INDAPAMIDE

INDAPAMIDE (in-dap'a-mide) Lozide , Lozol Classifications: electrolytic and water balance agent; thiazide diuretic; Therapeutic: thiazide diuretic Prototype: Hydrochlorothiazide Pregnancy Category: B

Availability

1.25, 2.5 mg tablets

Action

Sulfonamide derivative which has both diuretic and direct vascular effects. Action mechanism is similar to that of the thiazide diuretics. Principal site of action is on the proximal portion of the distal renal tubules. Enhances excretion of sodium, potassium, and water by interfering with sodium transfer across renal epithelium of the tubules.

Therapeutic Effect

Hypotensive activity appears to result from a decrease in plasma and extracellular fluid volume, decreased peripheral vascular resistance, direct arteriolar dilation, and calcium channel blockade.

Uses

Alone or with other antihypertensives in the management of hypertension in patients who have failed to respond to diet, exercise, or weight reduction.

Unlabeled Uses

Edema associated with CHF.

Contraindications

Hypersensitivity to indapamide or other sulfonamide derivatives, anuria, renal failure.

Cautious Use

Electrolyte imbalance, hypokalemia, severe renal disease; impaired hepatic function or progressive liver disease; prediabetic and type II diabetic patient, hyperparathyroidism, thyroid disorders; SLE; sympathectomized patient; history of gout; pregnancy (category B), lactation. Safe use in children is not established.

Route & Dosage

Hypertension, Edema Adult: PO 2.5 mg once/d, may increase to 5 mg/d if needed

Administration

Oral

• Give with food or milk to reduce GI irritation.
• Administer in a.m. to prevent nocturia. Urge patient to take at least 240 mL (8 oz) of fluid (if allowed) with the medication.
• Store in tight, light-resistant container unless otherwise directed.

Adverse Effects (≥1%)

CNS: Headache, dizziness, fatigue, weakness, muscle cramps or spasm, paresthesia, tension, anxiety, nervousness, agitation, vertigo, insomnia, mental depression, blurred vision, drowsiness. CV: Orthostatic hypotension, PVCs, dysrhythmias, flushing, palpitation. GI: Dry mouth, anorexia, nausea, vomiting, diarrhea, constipation, abdominal cramps or pain. Urogenital: Urinary frequency, nocturia, polyuria, glycosuria, impotence or reduced libido. Skin: Rash, hives, pruritus, vasculitis, photosensitivity. Metabolic: Dilutional hyponatremia, hyperuricemia, exacerbation of gout; hypokalemia, hyperglycemia, hypochloremia, hypercalcemia, increased BUN or creatinine, weight loss, exacerbation of SLE; increased cholesterol.

Diagnostic Test Interference

Since indapamide may cause hypercalcemia (and hypophosphatemia), it is generally withheld before tests for parathyroid function are performed.

Interactions

Drug: Effects of diazoxide and indapamide intensified; increased risk of digoxin toxicity with hypokalemia; decreased renal lithium clearance may increase risk of lithium toxicity.

Pharmacokinetics

Absorption: Readily from GI tract. Peak: 2–2.5 h. Duration: Up to 36 h. Metabolism: In liver. Elimination: 60% in urine; 16–23% in feces. Half-Life: 14–18 h.

Nursing Implications

Assessment & Drug Effects

• Monitor BP periodically throughout therapy.
• Lab tests: Obtain baseline and periodic BUN, serum creatinine, uric acid, blood glucose, serum electrolytes, and fluid balance.
• Monitor for digitalis toxicity with concurrent therapy.
• Note: Electrolyte imbalances may be clinically serious with protracted vomiting and diarrhea, excessive sweating, GI drainage, and paracentesis.
• Report promptly signs of hyponatremia or hypokalemia (see Appendix F).
• Monitor diabetics for loss of glycemic control.

Patient & Family Education

• Notify physician of decreased urine output, dizziness, weakness or muscle cramps, nausea, jaundice, or blurred vision.
• Take precautions from sun exposure because of risk of photosensitivity.
• Record weight at least every other day; inspect ankles and legs for edema. Report unexplained, progressive weight gain [e.g., 1–1.5 kg (2–3 lb) in 2–3 d].

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug