Indapamide

FDA label

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Titration Hypertension: wait 4 weeks at each dose before increasing. CHF edema: wait 1 week before increasing.

Renal Undefined

Hepatic Undefined

Doses of 5 mg and above add no further blood-pressure or heart-failure effect but cause more hypokalemia; there is minimal trial experience above 5 mg QD.

Instructions

• Take as a single daily dose in the morning.
• When first combined with another antihypertensive, reduce the usual dose of the other agent by 50%, then adjust as blood pressure response develops.

Contraindications

• Anuria
• Known hypersensitivity to other sulfonamide-derived drugs

Cautions

• Hypokalemia - dose-related and common (61% of patients had a K+ <3.4 mEq/L at 5 mg vs 20% at 1.25 mg); symptomatic hypokalemia in 2-7%.
• Other electrolyte/metabolic shifts: hyponatremia, hypochloremia, hyperuricemia, hyperglycemia, rising BUN/creatinine.
• Orthostatic hypotension, dizziness and lightheadedness, especially with other antihypertensives.
• Sulfonamide-type hypersensitivity: rash, photosensitivity, vasculitis, erythema multiforme, Stevens-Johnson syndrome, anaphylaxis.
• Blood dyscrasias reported (agranulocytosis, leukopenia, thrombocytopenia, aplastic anemia).
• Hepatobiliary/pancreatic reactions: intrahepatic cholestatic jaundice, hepatitis, pancreatitis, abnormal LFTs - reversible on discontinuation.
• Postmarketing: choroidal effusion, acute myopia, and acute angle-closure glaucoma.

Adverse reactions

• Headache (most common at 1.25 mg)
• Dizziness, lightheadedness, drowsiness, fatigue/weakness/lethargy
• Hypokalemia; muscle cramps or spasm, extremity numbness/tingling
• GI: constipation, diarrhea, dyspepsia, nausea, vomiting, abdominal pain, anorexia, dry mouth
• Peripheral edema; orthostatic hypotension, palpitations, PVCs
• Urinary frequency, nocturia, polyuria
• Rash, hives, pruritus; rarely vasculitis, photosensitivity, Stevens-Johnson syndrome
• Impotence or reduced libido
• Hyperuricemia, hyperglycemia, hyponatremia, hypochloremia, raised BUN/creatinine

Pregnancy Animal reproduction studies showed no fetal harm, but there are no adequate human studies; diuretics cross the placenta - use only if clearly needed, with possible fetal/neonatal jaundice and thrombocytopenia.

Lactation Undefined