Indapamide

Overview
Indapamide is a non-thiazide sulphonamide diuretic drug marketed by Servier, generally used in the treatment of hypertension and edema caused by congestive heart failure. Indapamide is marketed as Natrilix SR (sustained release). Combination preparations with perindopril (an ACE inhibitor antihypertensive) are also available.

Form and composition
Each sustained-release coated tablet contains 1.5 mg of 1-(4-chloro-3-sulfamyl-benzamido)-2-methylindoline (or indapamide hemihydrate).

Indications
Essential hypertension.

Dosage and administration
One tablet daily.

Contraindications
Indapamide is contraindicated in known hypersensitivity to sulfonamides, severe renal failure, hepatic encephalopathy or severe hepatic failure and hypokalemia (low blood potassium levels).

There is insufficient safety data to recommend indapamide use in pregnancy or breastfeeding.

Interactions
Caution is advised in the combination of indapamide with lithium and nonantiarrhythmic drugs causing wave burst arrhythmia (astemizole, bepridil, IV erythromycin, halofantrine, pentamidine, sultopride, terfenadine, vincamine).

Precautions
Monitoring of potassium and uric acid serum levels is recommended, especially in subjects with a predisposition or a sensitivity to hypokalemia and in patients with gout.

Adverse effects
Commonly reported adverse events are hypokalemia (low potassium levels), fatigue, orthostatic hypotension (blood pressure decrease on standing up) and allergic manifestations.

Overdosage
Symptoms of overdosage would be those associated with a diuretic effect: electrolyte disturbances, hypotension, and muscular weakness. Treatment should be symptomatic, directed at correcting the electrolyte abnormalities.

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