From the Guidelines
The equivalent dose of indapamide to chlorthalidone 25 mg is approximately 2.5 mg of indapamide. When switching between these thiazide-like diuretics, this conversion is generally accepted in clinical practice 1. Indapamide is more potent on a milligram-per-milligram basis compared to chlorthalidone, which is why a lower dose is needed to achieve similar effects. Both medications work by inhibiting sodium and chloride reabsorption in the distal tubules of the kidney, leading to increased urine output and reduced blood pressure. However, they have slightly different pharmacokinetic profiles, with indapamide having a longer half-life than many other thiazide diuretics.
Some key points to consider when making this substitution include:
- Monitoring blood pressure and electrolytes (particularly potassium, sodium, and magnesium) after switching, as individual patient responses may vary 1.
- Indapamide may have a more favorable metabolic profile with potentially less impact on glucose and lipid metabolism compared to some other thiazide diuretics, which might be beneficial for certain patients, particularly those with diabetes or metabolic syndrome 1.
- Using indapamide with caution in patients with a history of acute gout, unless the patient is on uric acid–lowering therapy 1.
- Being aware of the potential for hyponatremia and hypokalemia, as well as changes in uric acid and calcium levels, when using either chlorthalidone or indapamide 1.
Overall, the decision to switch between chlorthalidone and indapamide should be based on individual patient needs and responses, with careful monitoring and adjustment as necessary to optimize blood pressure control and minimize potential side effects.
From the Research
Equivalent Dose of Indapamide to Chlorthalidone 25 mg
- The equivalent dose of indapamide to chlorthalidone 25 mg is not directly stated in the provided studies.
- However, a study from 1975 2 compared the hypotensive activity of 5 mg indapamide daily with 100 mg chlorthalidone daily, suggesting that indapamide may be more potent than chlorthalidone.
- Another study from 2014 3 compared the effects of indapamide 1.5 mg Slow Release (SR)/day with hydrochlorothiazide 25 mg/d, but did not provide a direct comparison with chlorthalidone 25 mg.
- There is no direct evidence to support a specific equivalent dose of indapamide to chlorthalidone 25 mg, and further studies would be needed to determine this equivalence.
Available Comparisons
- A study from 1975 2 compared 5 mg indapamide with 100 mg chlorthalidone, which suggests a ratio of 1:20 between indapamide and chlorthalidone.
- Using this ratio, the equivalent dose of indapamide to chlorthalidone 25 mg would be approximately 1.25 mg indapamide, but this is highly speculative and not directly supported by the evidence.
- Further studies are needed to determine the equivalent dose of indapamide to chlorthalidone 25 mg, as the available evidence does not provide a clear answer.