Indapamide

Follow your doctor's directions. They may include a daily exercise program and a low-sodium or low-salt diet, potassium supplements, and increased amounts of potassium-rich foods (e.g., bananas, prunes, raisins, and orange juice) in your diet.

Keep this medicine in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medicine that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medicine.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Lozol (discontinued brand)

GENERIC AVAILABLE: Yes

Indapamide is a prescription medicine used to treat high blood pressure.

It's also given to people who suffer from edema (fluid retention) due to congestive heart disease or another medical condition.

Indapamide is a diuretic (water pill) that works by helping the kidneys rid the body of unneeded water and salt.

The Food and Drug Administration (FDA) approved indapamide in 1983. It's manufactured by various pharmaceutical companies as a generic drug (no brand-name version is available).

Indapamide Warnings

Before taking indapamide, tell your doctor if you have, or have ever had, any of the following:

• Diabetes
• Gout (a type of arthritis caused by a buildup of uric acid crystals in the joints)
• Any type of heart problem
• Kidney disease
• Liver disease
• Problems urinating
• Lupus (a chronic inflammatory condition)
• Thyroid or parathyroid disease
• Low levels of sodium or potassium in the blood
• Persistent vomiting
• A neurosurgical procedure known as a sympathectomy
• Allergies to any medication

Indapamide may affect your blood sugar levels. If you have diabetes, monitor your condition carefully while using this medicine.

Let your doctor know you're taking indapamide before having any type of medical or dental procedure.

Also, tell your doctor if you're currently on a low-salt diet.

Your doctor may recommend that you adopt a specific diet and exercise plan while taking indapamide. Follow these instructions carefully.

Try to avoid becoming dehydrated while using indapamide. Ask your doctor how much fluid you should consume throughout the day.

This medicine may make your skin more sensitive to sunlight. Avoid unnecessary exposure to the sun and tanning booths, and wear sunscreen and protective clothing while outdoors.

Your doctor will want to perform frequent tests to check your body's response to indapamide.

Keep all appointments with your doctor and laboratory.

Pregnancy and Indapamide

Indapamide should only be taken during pregnancy when it's clearly needed.

Tell your doctor if you become pregnant while using this medicine. You'll need to discuss the benefits and risks of taking indapamide during pregnancy.

It's not known whether this drug passes into breast milk. Don't breastfeed a baby while using indapamide.

Common Side Effects of Indapamide

Tell your doctor if any of the following side effects become severe or don't go away:

• Frequent urination (this symptom should decrease after a few weeks of treatment)
• Mild dizziness or lightheadedness (especially when standing or sitting up)
• Back pain
• Constipation
• Mild diarrhea
• Drowsiness
• Headache
• Nausea
• Runny nose
• Nervousness
• Trouble sleeping
• Upset stomach
• Weakness
• Vomiting
• Decreased sexual ability

Serious Side Effects of Indapamide

Tell your doctor right away if you experience any of the following serious side effects:

• Chest pain
• Blurred vision
• Jaundice
• Dark-colored urine
• Decreased urination or problems with urination
• Pale-colored stools
• Dry mouth
• Fainting
• Fast or irregular heartbeat
• Fatigue
• Fever, chills, cough, or sore throat
• Increased thirst
• Loss of appetite
• Numbness of the hands or feet
• Severe dizziness, drowsiness, or lightheadedness
• Severe stomach pain
• Red, swollen, peeling, or blistered skin
• Swelling of the hands, ankles, or feet
• Muscle pain, weakness, or cramping
• Confusion
• Mental or mood changes
• Seizures
• Unusual sluggishness, tiredness, or weakness
• Unusual bruising or bleeding
• Signs of anaphylaxis, which may include rash, hives, itching, difficulty breathing, chest tightness, or swelling of the face, mouth, lips, or tongue

Indapamide comes as a tablet to take by mouth, typically once daily in the morning.

Your dose will depend on your medical condition and response to treatment.

You can take this medicine with or without food.

At first, indapamide may make you urinate more often.

You may want to take your dose before 6 p.m. to avoid disturbing your sleep with the need to urinate.

Follow the instructions on your prescription label carefully. Don't take more or less indapamide than is recommended.

Continue to take indapamide even if you feel well. Don't stop your treatment without first talking to your doctor.

Indapamide Overdose

Symptoms of an indapamide overdose may include:

• Vomiting
• Nausea
• Weakness

If you suspect an overdose, contact a poison control center or emergency room immediately.

You can get in touch with a poison control center at 800-222-1222.

Missed Dose of Indapamide

If you miss a dose of indapamide, take it as soon as you remember.

But if it's almost time for your next scheduled dose, skip the missed dose and continue with your regular medication schedule.

Don't take extra medicine to make up for a missed dose.

Severe cases of hyponatremia, accompanied by hypokalemia have been reported with recommended doses of indapamide. This occurred primarily in elderly females. (See PRECAUTIONS, Geriatric Use.) This appears to be dose related. Also, a large case-controlled pharmacoepidemiology study indicates that there is an increased risk of hyponatremia with indapamide 2.5 mg and 5 mg doses. Hyponatremia considered possibly clinically significant ( < 125 mEq/L) has not been observed in clinical trials with the 1.25 mg dosage (see PRECAUTIONS). Thus, patients should be started at the 1.25 mg dose and maintained at the lowest possible dose. (See DOSAGE AND ADMINISTRATION.)

Hypokalemia occurs commonly with diuretics (see ADVERSE REACTIONS, hypokalemia), and electrolyte monitoring is essential, particularly in patients who would be at increased risk from hypokalemia, such as those with cardiac arrhythmias or who are receiving concomitant cardiac glycosides.

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.

No information provided. Please refer to the WARNINGS and PRECAUTIONS sections.

Indapamide may be found in some form under the following brand names:

• Lozol

Indapamide is part of the drug class:

• Low Ceiling Sulfonamide Diuretics

Serious side effects can occur including:

• worsening of kidney disease
• worsening of gout
• worsening of systemic lupus erythematosus (SLE). Medications like indapamide have exacerbated SLE.
• increased blood glucose levels
• electrolyte imbalance. This medication may affect electrolytes including sodium and potassium. Your doctor will check these levels using a blood test. Warning signs of electrolyte imbalance include:
  • dry mouth
  • thirst
  • weakness
  • lack of energy
  • drowsiness
  • restlessness
  • muscle pains or cramps
  • muscle fatigue
  • low blood pressure
  • decreased urination
  • fast heart rate
  • nausea and vomiting
• impaired liver function. This medication should be used with caution in patients with liver disease.

Do not take indapamide if you:

• are allergic to indapamide or any other ingredient in indapamide
• are not able to produce urine

You should not use indapamide if you are allergic to it, or if:

• you are unable to urinate; or

• you are allergic to sulfa drugs.

To make sure indapamide is safe for you, tell your doctor if you have:

• cirrhosis or other liver disease;

• kidney disease;

• low levels of potassium or sodium in your blood;

• gout;

• diabetes;

• lupus; or

• if you are on a low-salt diet.

Indapamide is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether indapamide passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

Indapamide is not approved for use by anyone younger than 18 years old.

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Hypertension

Used alone or in combination with other antihypertensive agents for all stages of hypertension.4 19 21 83 a 500

JNC classifies indapamide as a thiazide-like drug with regard to management of hypertension; the drug’s efficacy in hypertensive patients is similar to that of the thiazide diuretics.14 18 21 24 500 501

Thiazide-type diuretics are recommended as one of several preferred agents for the initial management of hypertension; other options include ACE inhibitors, angiotensin II receptor antagonists, and calcium-channel blockers.501 502 503 504 While there may be individual differences with respect to specific outcomes, these antihypertensive drug classes all produce comparable effects on overall mortality and cardiovascular, cerebrovascular, and renal outcomes.500 501 502 504 Individualize choice of therapy; consider patient characteristics (e.g., age, ethnicity/race, comorbidities, cardiovascular risk) as well as drug-related factors (e.g., ease of administration, availability, adverse effects, cost).500 501 502 503 504 515

The optimum BP threshold for initiating antihypertensive drug therapy is controversial.501 504 505 506 507 508 515 523 530 Further study needed to determine optimum BP thresholds/goals; individualize treatment decisions.501 503 507 515 526 530

JNC 7 recommends initiation of drug therapy in all patients with uncomplicated hypertension and BP ≥140/90 mm Hg;500 JNC 8 panel recommends SBP threshold of 150 mm Hg for patients ≥60 years of age.501 Although many experts agree that SBP goal of <150 mm Hg may be appropriate for patients ≥80 years of age,502 504 505 530 application of this goal to those ≥60 years of age is controversial, especially for those at higher cardiovascular risk.501 502 505 506 508 511 515

In the past, initial antihypertensive drug therapy was recommended for patients with diabetes mellitus or chronic kidney disease who had BP ≥130/80 mm Hg;500 503 current hypertension management guidelines generally recommend a BP threshold of 140/90 mm Hg for these individuals (same as for the general population of patients without these conditions), although a goal of <130/80 mm Hg may still be considered.501 502 503 504 520 530 535 536 541

Black hypertensive patients generally tend to respond better to monotherapy with thiazide diuretics or calcium-channel blockers than to other antihypertensive drug classes (e.g., ACE inhibitors, angiotensin II receptor antagonists).82 200 500 501 504 However, diminished response to these other drug classes is largely eliminated when administered concomitantly with a thiazide diuretic or calcium-channel blocker.500 504

Thiazide-like diuretics may be preferred in hypertensive patients with osteoporosis. Secondary beneficial effect in hypertensive geriatric patients of reducing the risk of osteoporosis secondary to effect on calcium homeostasis and bone mineralization.

Edema in Heart Failure

Management of edema and salt retention associated with heart failure.21 24 29 39 83

Most experts state that all patients with symptomatic heart failure who have evidence for, or a history of, fluid retention generally should receive diuretic therapy in conjunction with moderate sodium restriction, an agent to inhibit the renin-angiotensin-aldosterone (RAA) system (e.g., ACE inhibitor, angiotensin II receptor antagonist, angiotensin receptor-neprilysin inhibitor [ARNI]), a β-adrenergic blocking agent (β-blocker), and in selected patients, an aldosterone antagonist.524 700 713

Diuretics produce rapid symptomatic benefits, relieving pulmonary and peripheral edema more rapidly (within hours or days) than cardiac glycosides, ACE inhibitors, or β-blockers (in weeks or months).70

Loop diuretics (e.g., bumetanide, ethacrynic acid, furosemide, torsemide) are diuretics of choice for most patients with heart failure.524

Edema in Pregnancy

Diuretics should not be used for routine therapy in pregnant women with mild edema who are otherwise healthy.a

Use of thiazide-like diuretics may be appropriate in the management of edema of pathologic origin during pregnancy when clearly needed; routine use of diuretics in otherwise healthy pregnant women is irrational.21 30

Use of diuretics for the management of edema of physiologic and mechanical origin during pregnancy generally is not warranted.21 30

Dependent edema secondary to restriction of venous return by the expanded uterus should be managed by elevating the lower extremities and/or by wearing support hose; use of diuretics in these pregnant women is inappropriate.21 30

In rare cases when the hypervolemia associated with normal pregnancy results in edema that produces extreme discomfort, a short course of diuretic therapy may provide relief and may be considered when other methods (e.g., decreased sodium intake, increased recumbency) are ineffective.21 30 44

Diuretics will not prevent the development of toxemia, nor is there evidence that diuretics have a beneficial effect on the overall course of established toxemia.21 30

Edema (General)

Management of edema resulting from various causes†.24 29 39

No substantial difference in clinical effects or toxicity of comparable thiazide or thiazide-like diuretics, except metolazone may be more effective in edema with renal impairment.a

Specific Drugs

Storage

Oral

Tight, light-resistant containers at 20–25°C; avoid excessive heat.600

• Antihypertensive
• Diuretic, Thiazide-Related

There are no dosage adjustments provided in the manufacturer's labeling; however, the following adjustments have been recommended:

GFR 10 to 50 mL/minute: 1.25 to 2.5 mg once daily (Golightly 2013)

GFR <10 mL/minute: 1.25 to 2.5 mg once daily (limited data) (Golightly 2013)

Hemodialysis: 1.25 to 2.5 mg once daily (limited data); not dialyzable (Golightly 2013; Acchiardo 1983)

Store at 20°C to 25°C (68°F to 77°F).

Blood pressure (both standing and sitting/supine); serum electrolytes, hepatic function, renal function, uric acid; assess weight, I & O reports daily to determine fluid loss

Consult your pharmacist.

How to use Indapamide Powder

Consult your pharmacist.

Consult your pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Commonly reported side effects of indapamide include: hypokalemia. See below for a comprehensive list of adverse effects.

Indapamide should be used with caution in patients with renal impairment as it may induce azotemia in patients with severe renal insufficiency.