Indapamide

Indapamide is a thiazide-like diuretic[1] drug generally used in the treatment of hypertension, as well as decompensated heart failure. Combination preparations with perindopril (an ACE inhibitor antihypertensive) are also available. The thiazide-like diuretics (indapamide and chlorthalidone) are more effective than the thiazide-type diuretics (including hydrochlorothiazide) for reducing the risk of heart attack, stroke, and heart failure in persons with high blood pressure and the thiazide-like and thiazide-type diuretics have similar rates of adverse effects.[2]

Indapamide
Clinical data
AHFS/Drugs.comMonograph
MedlinePlusa684062
Pregnancy
category
  • AU: C
  • US: B (No risk in non-human studies)
    Routes of
    administration    		Oral tablet
    ATC code
    Legal status
    Legal status
    • UK: POM (Prescription only)
    Pharmacokinetic data
    Protein binding71–79%
    MetabolismHepatic
    Elimination half-life14–18 hours
    Identifiers
    CAS Number
    PubChem CID
    IUPHAR/BPS
    DrugBank
    ChemSpider
    UNII
    KEGG
    ChEMBL
    CompTox Dashboard (EPA)
    ECHA InfoCard100.043.633
    Chemical and physical data
    FormulaC16H16ClN3O3S
    Molar mass365.835 g/mol g·mol−1
    3D model (JSmol)
      (verify)

    It was patented in 1968 and approved for medical use in 1977.[3]

    Medical uses

    Hypertension and edema due to congestive heart failure. Indapamide has been proven in the HYVET trial to reduce stroke and all-cause mortality when given with or without perindopril to people over the age of 80 for the treatment of hypertension.[4]

    Contraindications

    Indapamide is contraindicated in known hypersensitivity to sulfonamides, severe kidney failure, hepatic encephalopathy or severe liver failure, and a low blood potassium level.

    There is insufficient safety data to recommend indapamide use in pregnancy or breastfeeding.

    Adverse effects

    Commonly reported adverse events are low potassium levels, fatigue, orthostatic hypotension (blood pressure decrease on standing up), and allergic manifestations.

    Monitoring the serum levels of potassium and uric acid is recommended, especially in subjects with a predisposition or a sensitivity to low levels of potassium in the blood and in patients with gout.

    Interactions

    Caution is advised in the combination of indapamide with lithium and nonantiarrhythmic drugs causing wave-burst arrhythmia (astemizole, bepridil, IV erythromycin, halofantrine, pentamidine, sultopride, terfenadine, and vincamine).

    Overdose

    Symptoms of overdosage would be those associated with a diuretic effect, i.e. electrolyte disturbances, low blood pressure, and muscular weakness. Treatment should be symptomatic, directed at correcting electrolyte abnormalities.

    Dosage and administration

    The adult dosage is 1.25 to 5 mg, orally and once daily, usually in the morning.

    Indapamide is available generically as 1.25 mg and 2.5 mg non-scored tablets.[5] It is also available in SR (sustained release) form.

    See also

    References
    1. Indapamide at the US National Library of Medicine Medical Subject Headings (MeSH)
    2. Olde Engberink RH, Frenkel WJ, van den Bogaard B, Brewster LM, Vogt L, van den Born BJ (May 2015). "Effects of thiazide-type and thiazide-like diuretics on cardiovascular events and mortality: systematic review and meta-analysis". Hypertension. 65 (5): 1033–40. doi:10.1161/HYPERTENSIONAHA.114.05122. PMID 25733241.
    3. Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 457. ISBN 9783527607495.
    4. Beckett, NS; Peters, R; Fletcher, AE; et al. (May 2008). "HYVET Trial" (PDF). N. Engl. J. Med. 358 (18): 1887–98. doi:10.1056/NEJMoa0801369. PMID 18378519.
    5. "Lexicomp Online Login". lexi.com.
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