Indapamide is a diuretic used to treat high blood pressure, alone or with other antihypertensive drugs, and to treat fluid retention (oedema) associated with heart failure. It acts on the kidneys to increase the elimination of water and salt.
Also known as: Natrilix
Indapamide-induced hypokalaemia raises digoxin toxicity.
Indapamide is a thiazide-like diuretic that depletes potassium and magnesium. Hypokalaemia potentiates digoxin toxicity (ventricular arrhythmias, even at therapeutic levels), especially in elderly hypertensive patients who frequently use the combination. Monitor serum potassium during treatment (keep ≥ 4.0 mEq/L), correct deficits, monitor the ECG and consider digoxin level monitoring if toxicity symptoms are suspected.
Thiazide-like diuretic + digoxin: diuretic-induced hypokalaemia increases digitalis toxicity. Monitor electrolytes.
The thiazide-like effect depletes potassium, sensitizing the myocardium to digoxin.
Potassium, ECG, GI symptoms.
Arrhythmia or bradycardia with nausea.
Monitor potassium and digoxin toxicity signs.
DailyMed (FDA) — approved Indapamide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=59cd3331-7afe-432a-8b50-39533fd5f392 ; approved Digoxin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e61d2108-d871-44c0-b12a-2e61fbb56967 — additional reference: Prontuário Terapêutico do INFARMED (11th ed., 2012)
Liquorice promotes pseudoaldosteronism with hypokalaemia and hypomagnesaemia, adding to the indapamide effect and increasing the risk of arrhythmias.
Avoid excessive liquorice intake; monitor serum potassium.
EMC-UK (MHRA) — approved Indapamide SmPC: https://www.medicines.org.uk/emc/product/6223/smpc
Indapamide is contraindicated in anuria because of the risk of drug accumulation and ineffective diuresis.
Do not use in patients with anuria.
EMC-UK (MHRA) — approved Indapamide SmPC: https://www.medicines.org.uk/emc/product/6223/smpc
Indapamide crosses the placenta; data in pregnancy are limited and use should only occur if the benefit outweighs the risk.
Avoid in pregnancy unless strictly indicated; it is not appropriate as an antihypertensive in pregnancy.
Indapamide is excreted into breast milk; it is not recommended during breastfeeding.
In women of childbearing age with hypertension, prefer antihypertensives with an established safety profile in pregnancy.
EMC-UK (MHRA) — approved Indapamide SmPC: https://www.medicines.org.uk/emc/product/6223/smpc
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Thiazide-like (indoline) diuretic with antihypertensive and diuretic effects; reduces sodium reabsorption in the distal tubule with a direct vasodilatory effect; dose-dependent hypokalaemia is the effect to watch.
Inhibits the Na+/Cl- cotransporter in the distal convoluted tubule, increasing sodium, chloride and water excretion (diuresis); also has a direct vasodilatory effect (reduced peripheral vascular resistance) contributing to the antihypertensive effect at low doses.
Well absorbed orally: peak 115 ng/mL (2.5 mg) and 260 ng/mL (5 mg) ~2 h after dosing; preferential reversible uptake by erythrocytes (blood/plasma ratio ~6:1 at peak); protein binding 71-79%.
Extensively metabolised (only ~7% excreted unchanged in urine within 48 h); renal elimination of ~70% of the dose and 23% via the GI tract (including biliary); biphasic urinary excretion with a terminal half-life of total radioactivity of 26 h.
Whole blood half-life ~14 h; the antihypertensive effect is maintained with once-daily dosing (1.25-2.5 mg).
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
