indapamide (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & 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

Safety & efficacy not established

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

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Interactions

Interaction Checker

and indapamide

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            Adverse 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

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            Warnings

            Contraindications

            Hypersensitivity to indapamide or sulfonamides

            Anuria

            Cautions

            Serum concentrations of uric acid increased by an average of 0.69 mg/100 mL in patients treated with indapamide 1.25 mg, and by an average of 1.0 mg/100 mL in patients treated with indapamide 2.5 mg and 5.0 mg, and frank gout may be precipitated in certain patients receiving indapamide; periodically monitor serum concentrations of uric acid during treatment

            Use with caution in patients with severe renal disease, as reduced plasma volume may exacerbate or precipitate azotemia; if progressive renal impairment observed consider withholding or discontinuing diuretic therapy; renal function tests should be performed periodically during treatment

            Use with caution in patients with impaired hepatic function or progressive liver disease; minor alterations of fluid and electrolyte balance may precipitate hepatic coma

            Latent diabetes may become manifest and insulin requirements in diabetic patients may be altered during thiazide administration; serum concentrations of glucose should be monitored routinely during treatment

            Calcium excretion is decreased by diuretics pharmacologically related to indapamide; prolonged treatment with drugs pharmacologically related to indapamide may be rarely associated with hypercalcemia and hypophosphatemia secondary to physiologic changes in parathyroid gland; treatment should be discontinued before tests for parathyroid function are performed

            Therapy may decrease serum protein-bound iodine levels without signs of thyroid disturbance

            Thiazides have exacerbated or activated systemic lupus erythematosus; consider possibility with this therapy as well

            Fluid and Electrolyte Imbalances

            • Severe cases of hyponatremia, accompanied by hypokalemia reported with recommended doses primarily in elderly females; appears to be dose-related
            • Increased risk of hyponatremia with 2.5 mg and 5 mg doses reported; hyponatremia considered possibly clinically significant (< 125 mEq/L) not reported with 1.25 mg dosage; thus, patients should start at 1.25 mg dose and maintained at lowest possible dose;
            • Hypokalemia occurs commonly with diuretics; electrolyte monitoring is essential, particularly in patients at increased risk from hypokalemia, such as those with cardiac arrhythmias or who are receiving concomitant cardiac glycosides
            • Perform periodic determinations of serum electrolytes at appropriate intervals; patients should be observed for clinical signs of fluid or electrolyte imbalance, such as hyponatremia, hypochloremic alkalosis, or hypokalemia
            • Warning signs include dry mouth, thirst, weakness, fatigue, lethargy, drowsiness, restlessness, muscle pains or cramps, hypotension, oliguria, tachycardia, and gastrointestinal disturbance
            • Electrolyte determinations are particularly important in patients who are vomiting excessively or receiving parenteral fluids, in patients subject to electrolyte imbalance (including those with heart failure, kidney disease, and cirrhosis), and in patients on a salt-restricted diet
            • The risk of hypokalemia secondary to diuresis and natriuresis is increased when larger doses are used when the diuresis is brisk when severe cirrhosis is present and during concomitant use of corticosteroids or ACTH
            • Interference with adequate oral intake of electrolytes will also contribute to hypokalemia; hypokalemia can sensitize or exaggerate response of heart to toxic effects of digitalis, such as increased ventricular irritability
            • Dilutional hyponatremia may occur in edematous patients; the appropriate treatment is restriction of water rather than administration of salt, except in rare instances when the hyponatremia is life-threatening
            • However, in actual salt depletion, appropriate replacement is the treatment of choice; any chloride deficit that may occur during treatment is generally mild and usually does not require specific treatment except in extraordinary circumstances as in liver or renal disease
            • Thiazide-like diuretics have been shown to increase the urinary excretion of magnesium; this may result in hypomagnesemia

            Drug interaction overview

            • In general, diuretics should not be given concomitantly with lithium because they reduce its renal clearance and add a high risk of lithium toxicity; read prescribing information for lithium preparations before use of such concomitant therapy
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            Pregnancy & 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.

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            Pharmacology

            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%)

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.