indapamide
{{Short description|Thiazide-like diuretic drug}}
{{Drugbox
| Watchedfields = changed
| verifiedrevid = 458622562
| image = Indapamide.svg
| width = 192
| alt =
| tradename = Lozol, Natrilix
| Drugs.com = {{drugs.com|monograph|indapamide}}
| MedlinePlus = a684062
| pregnancy_AU = C
| pregnancy_category =
| routes_of_administration = By mouth
| ATC_prefix = C03
| ATC_suffix = BA11
| ATC_supplemental =
| legal_UK = POM
| legal_EU = Rx-only
| bioavailability =
| protein_bound = 71–79%
| metabolism = Liver
| elimination_half-life = standard release: 14–18 hours,{{Cite web |title=Indapamide 2.5mg Tablets - Summary of Product Characteristics (SmPC) - (emc) |url=https://www.medicines.org.uk/emc/product/9470/smpc |access-date=2024-06-03 |website=www.medicines.org.uk}} slow release: 14–24 hours (mean 18){{Cite web |title=Natrilix SR 1.5 mg Tablets - Summary of Product Characteristics (SmPC) - (emc) |url=https://www.medicines.org.uk/emc/product/1152/smpc#gref |access-date=2024-06-03 |website=www.medicines.org.uk}}
| IUPHAR_ligand = 7203
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 26807-65-8
| PubChem = 3702
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00808
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 3574
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = F089I0511L
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00345
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 406
| C=16 | H=16 | Cl=1 | N=3 | O=3 | S=1
| smiles = O=S(=O)(N)c1c(Cl)ccc(c1)C(=O)NN3c2ccccc2CC3C
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 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)
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = NDDAHWYSQHTHNT-UHFFFAOYSA-N
}}
Indapamide is a thiazide-like diuretic{{MeshName|Indapamide}} drug used in the treatment of hypertension, as well as decompensated heart failure. Combination preparations with perindopril (an ACE inhibitor antihypertensive) are available. The thiazide-like diuretics (indapamide and chlorthalidone) reduce risk of major cardiovascular events and heart failure in hypertensive patients compared with hydrochlorothiazide with a comparable incidence of adverse events.{{cite journal | vauthors = Olde Engberink RH, Frenkel WJ, van den Bogaard B, Brewster LM, Vogt L, van den Born BJ | title = Effects of thiazide-type and thiazide-like diuretics on cardiovascular events and mortality: systematic review and meta-analysis | journal = Hypertension | volume = 65 | issue = 5 | pages = 1033–1040 | date = May 2015 | pmid = 25733241 | doi = 10.1161/HYPERTENSIONAHA.114.05122 | doi-access = free }} Both thiazide diuretics and thiazide-like diuretics are effective in reducing risk of stroke.{{cite journal | vauthors = | title = Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party | journal = BMJ | volume = 304 | issue = 6824 | pages = 405–412 | date = February 1992 | pmid = 1445513 | pmc = 1995577 | doi = 10.1136/bmj.304.6824.405 }}{{cite journal | vauthors = Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, Banya W, Bulpitt CJ | display-authors = 6 | title = Treatment of hypertension in patients 80 years of age or older | journal = The New England Journal of Medicine | volume = 358 | issue = 18 | pages = 1887–1898 | date = May 2008 | pmid = 18378519 | doi = 10.1056/NEJMoa0801369 | doi-access = free }} Both drug classes appear to have comparable rates of adverse effects as other antihypertensives such as angiotensin II receptor blockers and dihydropyridine calcium channel blockers and lesser prevalence of side-effects when compared to ACE-inhibitors and non-dihydropyridine calcium channel blockers.{{cite journal | vauthors = Suchard MA, Schuemie MJ, Krumholz HM, You SC, Chen R, Pratt N, Reich CG, Duke J, Madigan D, Hripcsak G, Ryan PB | display-authors = 6 | title = Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis | journal = Lancet | volume = 394 | issue = 10211 | pages = 1816–1826 | date = November 2019 | pmid = 31668726 | pmc = 6924620 | doi = 10.1016/s0140-6736(19)32317-7 }}
It was patented in 1968 and approved for medical use in 1977.{{cite book | vauthors = Fischer J, Ganellin CR |title=Analogue-based Drug Discovery |date=2006 |publisher=John Wiley & Sons |isbn=9783527607495 |page=457 |url=https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA457 |language=en}} It is on the World Health Organization's List of Essential Medicines.{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 22nd list (2021) | year = 2021 | hdl = 10665/345533 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2021.02 | hdl-access=free }}
Medical uses
Its indications include hypertension and edema due to congestive heart failure. Indapamide has been shown to reduce stroke rates in people with high blood pressure.{{cite journal | vauthors = Liu L, Wang Z, Gong L, Zhang Y, Thijs L, Staessen JA, Wang J | title = Blood pressure reduction for the secondary prevention of stroke: a Chinese trial and a systematic review of the literature | journal = Hypertension Research | volume = 32 | issue = 11 | pages = 1032–1040 | date = November 2009 | pmid = 19798097 | doi = 10.1038/hr.2009.139 | doi-access = free }}{{cite journal | vauthors = ((PROGRESS Collaborative Group)) | title = Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack | journal = Lancet | volume = 358 | issue = 9287 | pages = 1033–1041 | date = September 2001 | pmid = 11589932 | doi = 10.1016/s0140-6736(01)06178-5 | s2cid = 10053225 }} Studies have shown that the blood pressure lowering effects of indapamide in combination with perindopril reduce the rate of stroke in high risk patients (those with a history of high blood pressure, stroke or type two diabetes).{{cite journal | vauthors = Patel A, MacMahon S, Chalmers J, Neal B, Woodward M, Billot L, Harrap S, Poulter N, Marre M, Cooper M, Glasziou P, Grobbee DE, Hamet P, Heller S, Liu LS, Mancia G, Mogensen CE, Pan CY, Rodgers A, Williams B | display-authors = 6 | title = Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial | journal = Lancet | volume = 370 | issue = 9590 | pages = 829–840 | date = September 2007 | pmid = 17765963 | doi = 10.1016/s0140-6736(07)61303-8 | s2cid = 21153924 }} HYVET study showed that indapamide (sustained release), with or without perindopril as antihypertensive treatment in persons 80 years of age or older with sustained systolic blood pressure of 160 mmHg or higher, demonstrated significant reduction in all-cause mortality when treated to a target of 150/80 mmHg, but there was found to be no significant reduction in risk of death from cardiac causes. Two systematic reviews identified that indapamide with or without perindopril significantly reduced all cause mortality in young-elderly patients with a history of stroke, cardiovascular disease and type 2 diabetes mellitus, when greater reductions in mean office blood pressure are achieved, significant cardiovascular benefit was only observed when trials including the >75 years old cohort was included.{{cite journal | vauthors = Olde Engberink RH, Frenkel WJ, van den Bogaard B, Brewster LM, Vogt L, van den Born BJ | title = Effects of thiazide-type and thiazide-like diuretics on cardiovascular events and mortality: systematic review and meta-analysis | journal = Hypertension | volume = 65 | issue = 5 | pages = 1033–1040 | date = May 2015 | pmid = 25733241 | doi = 10.1161/HYPERTENSIONAHA.114.05122 | doi-access = free }}{{Cite journal| vauthors = Chalmers J, Mourad JJ, De Champvallins M, Mancia G |title=Benefit of Indapamide-Based Treatment on Mortality|date=July 2019|journal=Journal of Hypertension|language=en-US|volume=37|pages=e57|doi=10.1097/01.hjh.0000570928.33807.a8|issn=0263-6352|doi-access=free}}
Contraindications
Indapamide is contraindicated in known hypersensitivity to sulfonamides, severe kidney failure, hepatic encephalopathy or severe liver failure, and a low blood potassium level.{{cn|date=May 2024}}
There is insufficient safety data to recommend indapamide use in pregnancy or breastfeeding.{{cn|date=May 2024}}
Adverse effects
Commonly reported adverse events 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 (i.e.: astemizole, bepridil, IV erythromycin, halofantrine, pentamidine, sultopride, terfenadine, and vincamine).
Overdose
Symptoms of over dosage would be those associated with a diuretic effect (i.e. electrolyte disturbances), low blood pressure, and muscular weakness. Treatment should be symptomatic, directed at correcting electrolyte abnormalities.
See also
References
{{reflist}}
External links
- {{cite web | url = https://druginfo.nlm.nih.gov/drugportal/name/indapamide | publisher = U.S. National Library of Medicine | work = Drug Information Portal | title = Indapamide }}
{{Diuretics}}
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