From the Research
In hyponatremia, indapamide should typically be held until sodium levels normalize, which usually takes 24-72 hours depending on severity, as recommended by the most recent guidelines 1. If indapamide is the suspected cause of hyponatremia, discontinue it immediately and consider alternative antihypertensive medications that don't affect sodium levels. Monitor serum sodium levels daily while holding the medication, with a target correction rate of no more than 8-10 mEq/L in 24 hours to avoid osmotic demyelination syndrome, as supported by studies 2, 3. Fluid restriction may be necessary alongside medication discontinuation. The reason indapamide causes hyponatremia is that it's a thiazide-like diuretic that inhibits sodium reabsorption in the distal tubule while enhancing water retention, leading to dilutional hyponatremia. Some key points to consider in the management of hyponatremia include:
- Identifying and treating the underlying cause of hyponatremia, as emphasized in 1
- Classifying patients according to their fluid volume status, as discussed in 2
- Using vasopressin receptor antagonists as a promising treatment for hyponatremia, as highlighted in 4 Once sodium levels have normalized and stabilized, your healthcare provider may consider restarting indapamide at a lower dose with close monitoring, or more likely, switch to an alternative antihypertensive medication with less risk of electrolyte disturbances. It's essential to prioritize the patient's safety and avoid overly rapid correction of sodium levels, which can lead to severe neurological complications, as warned against in 5.