Indapamide
LOZOL
Pronunciation: in-DAP-a-mide
“In dap am I? (to) Lose all (potassium)”
Bananas dispersing → ↓ serum potassium
What it isNCC-inhibiting thiazide-like diuretic; hypertension.
Why this oneUnlike hydrochlorothiazide, it has direct outcome evidence in older adults and secondary stroke prevention.
What limits itHyponatremia and hypokalemia can be severe; monitor electrolytes and renal function after starting or changing therapy.
FDA-approved for
- hypertension (~1983)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adults | 1.25 mg QD in the morning | 1.25-2.5 mg QD | 5 mg QD (consider adding another antihypertensive instead) |
| Edema of congestive heart failure | Adults | 2.5 mg QD in the morning | 2.5 mg QD | 5 mg QD |
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.
Available strengths
- tab 1.25, 2.5 mg
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
Cost
Generic entry1995
NO BOXED WARNINGS
Principal riskHyponatremia and hypokalemia
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityVolume depletion and electrolyte disturbances; kidney function and interacting medications modify risk.
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