Xipamide

CLINICAL USE

Thiazide diuretic: Hypertension Oedema

DOSE IN NORMAL RENAL FUNCTION

Oedema: 40–80 mg in the morning Maintenance: 20 mg in the morning Hypertension: 20 mg in the morning

PHARMACOKINETICS

Molecular weight : 354.8

%Protein binding : 99

%Excreted unchanged in urine : 50

Volume of distribution (L/kg) : 10–21 litres

half-life – normal/ESRD (hrs) : 5–8/9–32

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD : Unknown dialysability. Dose as in normal renal function

HD : Dialysed. Dose as in normal renal function

HDF/high flux : Dialysed. Dose as in normal renal function

CAV/VVHD : Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Analgesics: increased risk of nephrotoxicity with NSAIDs; antagonism of diuretic effect

Anti-arrhythmics: hypokalaemia leads to increased cardiac toxicity; effects of lidocaine and mexiletine antagonised

Antibacterials: avoid administration with lymecycline

Antidepressants: increased risk of hypokalaemia with reboxetine; enhanced hypotensive effect with MAOIs; increased risk of postural hypotension with tricyclics

Anti-epileptics: increased risk of hyponatraemia with carbamazepine

Antifungals: increased risk of hypokalaemia with amphotericin Antihypertensives: enhanced hypotensive effect; increased risk of first dose hypotension with post-synaptic alpha- blockers like prazosin; hypokalaemia increases risk of ventricular arrhythmias with sotalol

Antipsychotics: hypokalaemia increases risk of ventricular arrhythmias with amisulpride or sertindole; enhanced hypotensive effect with phenothiazines; hypokalaemia increases risk of ventricular arrhythmias with pimozide – avoid concomitant use

Atomoxetine: hypokalaemia increases risk of ventricular arrhythmias Cardiac glycosides: increased toxicity if hypokalaemia occurs

Ciclosporin: increased risk of nephrotoxicity and possibly hypomagnesaemia Lithium excretion reduced (increased toxicity)

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Monitor for hypokalaemia Diuresis starts within 1–2 hours, peaks at 4–6 hours and lasts for almost 24 hours Manufacturer advises to avoid in severe renal impairment due to reduced clearance

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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