What is indapamide (Indapamide, a thiazide-like diuretic)?

From the Guidelines

Indapamide is a thiazide-like diuretic medication that is primarily used to treat high blood pressure and fluid retention, with a recommended dose of 1.25 to 2.5 mg once daily, as stated in the 2018 guideline by the American College of Cardiology/American Heart Association 1.

Key Points

• Indapamide works by increasing the amount of salt and water removed from the blood through urination, which reduces blood volume and lowers blood pressure.
• It is considered effective for hypertension management with fewer metabolic side effects than traditional thiazide diuretics.
• Patients taking indapamide should be aware of potential side effects including electrolyte imbalances (particularly low potassium), dizziness, headache, and increased blood sugar.
• Regular monitoring of electrolytes and kidney function is recommended while on this medication.
• Indapamide may be prescribed alone or in combination with other blood pressure medications for enhanced effectiveness, as suggested by the 2016 guideline by the Association of Anaesthetists of Great Britain and Ireland and the British Hypertension Society 1.

Important Considerations

• Patients should maintain adequate fluid intake while taking this medication but should consult their healthcare provider before taking it with other medications to avoid potential interactions.
• The 2013 European Society of Hypertension/European Society of Cardiology guideline suggests that diuretics, including indapamide, can be used as a first-line treatment for hypertension, but the choice of diuretic should be individualized based on patient characteristics and comorbidities 1.
• The 2012 European guidelines on cardiovascular disease prevention in clinical practice also support the use of indapamide as an antihypertensive agent, particularly in patients with multiple metabolic risk factors 1.
• The 2007 European guidelines on cardiovascular disease prevention in clinical practice recommend the use of thiazide diuretics, including indapamide, as a first-line treatment for hypertension, but also note that beta-blockers may have a reduced ability to protect against stroke 1.

From the FDA Drug Label

Indapamide is an oral antihypertensive/diuretic. The chemical name of indapamide is 4-Chloro-N-(2-methyl-1-indolinyl)-3-Sulfamoylbenzamide, and its molecular weight is 365.84. Indapamide is the first of a new class of antihypertensive/diuretics, the indolines.

Indapamide is an antihypertensive/diuretic drug, specifically part of a new class called indolines. It is used to treat hypertension and has a unique chemical structure that differs from thiazides 2 2.

From the Research

Definition and Mechanism of Action

• Indapamide is a thiazide-type diuretic agent indicated for the treatment of hypertension and edema 3, 4, 5, 6
• It has a dual mechanism of action: diuretic effect at the level of the distal tubule in the kidney and a direct vascular effect, both of which contribute to the antihypertensive efficacy of the drug 3, 4, 7
• Indapamide shows an alteration in vascular reactivity to calcium and other agonists, suggesting the possibility of a direct vascular effect 3

Pharmacokinetics and Pharmacodynamics

• Indapamide is rapidly and completely absorbed from the gastrointestinal tract, resulting in maximal blood levels in approximately 2.3 hours 3
• Coadministration of indapamide with food or antacids does not reduce bioavailability 3
• Linear proportionality of blood concentration with increasing doses is evident following both single and multiple doses 3
• Indapamide is widely distributed in the body with extensive binding to erythrocytes and plasma proteins (approximately 76%) 3
• Disappearance of indapamide from the blood is biphasic, with a terminal half-life of approximately 16 hours 3

Clinical Efficacy and Safety

• Indapamide has been shown to decrease blood pressure, particularly systolic blood pressure, with 24-h efficacy, allowing a once-daily dosage 4, 7
• It has a favorable metabolic profile and protects against hypertensive target-organ damage in the heart and the kidney 4, 7
• Indapamide is well tolerated and has no adverse impact on glucose and lipid metabolism 7
• It is highly effective in lowering blood pressure, whether given alone or in combination with other antihypertensive agents 4, 7, 6

Comparison with Other Diuretics

• Indapamide is a thiazide-like diuretic, which is longer acting than thiazide-type diuretics 5
• Thiazide-like agents, including indapamide, have been shown to lower cardiovascular events and have a place among the recommended first-line agents to treat hypertension 5
• Indapamide has been compared to other diuretics, such as hydrochlorothiazide and chlorthalidone, and has been found to have similar efficacy and safety profiles 5, 6