Indapamide

Indapamide
Names
IUPAC name
  • 4-chloro-N-(2-methyl-2,3-dihydroindol-1-yl)-3-sulfamoyl-benzamide
Clinical data
Drug classThiazide-like diuretic[1]
Main usesHigh blood pressure, swelling[1]
Side effectsLow potassium, headache, dizziness, tiredness, numbness, anxiety[1]
Pregnancy
category
  • AU: C
  • US: B (No risk in non-human studies)
    Routes of
    use    		By mouth
    Typical dose1.25 to 2.5 mg OD[2]
    External links
    AHFS/Drugs.comMonograph
    US NLMIndapamide
    MedlinePlusa684062
    Legal
    Legal status
    • UK: POM (Prescription only)
    Pharmacokinetics
    Protein binding71–79%
    MetabolismLiver
    Elimination half-life14–18 hours
    Chemical and physical data
    FormulaC16H16ClN3O3S
    Molar mass365.83 g·mol−1
    3D model (JSmol)
    SMILES
    • O=S(=O)(N)c1c(Cl)ccc(c1)C(=O)NN3c2ccccc2CC3C
    InChI
    • InChI=1S/C16H16ClN3O3S/c1-10-8-11-4-2-3-5-14(11)20(10)19-16(21)12-6-7-13(17)15(9-12)24(18,22)23/h2-7,9-10H,8H2,1H3,(H,19,21)(H2,18,22,23) checkY
    • Key:NDDAHWYSQHTHNT-UHFFFAOYSA-N checkY

    Indapamide is a medication used to treat high blood pressure and swelling due to heart failure or other causes.[1] It is a second line treatment for high blood pressure in pregnancy.[1] It is taken by mouth.[1] It may be used with other blood pressure medications.[1]

    Common side effects include low potassium, headache, dizziness, tiredness, numbness, and anxiety.[1] Other side effects may include low sodium, rash, gout, and high blood sugar.[1] It is a thiazide-like diuretic.[1]

    Indapamide was patented in 1968 and approved for medical use in 1977.[3] It is available as a generic medication.[2] In the United Kingdom it costs the NHS about £3.40 a month as of 2021.[2] In the United States this amount costs about 4 USD per month.[4] A combination medication with perindopril is also available.[2]

    Medical uses

    Its indications include hypertension and edema due to congestive heart failure. Indapamide has been shown to reduce stroke rates in people over the age of 52.[5][6][7] When used in combination with perindopril, evidence from multiple studies show a greater reduction in stroke occurrence.[5][7] In the HYVET study, indapamide has been demonstrated to reduce all-cause mortality in octogenarians regardless of the addition of perindopril.[5]

    Comparisons

    Thiazide-like diuretics (indapamide and chlorthalidone) appear to be more effective than the thiazide-type diuretics (hydrochlorothiazide) in reducing risks of major cardiovascular events and heart failure in persons with high blood pressure.[8] In terms of stroke risk, both thiazide-type and thiazide-like diuretics are effective in reducing it.[8][9][10]

    Dosage

    The adult dosage is 1.25 to 2.5 mg, orally and once daily, usually in the morning.[2]

    Indapamide is available generically as 1.25 mg and 2.5 mg non-scored tablets.[11] It is also available in SR (sustained release) form.

    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.

    Side effects

    Commonly reported side effects are low potassium levels, fatigue, orthostatic hypotension (an exaggerated decrease in blood pressure upon standing, often associated with syncope), and allergic manifestations.

    Monitoring the serum levels of potassium and uric acid is recommended, especially in subjects with a predisposition to low levels of potassium in the blood and gout.

    Interactions

    Caution is advised in the combination of indapamide with lithium and drugs causing prolonged QT interval (on EKG) or wave-burst arrhythmia (ie: astemizole, bepridil, IV erythromycin, halofantrine, pentamidine, sultopride, terfenadine, and vincamine).

    Overdose

    Symptoms of over dosage would be those associated with a diuretic effect (ie electrolyte disturbances), low blood pressure, and muscular weakness. Treatment should be symptomatic, directed at correcting electrolyte abnormalities.

    Society and culture

    Cost

    The cost in the U.S. of this medication is $41 (USD) for 100 tablets ( 2.5 mg)[12]

    • Indapamide costs (US)
    • Indapamide prescriptions (US)

    See also

    References

    1. 1 2 3 4 5 6 7 8 9 10 "Indapamide Monograph for Professionals". Drugs.com. Archived from the original on 10 January 2021. Retrieved 26 November 2021.
    2. 1 2 3 4 5 BNF 81: March-September 2021. BMJ Group and the Pharmaceutical Press. 2021. p. 181. ISBN 978-0857114105.
    3. ↑ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 457. ISBN 9783527607495. Archived from the original on 2021-08-28. Retrieved 2021-01-16.
    4. ↑ "Indapamide Prices, Coupons & Savings Tips - GoodRx". GoodRx. Archived from the original on 31 August 2016. Retrieved 26 November 2021.
    5. 1 2 3 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. Archived (PDF) from the original on 2019-04-12. Retrieved 2021-01-16.
    6. ↑ 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.
    7. 1 2 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.
    8. 1 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.
    9. ↑ "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.
    10. ↑ 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. Archived (PDF) from the original on 2021-08-29. Retrieved 2021-01-16.
    11. ↑ "Lexicomp Online Login". lexi.com. Archived from the original on 2016-01-07. Retrieved 2021-01-16.
    12. ↑ "Indapamide Prices, Coupons & Patient Assistance Programs". Drugs.com. Archived from the original on 16 January 2021. Retrieved 1 April 2021.
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