sitting/supine), serum electrolytes, renal function, assess weight, I & O reports daily to determine fluid loss


Cardiovascular Considerations

Indapamide may be used to treat hypertension but offers no compelling advantages over thiazide diuretics in this setting.


Mental Health: Effects on Mental Status

May rarely cause mood changes


Mental Health: Effects on Psychiatric Treatment

May decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

Take as directed, early in the day (last dose late afternoon). Do not exceed recommended dosage. Noninsulin-dependent diabetics should monitor serum glucose closely (medication may decrease effect of oral hypoglycemics). Monitor weight on a regular basis. Report sudden or excessive weight gain, swelling of ankles or hands, or difficulty breathing. You may experience dizziness, weakness, or drowsiness; use caution when changing position (rising from sitting or lying position) and when driving or engaging in tasks that require alertness until response to drug is known. Use may experience sensitivity to sunlight (use sunblock, wear protective clothing or sunglasses), impotence (reversible), dry mouth or thirst (frequent mouth care, chewing gum or sucking on lozenges may help). Report unusual bleeding, palpitations, numbness or tingling or cramping. Breast-feeding precautions: Consult prescriber if breast-feeding.


Nursing Implications

Take blood pressure with patient lying down and standing; may increase serum glucose in diabetic patients


Dosage Forms

Tablet: 1.25 mg, 2.5 mg


Copyright © 1978-2000 Lexi-Comp Inc. All Rights Reserved