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. Thiazide-like diuretic (indapamide and chlorthalidone) appears more effective than the thiazide-type diuretics (hydrochlorothiazide) in reducing risk of major cardiovascular events and heart failure in persons with high blood pressure.[2] In terms of risk of stroke, both thiazide-type and thiazide-like diuretic are effective in reducing it.[2][3][4] Both drug classes also appear to have similar rates of adverse effects when compared to other classes of anti-hypertensives.[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 mass365.83 g·mol−1
    3D model (JSmol)
      (verify)

    It was patented in 1968 and approved for medical use in 1977.[5]

    Medical uses

    Hypertension and edema due to congestive heart failure. Indapamide has been shown to reduce stroke occurrences in people over the age of 52.[6][7][8] When used in combination with perindopril, evidence from multiple studies show that a greater reduction in stroke occurrences may be obtained.[6][8] In the HYVET study, indapamide has been demonstrated to reduce all-cause mortality in octogenarians regardless of the addition of perindopril.[6]

    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.[9] 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. "Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party". BMJ. 304 (6824): 405–12. February 1992. doi:10.1136/bmj.304.6824.405. PMC 1995577. PMID 1445513.
    4. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. (May 2008). "Treatment of hypertension in patients 80 years of age or older" (PDF). The New England Journal of Medicine. 358 (18): 1887–98. doi:10.1056/NEJMoa0801369. PMID 18378519.
    5. Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 457. ISBN 9783527607495.
    6. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. (May 2008). "Treatment of hypertension in patients 80 years of age or older" (PDF). The New England Journal of Medicine. 358 (18): 1887–98. doi:10.1056/NEJMoa0801369. PMID 18378519.
    7. Liu L, Wang Z, Gong L, Zhang Y, Thijs L, Staessen JA, Wang J (November 2009). "Blood pressure reduction for the secondary prevention of stroke: a Chinese trial and a systematic review of the literature". Hypertension Research. 32 (11): 1032–40. doi:10.1038/hr.2009.139. PMID 19798097.
    8. PROGRESS Collaborative Group (September 2001). "Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack". Lancet. 358 (9287): 1033–41. doi:10.1016/s0140-6736(01)06178-5. PMID 11589932.
    9. "Lexicomp Online Login". lexi.com.
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