Drugs List

Therapeutic Indications

Uses

Treatment of essential hypertension

Contraindications

Children under 18 years
Addison's disease
Anuria
Breastfeeding
Galactosaemia
Hepatic encephalopathy
Hypercalcaemia
Hyponatraemia
Long QT syndrome
Porphyria
Pregnancy
Refractory hypokalaemia
Renal impairment - creatinine clearance below 30 ml/minute
Severe hepatic impairment
Symptomatic hyperuricaemia
Torsade de pointes

Precautions and Warnings

Allergic disposition
Elderly
Family history of long QT syndrome
Predisposition to narrow angle glaucoma
Asthma
Cardiac failure
Diabetes mellitus
Electrolyte imbalance
Glucose-galactose malabsorption syndrome
Gout
Hepatic cirrhosis
History of torsade de pointes
Hyperaldosteronism
Hyperparathyroidism
Hyperuricaemia
Hypokalaemia
Ischaemic heart disease
Lactose intolerance
Malnutrition
Mild hepatic impairment
Mild renal impairment
Nephrotic syndrome
Systemic lupus erythematosus

Advise patient to protect skin if restarting following photosensitivity
Correct electrolyte disorders before treatment
May cause hepatic encephalopathy in patients with hepatic disease
May exacerbate or activate systemic lupus erythematosus
Advise ability to drive/operate machinery may be affected by side effects
Some formulations contain lactose
Correct hypokalaemia before or during treatment
Monitor plasma sodium before and during treatment
Consider monitoring ECG in patients at risk of QT prolongation
Diabetic control may need adjustment
Monitor fluid and electrolyte status
Monitor glucose levels more closely in diabetics with low potassium
Monitor renal function
Monitor serum potassium regularly
Excess consumption of liquorice may increase the risk of hypokalaemia
May precipitate diabetes mellitus
May precipitate gout
Withdraw and consider hyperparathyroidism if frank hypercalcaemia develops
Discontinue before parathyroid function tests
Discontinue at once if hepatic encephalopathy occurs
Discontinue if hypercalcaemia occurs in patients with hyperparathyroidism
Discontinue if patient develops decreased visual acuity +/or ocular pain
Discontinue if photosensitivity occurs
Discontinue if renal function deteriorates
Advise patient not to take NSAIDs unless advised by clinician

Monitor serum potassium regularly. More frequent monitoring is required in the following: the elderly, malnourished and/or polymedicated, cirrhotic patients with oedema and ascites, coronary artery disease, cardiac failure, as they are at increased risk of arrhythmias. Individuals with long QT intervals, whether the origin is congenital or iatrogenic are also at risk. Bradycardia with hypokalaemia is a risk factor for severe arrhythmias including potentially fatal torsades de pointes. More frequent monitoring of plasma potassium levels is required in all of the above situations. The first measurement should be obtained during the first week after commencing therapy. Correct hypokalaemia if detected.

An idiosyncratic reaction resulting in choroidal effusion with visual field defect, transient myopia and acute closed angle glaucoma may occur. Symptoms including acute onset of decreased visual acuity or ocular pain may occur within hours to weeks of initiation of indapamide and can lead to permanent vision loss. If symptoms occur treatment should be discontinued and prompt medical or surgical treatments should be considered if the intraocular pressure remains uncontrolled.

Pregnancy and Lactation

Pregnancy

Indapamide is contraindicated in pregnancy.

Diuretics can reduce plasma volume and lead to a reduced perfusion of the placenta. Schaefer (2015) comments that diuretics are no longer part of the standard therapy for hypertension and oedema during pregnancy; they should only be used for particular indications. In such cases hydrochlorothiazide is the diuretic of choice. Use of indapamide is not an indication for interrupting pregnancy. Briggs (2015) comments that in general, diuretics are not recommended in the treatment of gestational hypertension because of the maternal hypovolaemia characteristic of the disease.

Thiazides and related diuretics may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbance and hypoglycaemia. Stimulation of labour, uterine inertia and meconium staining have also been reported.

Lactation

Indapamide is contraindicated in breastfeeding.

At the time of writing, there is limited published experience concerning the use of indapamide during breastfeeding. Indapamide is excreted into human breast milk.

Schaefer (2015) concludes that during breastfeeding, diuretics should not normally be prescribed for treating hypertension. However, when such a drug is urgently needed, moderately dosed treatment with hydrochlorothiazide can be undertaken, with attention to the side effects. Single doses of indapamide do not require limitation of breastfeeding, but therapy should be changed.

Side Effects

Abnormal liver function
Agranulocytosis
Angioedema
Aplastic anaemia
Arrhythmias
Blurred vision
Choroidal effusion
Constipation
Dehydration
Dry mouth
Erectile dysfunction
Fatigue
Gout
Haemolytic anaemia
Headache
Hepatic encephalopathy
Hepatic impairment
Hepatitis
Hypercalcaemia
Hyperglycaemia
Hypersensitivity reactions
Hypokalaemia
Hyponatraemia
Hypotension
Hypovolaemia
Increases in hepatic enzymes
Increases in plasma urate concentration
Leucopenia
Maculopapular rash
Metabolic alkalosis
Muscle spasm
Muscle weakness
Myalgia
Myopia
Narrow angle glaucoma
Nausea
Ocular pain
Pancreatitis
Paraesthesia
Photosensitivity
Prolongation of QT interval
Purpura
Renal failure
Rhabdomyolysis
Stevens-Johnson syndrome
Syncope
Thrombocytopenia
Torsades de pointes
Toxic epidermal necrolysis
Urticaria
Vertigo
Visual disturbances
Vomiting
Worsening of lupus erythematosus

Presentation

Oral formulations of indapamide.

Drugs List

Therapeutic Indications

Uses

Treatment of essential hypertension

Dosage

Adults

Additional Dosage Information

Contraindications

Children under 18 years
Addison's disease
Anuria
Breastfeeding
Galactosaemia
Hepatic encephalopathy
Hypercalcaemia
Hyponatraemia
Long QT syndrome
Porphyria
Pregnancy
Refractory hypokalaemia
Renal impairment - creatinine clearance below 30 ml/minute
Severe hepatic impairment
Symptomatic hyperuricaemia
Torsade de pointes

Precautions and Warnings

Allergic disposition
Elderly
Family history of long QT syndrome
Predisposition to narrow angle glaucoma
Asthma
Cardiac failure
Diabetes mellitus
Electrolyte imbalance
Glucose-galactose malabsorption syndrome
Gout
Hepatic cirrhosis
History of torsade de pointes
Hyperaldosteronism
Hyperparathyroidism
Hyperuricaemia
Hypokalaemia
Ischaemic heart disease
Lactose intolerance
Malnutrition
Mild hepatic impairment
Mild renal impairment
Nephrotic syndrome
Systemic lupus erythematosus

Advise patient to protect skin if restarting following photosensitivity
Correct electrolyte disorders before treatment
May cause hepatic encephalopathy in patients with hepatic disease
May exacerbate or activate systemic lupus erythematosus
Advise ability to drive/operate machinery may be affected by side effects
Some formulations contain lactose
Correct hypokalaemia before or during treatment
Monitor plasma sodium before and during treatment
Consider monitoring ECG in patients at risk of QT prolongation
Diabetic control may need adjustment
Monitor fluid and electrolyte status
Monitor glucose levels more closely in diabetics with low potassium
Monitor renal function
Monitor serum potassium regularly
Excess consumption of liquorice may increase the risk of hypokalaemia
May precipitate diabetes mellitus
May precipitate gout
Withdraw and consider hyperparathyroidism if frank hypercalcaemia develops
Discontinue before parathyroid function tests
Discontinue at once if hepatic encephalopathy occurs
Discontinue if hypercalcaemia occurs in patients with hyperparathyroidism
Discontinue if patient develops decreased visual acuity +/or ocular pain
Discontinue if photosensitivity occurs
Discontinue if renal function deteriorates
Advise patient not to take NSAIDs unless advised by clinician

Monitor serum potassium regularly. More frequent monitoring is required in the following: the elderly, malnourished and/or polymedicated, cirrhotic patients with oedema and ascites, coronary artery disease, cardiac failure, as they are at increased risk of arrhythmias. Individuals with long QT intervals, whether the origin is congenital or iatrogenic are also at risk. Bradycardia with hypokalaemia is a risk factor for severe arrhythmias including potentially fatal torsades de pointes. More frequent monitoring of plasma potassium levels is required in all of the above situations. The first measurement should be obtained during the first week after commencing therapy. Correct hypokalaemia if detected.

An idiosyncratic reaction resulting in choroidal effusion with visual field defect, transient myopia and acute closed angle glaucoma may occur. Symptoms including acute onset of decreased visual acuity or ocular pain may occur within hours to weeks of initiation of indapamide and can lead to permanent vision loss. If symptoms occur treatment should be discontinued and prompt medical or surgical treatments should be considered if the intraocular pressure remains uncontrolled.

Pregnancy and Lactation

Pregnancy

Indapamide is contraindicated in pregnancy.

Diuretics can reduce plasma volume and lead to a reduced perfusion of the placenta. Schaefer (2015) comments that diuretics are no longer part of the standard therapy for hypertension and oedema during pregnancy; they should only be used for particular indications. In such cases hydrochlorothiazide is the diuretic of choice. Use of indapamide is not an indication for interrupting pregnancy. Briggs (2015) comments that in general, diuretics are not recommended in the treatment of gestational hypertension because of the maternal hypovolaemia characteristic of the disease.

Thiazides and related diuretics may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbance and hypoglycaemia. Stimulation of labour, uterine inertia and meconium staining have also been reported.

Lactation

Indapamide is contraindicated in breastfeeding.

At the time of writing, there is limited published experience concerning the use of indapamide during breastfeeding. Indapamide is excreted into human breast milk.

Schaefer (2015) concludes that during breastfeeding, diuretics should not normally be prescribed for treating hypertension. However, when such a drug is urgently needed, moderately dosed treatment with hydrochlorothiazide can be undertaken, with attention to the side effects. Single doses of indapamide do not require limitation of breastfeeding, but therapy should be changed.

Side Effects

Abnormal liver function
Agranulocytosis
Angioedema
Aplastic anaemia
Arrhythmias
Blurred vision
Choroidal effusion
Constipation
Dehydration
Dry mouth
Erectile dysfunction
Fatigue
Gout
Haemolytic anaemia
Headache
Hepatic encephalopathy
Hepatic impairment
Hepatitis
Hypercalcaemia
Hyperglycaemia
Hypersensitivity reactions
Hypokalaemia
Hyponatraemia
Hypotension
Hypovolaemia
Increases in hepatic enzymes
Increases in plasma urate concentration
Leucopenia
Maculopapular rash
Metabolic alkalosis
Muscle spasm
Muscle weakness
Myalgia
Myopia
Narrow angle glaucoma
Nausea
Ocular pain
Pancreatitis
Paraesthesia
Photosensitivity
Prolongation of QT interval
Purpura
Renal failure
Rhabdomyolysis
Stevens-Johnson syndrome
Syncope
Thrombocytopenia
Torsades de pointes
Toxic epidermal necrolysis
Urticaria
Vertigo
Visual disturbances
Vomiting
Worsening of lupus erythematosus

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: March 2019

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: ALKAPAMID XL 1.5 mg prolonged-release tablets. HBS Healthcare Ltd. Revised January 2016.

Summary of Product Characteristics: Cardide SR 1.5mg prolonged release tablets. Teva UK Ltd. Revised June 2015.

Summary of Product Characteristics: Indapamide 2.5mg tablets. Zenvita. Revised July 2018.

Summary of Product Characteristics: Indipam XL 1.5mg prolonged release tablets. Actavis UK Ltd. Revised September 2020.

Summary of Product Characteristics: Lorvacs XL 1.5mg prolonged release tablets. Torrent Pharma (UK) Ltd. Revised December 2018.

Summary of Product Characteristics: Natrilix 2.5mg. Servier Laboratories Ltd. Revised October 2021.

Summary of Product Characteristics: Natrilix SR. Servier Laboratories Ltd. Revised October 2021.

Summary of Product Characteristics: Rawel XL. Consillient Health Ltd. Revised October 2014.

Summary of Product Characteristics: Tensaid XL 1.5mg prolonged-release film-coated tablets. Generics (UK) Ltd. Revised October 2016.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 21 March 2019

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Indapamide Last revised: 07 February 2019
Last accessed: 21 March 2019