BMA Concise Guide to Medicine & Drugs

Indapamide

Brand names Ethibide XL, Natrilix, Natrilix SR, Tensaid XL

Used in the following combined preparation Coversyl Plus

QUICK REFERENCE

Drug group Diuretic

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Indapamide is related in its effects and uses to the thiazide diuretics but is used to treat hypertension (high blood pressure). The drug increases secretion of salt by the kidneys in the same way as thiazide diuretics. This causes more water to be lost from the body, which reduces the total blood volume and lowers blood pressure. Indapamide is sometimes combined with other antihypertensive drugs but not with other diuretics. Indapamide’s diuretic effects are slight at low doses, but susceptible people need to have their blood levels of potassium and uric acid monitored. These include the elderly, those taking digitalis drugs, or those with gout or hyperaldosteronism (overproduction of the hormone aldosterone). Unlike the thiazides, indapamide does not affect control of diabetes at low doses.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, SR tablets.

Frequency and timing of doses Once daily in the morning.

Adult dosage range 1.5–2.5mg.

Onset of effect 1–2 hours, but the full effect may take several months.

Duration of action 12–24 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 4 hours, take a single dose now and skip the next.

Stopping the drug Do not stop taking the drug without consulting your doctor; high blood pressure may return.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Indapamide usually causes few adverse effects. The most common problems are rashes and mild disturbance of blood chemistry (due to loss of electrolytes, such as potassium, in the urine), which may cause fatigue and muscle cramps. If these are severe, discuss with your doctor. More rarely, the drug may cause headache, dizziness, diarrhoea or constipation, and nausea. Consult your doctor if these are severe or if you experience palpitations, fainting, tingling or pins and needles, or erectile dysfunction (impotence).

INTERACTIONS

Loop diuretics There is a risk of imbalance of salts in the blood if these drugs are taken with indapamide.

Anti-arrhythmic and digitalis drugs Loss of potassium with indapamide use may lead to toxicity with these drugs.

Lithium Blood levels of lithium are increased when it is taken with indapamide.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have liver or kidney problems.

· You have gout.

· You have hyperaldosteronism or hyperparathyroidism.

· You are allergic to sulphonamide drugs.

· You are taking other medicines.

Pregnancy Safety not established. Discuss with your doctor.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not prescribed.

Over 60 No special problems.

Driving and hazardous work No special problems.

Alcohol No special problems.

PROLONGED USE

Long-term use of indapamide may lead to potassium loss.

Monitoring Blood potassium and uric acid levels may be checked periodically.