Indapamide

Indapamide is a prescription medication used to treat Edema (swelling), and high blood pressure (Hypertension). 

• Indapamide is available under the following different brand names: Lozol

Adult dosage

Tablets

• 1.25mg
• 2.5mg

Edema

Adult dosage

• 2.5 mg orally once daily initially; may increase to 5 mg once daily

Hypertension

Adult dosage

• 1.25 mg orally in the morning initially; may increase at 4-week intervals up to 5 mg each morning

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Indapamide include:

• dizziness, 
• weakness, 
• tiredness, 
• back pain, 
• muscle cramps, 
• anxiety, 
• agitation, 
• headache, and 
• runny nose

Serious side effects of Indapamide include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• drowsiness, 
• lack of energy, 
• tiredness, 
• leg cramps, 
• muscle weakness, 
• limp feeling, 
• severe weakness, 
• loss of coordination, 
• feeling unsteady, 
• fast or irregular heartbeats, 
• fluttering in the chest, 
• numbness or tingling, 
• vomiting, 
• constipation, 
• headache, 
• confusion, 
• slurred speech, 
• lightheadedness, 
• dry mouth, 
• increased thirst, and 
• little or no urination

Rare side effects of Indapamide include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Indapamide has severe interactions with at least 48 other drugs. 
• Indapamide has serious interactions with at least 42 other drugs.
• Indapamide has moderate interactions with at least 165 other drugs.
• Indapamide has minor interactions with at least 142 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Hypersensitivity to indapamide or sulfonamides
• Anuria

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Indapamide?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Indapamide?”

Cautions

• Serum concentrations of uric acid increased by an average of 0.69 mg/100 mL in patients treated with indapamide 1.25 mg, and by an average of 1.0 mg/100 mL in patients treated with indapamide 2.5 mg and 5.0 mg, and frank gout may be precipitated in certain patients receiving indapamide; periodically monitor serum concentrations of uric acid during treatment
• Use with caution in patients with severe renal disease, as reduced plasma volume may exacerbate or precipitate azotemia; if progressive renal impairment is observed consider withholding or discontinuing diuretic therapy; renal function tests should be performed periodically during treatment
• Use with caution in patients with impaired hepatic function or progressive liver disease; minor alterations of fluid and electrolyte balance may precipitate hepatic coma
• Latent diabetes may become manifest and insulin requirements in diabetic patients may be altered during thiazide administration; serum concentrations of glucose should be monitored routinely during treatment
• Calcium excretion is decreased by diuretics pharmacologically related to indapamide; prolonged treatment with drugs pharmacologically related to indapamide may be rarely associated with hypercalcemia and hypophosphatemia secondary to physiologic changes in the parathyroid gland; treatment should be discontinued before tests for parathyroid function are performed
• Therapy may decrease serum protein-bound iodine levels without signs of thyroid disturbance
• Thiazides have exacerbated or activated systemic lupus erythematosus; consider possibility with this therapy as well

Angle-closure glaucoma

• Sulfonamide or sulfonamide-derivative drugs, like indapamide, can 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; symptoms may include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation
• Untreated, angle-closure glaucoma may result in permanent visual field loss; primary treatment is to discontinue indapamide as rapidly as possible; prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled
• Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy

Fluid and Electrolyte Imbalances

• Severe cases of hyponatremia, accompanied by hypokalemia reported with recommended doses primarily in elderly females; appears to be dose-related
• Increased risk of hyponatremia with 2.5 mg and 5 mg doses reported; hyponatremia considered possibly clinically significant (< 125 mEq/L) not reported with 1.25 mg dosage; thus, patients should start at 1.25 mg dose and maintained at lowest possible dose;
• Hypokalemia occurs commonly with diuretics; electrolyte monitoring is essential, particularly in patients at increased risk from hypokalemia, such as those with cardiac arrhythmias or who are receiving concomitant cardiac glycosides
• Perform periodic determinations of serum electrolytes at appropriate intervals; patients should be observed for clinical signs of fluid or electrolyte imbalance, such as hyponatremia, hypochloremic alkalosis, or hypokalemia
• Warning signs include dry mouth, thirst, weakness, fatigue, lethargy, drowsiness, restlessness, muscle pains or cramps, hypotension, oliguria, tachycardia, and gastrointestinal disturbance
• Electrolyte determinations are particularly important in patients who are vomiting excessively or receiving parenteral fluids, in patients subject to electrolyte imbalance (including those with heart failure, kidney disease, and cirrhosis), and patients on a salt-restricted diet
• The risk of hypokalemia secondary to diuresis and natriuresis is increased when larger doses are used when the diuresis is brisk when severe cirrhosis is present and during concomitant use of corticosteroids or ACTH
• Interference with adequate oral intake of electrolytes will also contribute to hypokalemia; hypokalemia can sensitize or exaggerate the response of the heart to toxic effects of digitalis, such as increased ventricular irritability
• Dilutional hyponatremia may occur in edematous patients; the appropriate treatment is a restriction of water rather than administration of salt, except in rare instances when the hyponatremia is life-threatening
• However, in actual salt depletion, appropriate replacement is the treatment of choice; any chloride deficit that may occur during treatment is generally mild and usually does not require specific treatment except in extraordinary circumstances as in liver or renal disease
• Thiazide-like diuretics have been shown to increase the urinary excretion of magnesium; this may result in hypomagnesemia

Drug interaction overview

• In general, diuretics should not be given concomitantly with lithium because they reduce its renal clearance and add a high risk of lithium toxicity; read prescribing information for lithium preparations before use of such concomitant therapy

Pregnancy and Lactation

• May be acceptable during pregnancy. 
• Lactation: not known if excreted into breast milk, avoid