indapamide: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
indapamide: clinical details
Prescribing considerations
- Confirm adult essential hypertension.
- Assess renal and hepatic function, hydration, baseline electrolytes and arrhythmia risk factors.
- Use particular caution with older or malnourished people, cirrhosis, coronary disease, heart failure, prolonged QT, diabetes, gout or polypharmacy.
- Review treatment during significant vomiting, diarrhoea, fever or other volume depletion.
- Selected formulations contain lactose.
Contraindications and cautions
- Hypersensitivity to indapamide, other sulfonamides or product excipients
- Severe renal failure
- Hepatic encephalopathy or severe hepatic impairment
- Hypokalaemia
Monitoring
- Blood pressure and symptoms of postural hypotension
- Sodium before treatment and periodically thereafter
- Potassium, with earlier or more frequent checks in high-risk patients
- Renal function, particularly during dehydration or when interacting medicines are introduced
- Magnesium where clinically indicated, especially with arrhythmia or digitalis risk
- Glucose in diabetes and uric acid where gout or hyperuricaemia is relevant
- Calcium if hypercalcaemia is suspected; consider ECG monitoring when arrhythmia risk is increased
Clinical pharmacology
Indapamide is a sulfonamide-derived, thiazide-like diuretic that inhibits sodium reabsorption in the cortical diluting segment. Its antihypertensive effect also reflects improved arterial compliance and reduced peripheral vascular resistance. It is extensively metabolised, highly protein-bound and eliminated mainly as inactive metabolites.
Formulation and product differences
- Selected UK products include conventional film-coated tablets and prolonged-release film-coated tablets.
- Prolonged-release formulations use a matrix to sustain release and must be swallowed whole rather than chewed.
- Selected products contain lactose, but the amount and excipient composition differ by manufacturer.
indapamide preparations and strengths
Modified-release tablet
Route: Oral
Strengths: 1.5 mg
Tablet
Route: Oral
Strengths: 2.5 mg
indapamide interactions
Tell the prescriber or pharmacist about all prescribed, non-prescribed and complementary products. Important examples include:
Lithium
Indapamide can increase lithium concentrations and toxicity; the combination is generally avoided or requires close lithium monitoring.
NSAIDs, including ibuprofen
They may reduce blood-pressure control and increase the risk of kidney injury, particularly during dehydration.
Medicines that prolong the QT interval
Low potassium can increase the risk of dangerous ventricular arrhythmias, requiring electrolyte and sometimes ECG monitoring.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.