Indapamide

Pronunciation: (IN-DAP-uh-mide)
Class: Thiazide diuretic

Trade Names

Indapamide
- Tablets 1.25 mg
- Tablets 2.5 mg

Apo-Indapamide (Canada)
Gen-Indapamide (Canada)
Lozide (Canada)
PMS-Indapamide (Canada)

Pharmacology

Enhances excretion of sodium, chloride, and water by interfering with transport of sodium ions across renal tubular epithelium.

Pharmacokinetics

Absorption

C _max is approximately 115 to 260 ng/mL (dose-dependent). The T _max is 2 h.

Distribution

71% to 79% is protein bound.

Metabolism

Extensively metabolized.

Elimination

The t _½ is 26 h. More than 70% is excreted in the urine, and 23% is excreted in the GI tract, probably including the biliary route.

Indications and Usage

Treatment of edema associated with CHF, hepatic cirrhosis, renal dysfunction, and corticosteroid or estrogen therapy; management of hypertension.

Unlabeled Uses

Treatment of calcium nephrolithiasis, osteoporosis, or diabetes insipidus.

Contraindications

Hypersensitivity to thiazides, related diuretics, or sulfonamide-derived drugs; anuria.

Dosage and Administration

Adults

PO 1.25 to 5 mg every morning. Maximum 5 mg/day.

General Advice

• Administer as morning dose to prevent nocturia.
• Give with food or milk if GI upset occurs.
• Store in tightly closed container at room temperature.

Drug Interactions

Bile acid sequestrants

May reduce thiazide absorption; give thiazide at least 2 h before resin.

Diazoxide

Hyperglycemia may occur.

Digitalis glycosides

Diuretic-induced hypokalemia and hypomagnesemia may precipitate digitalis-induced arrhythmias.

Lithium

May decrease renal excretion of lithium; monitor lithium levels.

Loop diuretics

May result in synergistic effects and result in profound diuresis and serious electrolyte abnormalities.

Sulfonylureas, insulin

May decrease hypoglycemic effect of sulfonylureas. May need to adjust dosage of sulfonylureas or insulin.

Laboratory Test Interactions

May decrease serum protein-bound iodine levels without signs of thyroid disturbance. May cause diagnostic interference of serum electrolyte levels, blood and urine glucose levels, serum bilirubin levels and serum uric acid levels. May increase serum magnesium levels in uremic patients.

Adverse Reactions

Cardiovascular

Orthostatic hypotension; palpitations.

CNS

Dizziness; lightheadedness; vertigo; headache; weakness; restlessness; insomnia; drowsiness; fatigue; lethargy; anxiety; depression; nervousness.

Dermatologic

Rash; necrotizing angiitis; vasculitis; cutaneous vasculitis; pruritus.

EENT

Blurred vision.

GI

Anorexia; gastric irritation; epigastric distress; nausea; vomiting; abdominal pain/cramping/bloating; diarrhea; constipation; dry mouth.

Genitourinary

Nocturia; impotence/reduced libido.

Hematologic

Neutropenia.

Metabolic

Hyperglycemia; glycosuria; hyperuricemia.

Respiratory

Rhinorrhea.

Miscellaneous

Muscle cramp or spasm; acute gout.

Precautions

Pregnancy

Category B .

Lactation

May be excreted in breast milk.

Hypersensitivity

May occur in patients with or without history of allergy or bronchial asthma; cross-sensitivity with sulfonamides may also occur.

Renal Function

May precipitate azotemia; use with caution.

Hepatic Function

Minor alterations of fluid and electrolyte balance may precipitate hepatic coma; use with caution.

Electrolyte balance

Severe hyponatremia and hypokalemia may infrequently occur with recommended doses; more common in elderly females.

Lipids

May cause increased concentrations of total triglycerides and LDL in some patients.

Lupus erythematosus

Exacerbation or activation may occur.

Postsympathectomy patients

Antihypertensive effects may be enhanced.

Overdosage

Symptoms

Orthostatic or general hypotension, syncope, electrolyte abnormalities, potassium deficiency, vomiting, respiratory depression, lethargy, shock, weakness, confusion, dizziness, cramps of calf muscles, thirst, polyuria, anuria.

Patient Information

• Tell patient to take medication early in day to prevent sleep problems.
• Instruct patient to take drug with food or milk to minimize GI irritation.
• Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
• Instruct patients with diabetes to report increased blood glucose levels.
• Caution patients to avoid sudden position changes to prevent orthostatic hypotension.
• Advise patients to include in diet foods that are high in potassium (eg, bananas, broccoli, dried fruits, grapefruit, lima beans, nuts, oranges).
• Tell patient to report decrease in urinary output, jaundice, muscle cramps, weakness, nausea, blurred vision, or dizziness.
• For patients being treated for hypertension, explain benefits of weight reduction, exercise, reduction of alcohol and sodium intake, cessation of smoking.

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