indapamide

CLINICAL USE

Thiazide-like diuretic:Essential hypertension

DOSE IN NORMAL RENAL FUNCTION

2.5 daily in the morningModified release: 1.5 mg daily in the morning

PHARMACOKINETICS

Molecular weight :365.8

%Protein binding :79

%Excreted unchanged in urine : 5–7

Volume of distribution (L/kg) :0.3–1.3

half-life – normal/ESRD (hrs) :14–24/Unchanged

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. See ‘Other Information’

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in GFR <10 mL/min

HD :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Not dialysed. Dose as in GFR <10 mL/min

CAV/VVHD :Not dialysed. 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 amphotericinAntihypertensives: 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

–

Route

Oral

Rate of Administration

–

Comments

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OTHER INFORMATION

If pre-existing renal insufficiency is aggravated – stop indapamideDoses greater than 2.5 mg daily are not recommendedCaution if hypokalaemia develops Ineffective in ERF One-month studies of functionally anephric patients undergoing chronic haemodialysis have not shown evidence of drug accumulation, despite the fact that indapamide is not dialysable.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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