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Pronunciation |
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(in
DAP a
mide) |
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U.S. Brand
Names |
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Lozol® |
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Generic
Available |
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No |
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Canadian Brand
Names |
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Apo®-Indapadmide;
Lozide® |
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Pharmacological Index |
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Diuretic, Thiazide |
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|
Use |
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Management of mild to moderate hypertension; treatment of edema in congestive
heart failure and nephrotic syndrome |
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Pregnancy Risk
Factor |
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B (Per manufacturer); D (based on expert analysis) |
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Contraindications |
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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. |
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Adverse
Reactions |
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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 |
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|
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 |
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|
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. |
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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 |
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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 |
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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 |
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Dietary
Considerations |
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May be administered with food or milk to decrease GI adverse
effects |
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Monitoring
Parameters |
|
Blood pressure (both standing and sitting/supine), serum electrolytes, renal
function, assess weight, I & O reports daily to determine fluid
loss |
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|
Cardiovascular
Considerations |
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Indapamide may be used to treat hypertension but offers no compelling
advantages over thiazide diuretics in this setting. |
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Mental Health: Effects
on Mental Status |
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May rarely cause mood changes |
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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 |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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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. |
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Nursing
Implications |
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Take blood pressure with patient lying down and standing; may increase serum
glucose in diabetic patients |
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Dosage Forms |
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Tablet: 1.25 mg, 2.5 mg |
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