Indapamide

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Contents

[edit] BRAND NAMES

[edit] STRUCTURE

Indapamide.jpg

[edit] MECHANISM OF ACTION

Indapamide, a thiazide-like diuretic, has a dual mechanism of action, both of which contribute to the antihypertensive efficacy of the drug:

  • A diuretic effect at the level of the proximal segment of the distal tubule in the kidney.
  • Direct vascular effect: It appears to cause vasodilation, probably by inhibiting the passage of calcium and other ions (sodium, potassium) across membranes

The SR formulation avoids unnecessary plasma peak concentrations, which may be associated with side effects and has been shown to decrease BP, particularly SBP, with 24-h efficacy, allowing a once-daily dosage[1]

[edit] INDICATIONS

  • Treatment of hypertension alone or in combination with other antihypertensive drugs
  • Treatment of edema associated with congestive heart failure.

[edit] DOSAGE

  • Hypertension:
    • 2.5 mg tablets: The adult starting indapamide dose for hypertension is 1.25 mg as a single daily dose taken in the morning. If the response to 1.25 mg is not satisfactory after four weeks, the daily dose may be increased to 2.5 mg taken once daily. If the response to 2.5 mg is not satisfactory after four weeks, the daily dose may be increased to 5.0 mg taken once daily, but adding another antihypertensive should be considered.
    • 1.5 mg sustained release tablets: One tablet (1.5 mg) daily to be taken in the morning


  • Edema of Congestive Heart Failure:
    • 2.5 mg tablets: The starting dose is 2.5 mg as a single daily dose taken in the morning. If the response to 2.5 mg is not satisfactory after one week, the daily dose may be increased to 5.0 mg taken once daily.

[edit] DOSAGE FORMS AND STRENGTHS

  • 2.5 mg tablets
  • 1.5 mg sustained release tablets

[edit] CONTRAINDICATIONS

  • Severe renal failure, anuria, progressive and severe oliguria
  • Hepatic encephalopathy or severe impairment of liver function
  • Known hypersensitivity to indapamide or to other sulfonamide-derived drugs
  • Hypokalemia
  • Pregnancy and lactation

[edit] WARNINGS AND PRECAUTIONS

  • Hypokalemia may occur
  • Hyperuricemia may occur. Rarely gout has been reported but in patients with hyperuricemia tendency to gout attacks may be increased.

[edit] INTERACTIONS

  • Lithium carbonate: In general, diuretics should not be given concomitantly with lithium because they reduce its renal clearance and add a high risk of lithium toxicity.
  • Torsades de pointes-inducing drugs: Co-administration of Indapamide and Torsades de pointes-inducing drugs, including the following, is not recommended due to the increased risk of ventricular arrhythmias, particularly torsades de pointes (hypokalaemia is a risk factor):

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category C (Australia)
  • Pregnancy Category B (US).
    Indapamide should be avoided in pregnant women and should never be used to treat physiological edema of pregnancy. Diuretics can cause fetoplacental ischemia, with a risk of impaired fetal growth.
  • Nursing mothers: Breast-feeding is not recommended as indapamide is excreted in human breast milk and the possible effect on the newborn is unknown.

[edit] SIDE EFFECTS

Possible adverse effects include:

  • Significant hypokalaemia has been reported in 4% of patients. Hypokalaemia may occur at all doses with consequent weakness, cramps and cardiac dysrhythmias. Hypokalaemia is a particular hazard in patients receiving concomitant cardiac glycosides; dangerous or fatal cardiac arrhythmias may be precipitated.
  • Hypotension
  • Dizziness
  • fatigue
  • Headache
  • Muscle cramps
  • Photosensitivity

[edit] RELATED LINKS

[edit] REFERENCES

  1. http://www.ncbi.nlm.nih.gov/pubmed/16313275
Antihypertensives
ACE inhibitors Benazepril (Lotensin)   Captopril (Capoten)   Cilazapril   Delapril   Enalapril (Renitec, Vasotec)   Fosinopril (Monopril)  Lisinopril (Prinivil, Zestril)   Moexipril (Univasc)  Perindopril (Aceon)  Quinapril (Accupril)  Ramipril (Altace, Triatec)   Trandolapril (Mavik)  Zofenopril (Bifril, Zopranol)
Angiotensin II receptor antagonist Azilsartan (Edarbi)   Candesartan (Atacand)   Eprosartan (Teveten)   Irbesartan (Aprovel, Avapro, Karvea)   Losartan (Cozaar)   Olmesartan (Benicar, Olmetec)   Telmisartan (Micadis)   Valsartan (Diovan, Tareg)
Renin inhibitors Aliskiren (Rasilez, Tekturna)
Alpha-1 blockers Doxazosin (Cardura)   Prazosin (Minipress)   Terazosin (Hytrin)
Alpha-2 agonists (centrally acting) Clonidine (Oral route)   Clonidine (Transdermal) (Catapresan)   Guanfacine (Tenex)   Methyldopa (Aldomet)
Calcium channel blockers Dihydropyridines‎ Amlodipine (Norvasc)   Barnidipine (Vasexten)   Felodipine (Plendil)   Isradipine (Dynacirc)   Lacidipine (Lacipil, Motens)   Lercanidipine (Zanidip)   Manidipine   Nicardipine   Nifedipine (Adalat)   Nisoldipine   Nitrendipine
Benzothiazepine‎ Diltiazem (Cardizem, Taztia XT, Tiazac, Tildiem)
Phenylalkylamine‎ Gallopamil   Verapamil (Calan)
Beta blockers Beta1 selective (cardioselective) Acebutolol (Sectral)   Atenolol (Tenormin)   Betaxolol (Kerlon)   Bisoprolol (Concor)   Celiprolol (Cordiax)   Metoprolol (Betaloc, Lopressor, Toprol-XL)   Nebivolol (Bystolic, Lobivon, Nebilox)
Nonselective (Beta1 and Beta2 blockers) Oxprenolol (Trasitensin)   Propranolol (Inderal)   Timolol (Blocadren)
Nonselective (Beta1, Beta2 and Alpha1 blockers) Carvedilol (Dilatrend)   Labetalol (Trandate)
Beta blocker with intrinsic sympathomimetic activity (ISA) Acebutolol (Sectral)   Celiprolol (Cordiax)
Lipophilic Beta blockers Propranolol (Inderal)   Metoprolol (Betaloc, Lopressor, Toprol-XL)   Oxprenolol (Trasitensin)
Diuretics Carbonic anhydrase inhibitors Acetazolamide (Diamox)
Loop diuretics Bumetanide   Etacrynic acid   Furosemide (Lasix)   Piretanide   Torasemide (Demadex)
Thiazide diuretics Chlorothiazide (Diuril)   Hydrochlorothiazide (Esidrex)
Thiazide-like diuretics Chlortalidone (Hygroton)   Indapamide (Lozol, Lozide)   Metolazone
Potassium-sparing diuretics Epithelial sodium channel blockers: Amiloride (Midamor)   Triamterene (Dyrenium)
Aldosterone receptor antagonists: Potassium canrenoate   Eplerenone (Inspra)   Spironolactone (Aldactone)
Osmotic diuretics Mannitol
Combination therapy Amiloride/Hydrochlorothiazide (Moduretic)   Spironolactone/Hydrochlorothiazide (Aldactazide)