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تعداد آیتم قابل مشاهده باقیمانده : -82 مورد

Indapamide: Drug information

Indapamide: Drug information
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For additional information see "Indapamide: Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: Canada
  • APO-Indapamide;
  • Indapamide 1.25;
  • JAMP-Indapamide [DSC];
  • Lozide [DSC];
  • MYLAN-Indapamide;
  • TRIA-Indapamide
Pharmacologic Category
  • Antihypertensive;
  • Diuretic, Thiazide-Related
Dosing: Adult
Calcium nephrolithiasis

Calcium nephrolithiasis (off-label use): Oral: 2.5 mg once daily (Ref).

Edema or general volume overload

Edema or general volume overload (adjunctive to loop diuretic):

Note: Optimize loop diuretic therapy before adding indapamide; combination diuretic therapy is typically for short-term use to restore euvolemia in patients already taking high-dose loop diuretic therapy who are resistant (eg, furosemide total daily dose of 160 to 320 mg/day IV or equivalent). Combination diuretic therapy can cause severe electrolyte depletion (eg, potassium, magnesium, sodium); prior to and during therapy, electrolytes should be monitored and appropriately managed (Ref).

Oral: Initial: 2.5 mg once daily; may increase dose, as needed, up to 5 mg once daily depending on patient response; may administer every other day or on specific days of the week; may be administered in combination with or shortly before the scheduled loop diuretic. Assess volume status frequently (eg, daily or at least every 2 to 3 days) to determine effectiveness and avoid over-diuresis. Continue until euvolemia is restored, although some patients may require scheduled treatment for maintenance (Ref).

Hypertension, chronic

Hypertension, chronic:

Note: For patients who warrant combination therapy (BP >20/10 mm Hg above goal or suboptimal response to initial monotherapy), may use in combination with another appropriate agent (eg, angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, dihydropyridine calcium channel blocker) (Ref); however, some experts prefer regimens that do not include thiazide diuretics for combination therapy (Ref).

Oral: Initial: 1.25 to 2.5 mg once daily; evaluate response after ~2 to 4 weeks and titrate dose as needed; doses >2.5 mg/day are generally not recommended due to greater risk for adverse effects with minimal added antihypertensive benefit; if additional blood pressure control is needed, consider combination therapy. Patients with severe asymptomatic hypertension and no signs of acute end organ damage should be evaluated for medication titration within 1 week (Ref).

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function:

eGFR ≥30 mL/minute/1.73 m2: No dosage adjustment necessary (Ref).

eGFR <30 mL/minute/1.73 m2: No dosage adjustment necessary. The diuretic effect may become diminished as kidney function declines, but small, short-term studies suggest hypertensive benefit may be preserved (Ref).

Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m2): Augmented renal clearance (ARC) is a condition that occurs in certain critically ill patients without organ dysfunction and with normal serum creatinine concentrations. Younger patients (<55 years of age) admitted post trauma or major surgery are at highest risk for ARC, as well as those with sepsis, burns, or hematologic malignancies. An 8- to 24-hour measured urinary CrCl is necessary to identify these patients (Ref).

No dosage adjustment necessary (Ref).

Hemodialysis, intermittent (thrice weekly): Not significantly dialyzable: Dose as if eGFR <30 mL/minute/1.73 m2 (Ref).

Peritoneal dialysis: Unlikely to be significantly dialyzable: Dose as if eGFR <30 mL/minute/1.73 m2 (Ref).

CRRT: Dose as if eGFR <30 mL/minute/1.73 m2 (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): Dose as if eGFR <30 mL/minute/1.73 m2 (Ref).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in manufacturer’s labeling; use with caution.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%: Endocrine & metabolic: Hypokalemia (<3.5 mEq/L: 20% to 72%, dose-dependent)

1% to 10%:

Cardiovascular: Cardiac arrhythmia (<5%), chest pain (<5%), flushing (<5%), orthostatic hypotension (<5%), palpitations (<5%), peripheral edema (<5%), vasculitis (<5%), ventricular premature contractions (<5%)

Dermatologic: Pruritus (<5%), skin rash (<5%), urticaria (<5%)

Endocrine & metabolic: Decreased libido (<5%), glycosuria (<5%), hyperglycemia (<5%), hyperuricemia (<5%), hypochloremia (<5%), hyponatremia (<5%), weight loss (<5%)

Gastrointestinal: Abdominal cramps (<5%), abdominal pain (<5%), anorexia (<5%), constipation (<5%), diarrhea (<5%), dyspepsia (<5%), gastric irritation (<5%), nausea (<5%), vomiting (<5%), xerostomia (<5%)

Genitourinary: Impotence (<5%), nocturia (<5%), urinary frequency (<5%)

Infection: Infection (≥5%)

Nervous system: Agitation (≥5%), anxiety (≥5%), depression (<5%), dizziness, drowsiness (<5%), fatigue (≥5%), headache (≥5%), hypertonia (<5%), insomnia (<5%), irritability (≥5%), lethargy (≥5%), malaise (≥5%), nervousness, numbness of extremities (≥5%), pain (≥5%), tension (≥5%), tingling of extremities (<5%), vertigo (<5%)

Neuromuscular & skeletal: Asthenia, back pain (≥5%), muscle cramps (≥5%), muscle spasm (≥5%)

Ophthalmic: Blurred vision (<5%), conjunctivitis (<5%)

Renal: Increased blood urea nitrogen (<5%), increased serum creatinine (<5%), polyuria (<5%)

Respiratory: Cough (<5%), flu-like symptoms (<5%), pharyngitis (<5%), rhinitis (≥5%), rhinorrhea (<5%), sinusitis (<5%)

Frequency not defined:

Dermatologic: Bullous rash, erythema multiforme, skin photosensitivity, Stevens-Johnson syndrome

Gastrointestinal: Pancreatitis

Hematologic & oncologic: Agranulocytosis, aplastic anemia, leukopenia, purpuric disease, thrombocytopenia

Hepatic: Abnormal hepatic function tests, cholestatic jaundice, hepatitis

Hypersensitivity: Anaphylaxis

Respiratory: Pneumonitis

Miscellaneous: Fever

Postmarketing: Ophthalmic: Angle-closure glaucoma, choroidal effusion, myopia (acute)

Contraindications

Hypersensitivity to indapamide or any component of the formulation or sulfonamide-derived drugs; anuria.

Note: Although the FDA-approved product labeling states this medication is contraindicated in patients with hypersensitivity to sulfonamide-containing drugs, the scientific basis of this cross-sensitivity has been challenged.

Canadian labeling: Additional contraindications (not in US labeling): Severe renal failure (CrCl <30 mL/minute); hepatic encephalopathy; severe hepatic impairment; hypokalemia; concomitant use with antiarrhythmic agents causing torsade de pointes; pregnancy; breastfeeding; hereditary problems of galactose intolerance, glucose-galactose malabsorption, or total lactase deficiency.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

Concerns related to adverse effects:

• Electrolyte disturbances: Severe hyponatremia with hypokalemia has been reported at recommended doses (particularly in elderly women); risk may be dose dependent, therefore, use lowest dose possible. Hypochloremic alkalosis, hypomagnesemia, or hypercalcemia can also occur; monitor electrolytes periodically during therapy.

• Ocular effects: Sulfonamide or sulfonamide derivatives, including indapamide, may cause an idiosyncratic reaction resulting in acute angle-closure glaucoma and elevated intraocular pressure with or without a noticeable acute myopic shift and/or choroidal effusions. Symptom onset (eg, decreased visual acuity, ocular pain) typically occurs within hours to weeks after treatment initiation and may result in permanent vision loss if left untreated. Risk may be increased in patients with sulfonamide or penicillin allergy.

• Sulfonamide (“sulfa”) allergy: The FDA-approved product labeling for many medications containing a sulfonamide chemical group includes a broad contraindication in patients with a prior allergic reaction to sulfonamides. There is a potential for cross-reactivity between members of a specific class (eg, two antibiotic sulfonamides). However, concerns for cross-reactivity have previously extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004). In particular, mechanisms of cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. T-cell-mediated (type IV) reactions (eg, maculopapular rash) are less well understood and it is not possible to completely exclude this potential based on current insights. In cases where prior reactions were severe (Stevens-Johnson syndrome/TEN), some clinicians choose to avoid exposure to these classes.

Disease-related concerns:

• Adrenal insufficiency: Avoid use of diuretics for treatment of elevated blood pressure in patients with primary adrenal insufficiency (Addison disease). Adjustment of glucocorticoid/mineralocorticoid therapy and/or use of other antihypertensive agents is preferred to treat hypertension (Bornstein 2016; Inder 2015).

• Bariatric surgery: Dehydration: Avoid diuretics in the immediate postoperative period after bariatric surgery; electrolyte disturbances and dehydration may occur. Diuretics may be resumed, if indicated, once oral fluid intake goals are met (Ziegler 2009).

• Diabetes: Use with caution in patients with prediabetes or diabetes mellitus; may see a change in glucose control.

• Gout: In certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure, gout can be precipitated.

• Hepatic impairment: Use with caution in patients with severe hepatic dysfunction; in cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy.

• Hypercholesterolemia: Use with caution in patients with moderate or high cholesterol concentrations; thiazide diuretics have been shown to increase cholesterol concentrations; however, indapamide (a thiazide-like diuretic) has not been shown to adversely affected lipids.

• Hypokalemia: Use with caution in patients with hypokalemia; correct before initiating therapy.

• Kidney impairment: Use with caution in severe kidney disease.

• Systemic lupus erythematosus: Can cause systemic lupus erythematosus exacerbation or activation.

Dosage forms specific issues:

• Lactose: Formulation may contain lactose.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: 1.25 mg, 2.5 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Indapamide Oral)

1.25 mg (per each): $0.68 - $1.42

2.5 mg (per each): $0.83 - $1.55

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Tablet, Oral:

Lozide: 1.25 mg [DSC] [contains corn starch, fd&c yellow #6(sunset yellow)alumin lake]

Generic: 1.25 mg, 2.5 mg

Administration: Adult

Oral: May be administered without regard to meals (Ref); however, administration with food or milk may decrease GI adverse effects. Administer early in day to avoid nocturia.

Use: Labeled Indications

Edema or general volume overload: Treatment of edema in heart failure.

Hypertension, chronic: Management of mild to moderate hypertension.

Use: Off-Label: Adult

Calcium nephrolithiasis

Medication Safety Issues
Sound-alike/look-alike issues:

Indapamide may be confused with Iopidine

Older Adult: High-Risk Medication:

Beers Criteria: Diuretics are identified in the Beers Criteria as potentially inappropriate medications to be used with caution in patients 65 years and older due to the potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium concentration closely when initiating or adjusting the dose in older adults (Beers Criteria [AGS 2023]).

International issues:

Pretanix [Hungary] may be confused with Protonix brand name for pantoprazole [US, Canada]

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Agents with Clinically Relevant Anticholinergic Effects: May increase serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Ajmaline: Sulfonamides may increase adverse/toxic effects of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor

Alcohol (Ethyl): May increase orthostatic hypotensive effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Allopurinol: Thiazide and Thiazide-Like Diuretics may increase hypersensitivity effects of Allopurinol. Risk C: Monitor

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification

Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Thiazide and Thiazide-Like Diuretics may increase hypotensive effects of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may increase nephrotoxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antidiabetic Agents: Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Arsenic Trioxide: Thiazide and Thiazide-Like Diuretics may increase hypotensive effects of Arsenic Trioxide. Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects of Arsenic Trioxide. Management: When possible, avoid concurrent use of arsenic trioxide with drugs that can cause electrolyte abnormalities, such as the thiazide and thiazide-like diuretics. Risk D: Consider Therapy Modification

Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Beta2-Agonists: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Bile Acid Sequestrants: May decrease absorption of Thiazide and Thiazide-Like Diuretics. Management: Separate administration of bile acid sequestrants and oral thiazide diuretics by at least 4 hours. Monitor for decreased therapeutic effects of thiazide diuretics if coadministered with a bile acid sequestrant. Risk D: Consider Therapy Modification

Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

Calcium Salts: Thiazide and Thiazide-Like Diuretics may increase serum concentration of Calcium Salts. Risk C: Monitor

Cardiac Glycosides: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. Risk C: Monitor

Corticosteroids (Systemic): May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

CycloPHOSphamide: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of CycloPHOSphamide. Specifically, granulocytopenia may be enhanced. Risk C: Monitor

Desmopressin: Hyponatremia-Associated Agents may increase hyponatremic effects of Desmopressin. Risk C: Monitor

Dexketoprofen: May increase adverse/toxic effects of Sulfonamides. Risk C: Monitor

Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Diacerein: May increase therapeutic effects of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor

Diazoxide Choline: May increase adverse/toxic effects of Thiazide and Thiazide-Like Diuretics. Specifically, the hyperglycemic and hyperuricemic effects may be increased. Risk C: Monitor

Diazoxide: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Diazoxide. Risk C: Monitor

Dichlorphenamide: Thiazide and Thiazide-Like Diuretics may increase hypokalemic effects of Dichlorphenamide. Risk C: Monitor

Dofetilide: Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects of Dofetilide. Thiazide and Thiazide-Like Diuretics may increase serum concentration of Dofetilide. Management: Although hydrochlorothiazide is specifically cited as a contraindication, the risk likely extends to all thiazide and thiazide-like diuretics and may be even greater with chlorthalidone or bendroflumethiazide. Consider alternatives when possible. Risk D: Consider Therapy Modification

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

EPINEPHrine (Systemic): Diuretics may increase arrhythmogenic effects of EPINEPHrine (Systemic). Diuretics may decrease vasopressor effects of EPINEPHrine (Systemic). Risk C: Monitor

Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Ipragliflozin: May increase adverse/toxic effects of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor

Isocarboxazid: May increase hypotensive effects of Diuretics. Risk X: Avoid

Ivabradine: Thiazide and Thiazide-Like Diuretics may increase arrhythmogenic effects of Ivabradine. Risk C: Monitor

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Levosulpiride: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Levosulpiride. Risk X: Avoid

Licorice: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Lithium: Thiazide and Thiazide-Like Diuretics may decrease excretion of Lithium. Management: Reduce the lithium dose if coadministered with thiazide or thiazide-like diuretics. Monitor serum lithium levels during coadministration with thiazide and thiazide-like diuretics. Risk D: Consider Therapy Modification

Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Mecamylamine: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Mecamylamine. Management: Consider avoiding the use of mecamylamine and thiazide diuretics. If combined, mecamylamine prescribing information suggests reducing the mecamylamine dose by 50% in order to avoid excessive hypotension. Risk D: Consider Therapy Modification

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methenamine: Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Methenamine. Risk C: Monitor

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Multivitamins/Fluoride (with ADE): May increase hypercalcemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Multivitamins/Minerals (with ADEK, Folate, Iron): Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Multivitamins/Minerals (with ADEK, Folate, Iron). Risk C: Monitor

Multivitamins/Minerals (with AE, No Iron): Thiazide and Thiazide-Like Diuretics may increase serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Neuromuscular-Blocking Agents (Nondepolarizing): Thiazide and Thiazide-Like Diuretics may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Thiazide and Thiazide-Like Diuretics may increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification

Opioid Agonists: May increase adverse/toxic effects of Diuretics. Opioid Agonists may decrease therapeutic effects of Diuretics. Risk C: Monitor

Palopegteriparatide: Thiazide and Thiazide-Like Diuretics may increase therapeutic effects of Palopegteriparatide. Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Palopegteriparatide. Risk C: Monitor

Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Piperacillin: May increase hypokalemic effects of Diuretics. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Diuretics may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor

Promazine: Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects of Promazine. Risk X: Avoid

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Reboxetine: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Selective Serotonin Reuptake Inhibitor: May increase hyponatremic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Sodium Phosphates: Diuretics may increase nephrotoxic effects of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor

Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor

Topiramate: Thiazide and Thiazide-Like Diuretics may increase hypokalemic effects of Topiramate. Thiazide and Thiazide-Like Diuretics may increase serum concentration of Topiramate. Risk C: Monitor

Toremifene: Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Toremifene. Risk C: Monitor

Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

Vitamin D Analogs: Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Vitamin D Analogs. Risk C: Monitor

Reproductive Considerations

When diuretics are used for the treatment of heart failure in patients planning to become pregnant, adjust dose prior to conception to minimize risk of placental hypoperfusion (AHA/ACC/HFSA [Heidenreich 2022]); agents other than indapamide may be preferred (ESC [Regitz-Zagrosek 2018]).

Medications considered acceptable for the treatment of chronic hypertension during pregnancy may generally be continued in patients trying to conceive. Diuretics are second-line agents for the treatment of hypertension in pregnant patients (ACC/AHA [Whelton 2018]; ACOG 2019; NICE 2019; SOGC [Magee 2022]).

Pregnancy Considerations

Diuretics cross the placenta and are found in cord blood.

Maternal use may cause fetal or neonatal jaundice, thrombocytopenia, or other adverse events observed in adults.

Chronic maternal hypertension is also associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to the duration and severity of maternal hypertension. Untreated chronic hypertension may also increase the risks of adverse maternal outcomes, including gestational diabetes, preeclampsia, delivery complications, stroke, and myocardial infarction (ACOG 2019).

Use of thiazide diuretics during pregnancy may be considered to treat edema due to pathologic causes (as in the nonpregnant patient); monitor.

Patients with preexisting hypertension may continue their medication during pregnancy unless contraindications exist (ESC [Regitz-Zagrosek 2018]). Diuretics are second-line agents for the treatment of hypertension in pregnant patients (ACOG 2019; SOGC [Magee 2022]); however, data related to the use of indapamide in pregnancy are insufficient and other agents may be preferred (ESC [Regitz-Zagrosek 2018]).

Heart failure in pregnancy is associated with adverse maternal and fetal outcomes, including premature birth, infants born small for gestational age, and increased risk of maternal and fetal death (Bright 2021). Thiazide diuretics may be used for symptom management in pregnant patients with heart failure complicated by pulmonary congestion; closely monitor volume status and adjust dose to minimize risk of placental hypoperfusion (AHA/ACC/HFSA [Heidenreich 2022]; ESC [Regitz-Zagrosek 2018]); however, data related to the use of indapamide in pregnancy are insufficient and other agents may be preferred (ESC [Regitz-Zagrosek 2018]).

Breastfeeding Considerations

It is not known if indapamide is present in breast milk.

If indapamide is needed, the manufacturer recommends that breastfeeding be discontinued.

Dietary Considerations

May be taken without regard to meals (Caruso 1983); however, administration with food or milk may to decrease GI adverse effects.

Monitoring Parameters

Blood pressure; serum electrolytes; fluid intake and output; kidney function; uric acid; visual changes (to assess for ocular adverse 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

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Rapid and complete

Distribution: Vd: 25 L (Grebow, 1982)

Protein binding, plasma: 71% to 79%

Metabolism: Extensively hepatic

Bioavailability: 93% (Ernst, 2009)

Half-life elimination: Biphasic: 14 and 25 hours

Time to peak: 2 hours

Excretion: Urine (~70%; 7% as unchanged drug within 48 hours); feces (23%)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Natrilix;
  • (AR) Argentina: Bajaten | Duremid | Indapamida duremid | Natrilix | Noranat;
  • (AT) Austria: Fludex | Indapamid actavis | Indapamid ratiopharm | Indapamid stada;
  • (AU) Australia: Apo-indapamide | Chemmart indapamide | Cm indapamide | Dapa | Indahexal | Indapamide an | Indapamide Ga | Indapamide pfizer | Indapamide Sandoz | Insig | Napamide | Naride | Natrilix | Odaplix SR | Tenaxil | Terry white chemists indapamide | Tw indapamide;
  • (BD) Bangladesh: Hypen | Idatix | Indapa | Indelix | Indicontin | Indimide | Micturex | Natrilix | Repres | Xelix sr;
  • (BE) Belgium: Docindapa | Fludex | Indapamide eurogenerics | Indapamide merck-generics | Indapamide ratiopharm;
  • (BF) Burkina Faso: Fludex | Strimide;
  • (BG) Bulgaria: Alvonamid | Daxpamil | Indapagamma | Indapamide sr alkaloid int | Indapen | Indicon sr | Indipam | Indolen sr | Mivara | Neopamid | Neopamid sr | Pisizif | Rawel | Sophtensif | Tertensif | Tevaindam;
  • (BR) Brazil: Dapamix | Flux | Indafix | Indapamida | Indapamida mg | Indapen | Indatrat sr | Natrilix | Natrilix sr | Pharmida sr | Vasotrilix;
  • (CH) Switzerland: Fludapamid | Fludex | Indapamid spirig hc | Indapamid Teva;
  • (CI) Côte d'Ivoire: Adex | Inditor | Strimide;
  • (CL) Chile: Indapress | Natrilix;
  • (CN) China: Gao yi xiao | Miao lin | Na cui li | Natrilix | Ping zhi | Sheng chang | Shou bi shan | Yi te an;
  • (CO) Colombia: Diurex | Garmisch diurex | Inditor | Natrilix | Natrilix sr;
  • (CZ) Czech Republic: Arifon | Indap | Indapamid hf | Indapamid Pmcs | Indapamid stada | Indapamid Teva | Indapamide orion | Rawel | Tertensif;
  • (DE) Germany: Diuretal | Indapagamma | Indapamid | Indapamid actavis | Indapamid AL | Indapamid bioeq pharma | Indapamid heumann | Indapamid puren | Indapamid ratiopharm | Indapamid Servier | Indapamid stada | Lorvacs xl | Natrilix | Natrilix sr;
  • (DK) Denmark: Indacar;
  • (DO) Dominican Republic: Hidromax | Indapamida | Natrilix;
  • (EC) Ecuador: Indapamida | Natrilix | Natrilix sr | Vasotrilix;
  • (EE) Estonia: Indamax | Rawel | Tertensif | Tertensif sr;
  • (EG) Egypt: Diurex | Hypotense | Indamide | Natrilix | Natristazen;
  • (ES) Spain: Extur | Indapamida Apotex | Indapamida Cinfa | Indapamida Kern Pharma | Indapamida Mabo | Indapamida merck | Indapamida Mylan | Indapamida normon | Indapamida Pensa | Indapamida Sandoz | Indapamida tarbis | Indapamida teva | Tertensif;
  • (ET) Ethiopia: Natrilix;
  • (FI) Finland: Indapamide orion | Natrilix | Tertensif;
  • (FR) France: Fludex | Indapamide Arrow | Indapamide biogaran | Indapamide Dci | Indapamide eg | Indapamide Isomed LP | Indapamide krka | Indapamide merck | Indapamide Mylan | Indapamide qualimed | Indapamide Ranbaxy | Indapamide ratiopharm | Indapamide Sandoz | Indapamide Winthrop | Indapamide zydus;
  • (GB) United Kingdom: Alkapamid xl | Cardide SR | Ethibide | Indapamide Arrow | Indapamide cox | Indapamide krka | Indapamide Sandoz | Indipam | Lorvacs xl | Mapemid | Natramid | Natrilix | Natrilix sr | Nindaxa | Opumide | Rawel | Tensaid | Varbim;
  • (GR) Greece: Dixamid | Fludex | Magniton r | Transipen;
  • (HK) Hong Kong: Apo-indapamide | Clonilix | Cp indap | Dapa | Eutrilax | Frumeron | Indalix | Indapamide Sandoz | Indapamide teva | Napamide | Narix | Natrilix | Panid | Rawel | Vick-Trilix;
  • (HR) Croatia: Amoron | Indamid sr | Rawel | Tertensif | Tond sr;
  • (HU) Hungary: Apadex | Indacord | Indapagamma | Indapamid sandoz | Indastad | Lapiden | Narva sr | Pretanix | Rawel;
  • (ID) Indonesia: Natrilix;
  • (IE) Ireland: Clonilix | Icorvida | Inamide | Napamide | Natrilix;
  • (IL) Israel: Pamid;
  • (IN) India: Diurix | Divret | In | Indap | Indicontin | Inditis sr | Inditor | Inmide | Inwell | Lorvas | Natridac | Natrilix | Natritor | Nidium pr | Perifer;
  • (IT) Italy: Indamol | Indapamide actavis | Indapamide doc | Indapamide Mgi | Indapamide Mylan | Indapamide Sandoz | Ipamix | Natrilix | Natrilix lp | Pressural | Veroxil;
  • (JM) Jamaica: Natrilix sr;
  • (JO) Jordan: Dapamix sr | Natrilix | Natrilix sr;
  • (JP) Japan: Nashindolen | Natrix | Tenaxil;
  • (KE) Kenya: Fumeron | Indapa sr | Indicontin | Induric | Induric sr | Lorvas | Natrilix sr;
  • (KR) Korea, Republic of: Dapid | Fludex | Fludex sr | Indapam | Natrix sr | Panid;
  • (KW) Kuwait: Natrilix;
  • (LB) Lebanon: Diurimat | Fludex | Natrilix | Rawel;
  • (LT) Lithuania: Arifon | Doprimin | Indamax | Indapagamma | Indapamide actavis | Indapamide orion | Indapamide teva | Indapen | Pamid | Rawel | Tertensif;
  • (LU) Luxembourg: Docindapa | Fludex;
  • (LV) Latvia: Arifon | Indamax | Indapagamma | Indapamide actavis | Indapamide orion | Indapamide sr servier | Indapen | Pamid | Rawel | Tertensif;
  • (MA) Morocco: Adex | Apadex | Diurimat | Fludex | Glomerid lp | Natrilix | Perdex lp | Sodrix | Thiazilix | Tiasurex | Zydex;
  • (MX) Mexico: Natrilix sr | Tormide;
  • (MY) Malaysia: Agelan | Apo-indapamide | Argilan | Bepelix | Dapa | Indakline | Indalix | Intril | Natrilix | Natrilix sr | Rinalix;
  • (NG) Nigeria: Datrilix | Indatab sr;
  • (NL) Netherlands: Fludex;
  • (NZ) New Zealand: Dapa | Napamide | Naplin | Natrilix;
  • (PA) Panama: Natrilix sr;
  • (PE) Peru: Inditor | Natrilix | Natrilix sr;
  • (PH) Philippines: Natrilix | Vazamide;
  • (PK) Pakistan: Natrilix | Sizamide | Uromid;
  • (PL) Poland: Apo-indap | Diuresin | Fodrin | Indapamid ratiopharm | Indapamide Arrow | Indapamide krka | Indapamide sr genoptim | Indapamide sr mercapharm | Indapamidum Farmacom | Indapen | Indapres | Indapsan | Indastad | Indix sr | Ipres | Ivipamid | Natrilix | Opamid | Rawel | Sophtensif | Symapamid | Tertensif;
  • (PR) Puerto Rico: Lozol;
  • (PT) Portugal: Fludex | Indapamida | Indapamida Actavis | Indapamida farmoz | Indapamida GP | Indapamida labesfal | Indapamida Mepha | Indapamida Qritou | Indapamida teva | Tandix | Vasodipin;
  • (PY) Paraguay: Natrilix sr | Noranat;
  • (QA) Qatar: Dapamix SR | Indamix SR | Indanorm | Natrilix SR;
  • (RO) Romania: Diuremid sr | Iduren sr | Impamid | Indapagamma | Indapamid lph | Indapamid SR 1,5 mg Laropharm | Indapamid sr ozone | Indapamid sr zentiva | Indapamid stada | Indapamida Actavis | Indapamida atb | Indapamida slavia | Indapamida SR Torrent | Indapamida terapia | Indapamida teva | Indapen | Indater sr | Rawel | Reditens sr;
  • (RU) Russian Federation: Akripamide | Akripamide retard | Akuter sanovel | Arifon | Indap | Indapamid | Indapamid retard | Indapamid sandoz | Indapamid stada | Indapamid Teva | Indapamide alkaloid | Indapamide long richter | Indapamide nycomed | Indapamide pharmasyntez | Indapamide renewal | Indapamide retard | Indapamide retard obl | Indapresin | Indapsan | Indipam | Indiur | Ionik | Ipres long | Lorvas | Rawel | Retapres | Sr indamed | Vero indapamid;
  • (SA) Saudi Arabia: Natrilix | Normalix sr | Pamedix;
  • (SE) Sweden: Natrilix;
  • (SG) Singapore: Apo-indapamide | Dapa | Frumeron | Napamide | Natrilix | Rinalix;
  • (SI) Slovenia: Amoron | Cardide | Rawel | Tertensif;
  • (SK) Slovakia: Actapam | Apadex | Indapamid Mylan | Indapamid ratiopharm | Indapamid sr krka | Indapamid stada | Indapamid Teva | Indapamide orion | Tertensif;
  • (TH) Thailand: Frumeron | Indapar | Inpamide | Intril | Lorvas | Napamide | Natrilix;
  • (TN) Tunisia: Adex | Fludex | Flupamide;
  • (TR) Turkey: Flubest | Fludex | Fludin | Flupamid | Indapen | Indurin | Indurin sr;
  • (TW) Taiwan: Dapa | Dapamide | Depermide | Frumeron | Iloka | Indamide | Indap | Indapin | Jatrisyn | Kamart | Makamide | Milix | Nakamide | Napamide | Narix | Natrilix | Pressural | Winmide;
  • (UA) Ukraine: Apilac | Arifon | Hemopamid retard | Indap | Indapamid | Indapamid apo | Indapamid astrapharm | Indapamid ratiopharm | Indapamid sr | Indapen | Indiur | Indopres | Ipamid | Lorvas | Softenzif;
  • (UG) Uganda: Indicontin | Lorvas;
  • (UY) Uruguay: Dapamin | Natrilix | Tendiuril;
  • (VE) Venezuela, Bolivarian Republic of: Natrilix;
  • (VN) Viet Nam: Natrilix sr | Pamidstad;
  • (ZA) South Africa: Adco Dapamax | Catexan | Cipla-indapamide | Dapamax | Daptril | Dyna indapamide | Hydro less | Indalix | Lixamide | Merck-indapamide | Micro-indapamide | Natrilix | Rolab-indapamide;
  • (ZW) Zimbabwe: Hydro less | Lorvas
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