Dosing and uses of Indapamide
Adult dosage forms and strengths
tablets
- 1.25mg
- 2.5mg
Edema
2.5 mg PO qDay initially; may increase to 5 mg qDay
Hypertension
1.25 mg PO qAM initially; may increase at 4-week intervals up to 5 mg qAm
Overdose Management
May use normal saline for volume replacement
May use dopamine or norepinephrine to treat hypotension
If dysrhythmia due to decreased K+ or Mg+ suspected replace aggressively
Discontinue treatment if no symptoms after 6hr
Pediatric dosage forms and strengths
Safety & efficacy not established
Geriatric dosage forms and strengths
Edema
2.5 mg PO qDay initially; may increase to 5 mg qDay
Hypertension
1.25 mg PO qAM initially; may increase at 4-week intervals up to 5 mg qAm
Indapamide adverse (side) effects
1-10%
Hypotension
Palpation
Flushing
Dizziness
Lightheadedness
Vertigo
Headache
Weakness
Restlessness
Drowsiness
Fatigue
Lethargy
Malaise
Anorexia
Nausea/vomiting
Nocturia
Polyuria
Blurred vision
Rhinnorhea
Electrolyte abnormalities
Pruritus
Rash
<1%
Cutaneous vasculitis
Glycosuria
Pancreatitis
Warnings
Contraindications
Hypersensitivity to indapamide or sulfonamides
Anuria
Cautions
Hypotension, DM, fluid or electrolyte imbalance, hyperuricemia or gout, SLE, liver disease, renal disease
Avoid concurrent use with lithium
More effective in impaired renal function than thiazides
No effect on lipids/cholesteroL
Severe cases of hyponatremia, accompanied by hypokalemia have been reported with recommended doses in elderly females
Pregnancy and lactation
Pregnancy category: B
Lactation: not known if excreted into breast milk, avoid
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Indapamide
Mechanism of action
Similar to thiazide diuretics, enhances Na, Cl and water excretion by interfering with transport of Na+ ion across renal tubular epithelium at proximal segment of distal tubule
Pharmacokinetics
Half-Life: 14-25 hr
Onset: 1-3 hr
Duration: 8-12 hr
Peak Plasma Time: 2 hr
Bioavailability: 93%
Protein Bound: 71-79%
Vd: 24-25 L
Metabolism: Liver
Metabolites: 19 metabolites, not identified, activity unknown
Excretion: Urine (70% with 7% unchanged), feces (23%)
