indapamide

Action

Increases sodium and water excretion by inhibiting sodium reabsorption in distal tubule; enhances excretion of sodium, chloride, potassium, and water. May cause arteriolar vasodilation.

Availability

Tablets: 1.25 mg, 2.5 mg

Indications and dosages

➣ Edema caused by heart failure

Adults: 2.5 mg P.O. daily in morning. After 1 week, may increase to 5 mg/day.

➣ Mild to moderate hypertension

Adults: 1.25 mg P.O. daily in morning. May increase q 4 weeks, up to 5 mg/day.

Contraindications

• Hypersensitivity to drug, other thiazide-like drugs, or tartrazine

• Anuria

Precautions

Use cautiously in:

• renal or severe hepatic impairment, ascites, fluid or electrolyte imbalances, gout, systemic lupus erythematosus, impaired glucose tolerance, hyperparathyroidism, bipolar disorder

• pregnant or breastfeeding patients.

Administration

• Administer with food or milk to reduce GI upset.

• Give early in day to avoid nocturia.

Adverse reactions

CNS: dizziness, light-headedness, headache, restlessness, insomnia, lethargy, fatigue, drowsiness, asthenia, depression, anxiety, nervousness, paresthesia, irritability, agitation

CV: orthostatic hypotension, palpitations, premature ventricular contractions, arrhythmias

EENT: blurred vision, rhinorrhea

GI: nausea, vomiting, diarrhea, constipation, bloating, epigastric distress, gastric irritation, abdominal pain or cramps, dry mouth, anorexia

GU: nocturia, polyuria, glycosuria, erectile dysfunction

Metabolic: dehydration, gout, hyperglycemia, hypokalemia, hypocalcemia, hypomagnesemia, hyponatremia, hypovolemia, hypophosphatemia, hyperuricemia, hypochloremic alkalosis

Musculoskeletal: muscle cramps and spasms

Skin: flushing, rash, urticaria, pruritus, photosensitivity, cutaneous vasculitis, necrotizing vasculitis

Other: weight loss

Interactions

Drug-drug. Amphotericin B, corticosteroids: additive hypokalemia

Antihypertensives, nitrates: additive hypotension

Cholestyramine, colestipol: decreased indapamide absorption

Lithium: decreased lithium excretion, increased risk of lithium toxicity

Sulfonylureas: decreased hypoglycemic efficacy

Drug-diagnostic tests. Bilirubin, blood and urine glucose (in diabetic patients), blood urea nitrogen (BUN), calcium, creatinine, uric acid: increased values Cholesterol, low-density lipoproteins, magnesium, potassium, protein-bound iodine, sodium, triglycerides, urinary calcium: decreased values

Drug-herbs. Ginkgo: decreased antihypertensive effect

Licorice, stimulant laxative herbs (aloe, cascara sagrada, senna): increased risk of hypokalemia

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Sun exposure: increased risk of photosensitivity

Patient monitoring

☞ Assess for signs and symptoms of hypokalemia, including ventricular arrhythmias, muscle weakness, and cramping.

• Monitor BUN, creatinine, and electrolyte levels.

• Assess daily weight and fluid intake and output.

• Monitor blood pressure response to drug.

• Watch for signs and symptoms of orthostatic hypotension.

Patient teaching

• Advise patient to consume potassium-rich foods, such as oranges, bananas, potatoes, and spinach.

• Instruct patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.

• Tell patient to weigh himself daily on same scale at same time of day while wearing similar clothing. Instruct him to report gain of more than 2 lb (0.9 kg) in 1 day or 5 lb (2.2 kg) in 1 week.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.