Overview
Indapamide is a thiazide-like diuretic used primarily for hypertension and edema associated with heart failure. It acts by inhibiting sodium reabsorption in the distal convoluted tubule of the kidney, leading to increased excretion of sodium, chloride, and water. It also has vasodilatory effects that contribute to its antihypertensive action.
Mechanism of Action
Inhibits sodium reabsorption in the distal convoluted tubule by blocking the Na+-Cl- symporter, leading to increased excretion of sodium, chloride, and water. Also exhibits direct vasodilatory effects on peripheral arterioles, reducing peripheral vascular resistance.
Indications
- Hypertension
- Edema associated with congestive heart failure
Dosage
Hypertension: 1.25-2.5 mg once daily, may increase to 5 mg daily if needed. Edema: 2.5 mg once daily, may increase to 5 mg daily. Take in the morning with or without food.
Contraindications
- Anuria
- Severe renal impairment (eGFR <30 mL/min)
- Severe hepatic impairment
- Hypersensitivity to indapamide or sulfonamide-derived drugs
- Electrolyte imbalances (severe hypokalemia, hyponatremia)
Side Effects
- Headache
- Dizziness
- Fatigue
- Muscle cramps
- Nausea
- Hypokalemia
- Hyponatremia
- Hyperglycemia
- Hyperuricemia
- Orthostatic hypotension
- Photosensitivity
- Rash
Interactions
- Lithium (increased lithium toxicity)
- NSAIDs (reduced antihypertensive effect)
- Digoxin (increased risk of digoxin toxicity with hypokalemia)
- Other antihypertensives (additive effects)
- Corticosteroids (increased risk of hypokalemia)
- ACE inhibitors/ARBs (increased risk of renal impairment)