Indapamide Dosage and Usage for Hypertension
The recommended starting dose of indapamide for hypertension is 1.25 mg once daily taken in the morning. If blood pressure is not adequately controlled after 4 weeks, the dose may be increased to 2.5 mg once daily, and if necessary, further increased to 5 mg once daily after another 4 weeks. 1
Dosing Schedule and Titration
- Initial dose: 1.25 mg once daily in the morning 1, 2
- If response is inadequate after 4 weeks: Increase to 2.5 mg once daily 1
- If response remains inadequate after another 4 weeks: Increase to 5 mg once daily or consider adding another antihypertensive agent 1
- Doses above 5 mg daily have not shown additional blood pressure-lowering effects but are associated with greater risk of hypokalemia 1
Efficacy and Mechanism of Action
- Indapamide is a thiazide-like diuretic that has demonstrated effective reduction of blood pressure and cardiovascular events 3
- It has a dual mechanism of action: diuretic activity in the distal tubules and direct vascular effects that decrease peripheral vascular resistance 4, 5
- Blood pressure reduction typically begins within 1-2 weeks, reaches 65% of maximum effect by 1 month, and achieves maximum effect after 3-4 months of treatment 4
- Studies show that the lower 1.25 mg dose is as effective as the 2.5 mg dose in maintaining blood pressure control in patients with mild to moderate hypertension 2
Combination Therapy
- Indapamide is recommended as part of first-line treatment for hypertension, often in combination with other agents 3
- Preferred combinations include a RAS blocker (ACE inhibitor or ARB) with indapamide 3
- For patients not controlled on two drugs, a three-drug combination of a RAS blocker, a dihydropyridine calcium channel blocker, and indapamide is recommended 3
- Fixed-dose single-pill combinations containing indapamide are recommended when available to improve adherence 3
Special Considerations
- Indapamide has been successfully used in combination with perindopril for secondary prevention in patients with history of stroke or TIA 3
- In patients with diabetes, indapamide (often with perindopril) has shown cardiovascular benefits 3
- Monitor serum potassium levels, as indapamide may cause hypokalemia, though this effect is less pronounced with the 1.25 mg dose compared to 2.5 mg 2, 4
- Indapamide is generally well-tolerated with minimal metabolic effects on carbohydrate and lipid metabolism compared to traditional thiazide diuretics 4, 6
Administration Tips
- Take medication at the most convenient time of day to establish a habitual pattern and improve adherence 3
- Morning administration is typically recommended 1
- Food or antacids do not significantly affect the bioavailability of indapamide 5
Monitoring
- For patients treated with indapamide, monitor serum creatinine, estimated glomerular filtration rate, and serum potassium levels at least annually 3
- The target blood pressure for most adults should be 120-129 mmHg systolic, provided the treatment is well tolerated 3
Indapamide offers advantages over traditional thiazide diuretics due to its once-daily dosing, good therapeutic effect with prolonged usage, and potentially fewer metabolic side effects 4, 6, 7. Starting with the lower 1.25 mg dose may provide effective blood pressure control while minimizing the risk of electrolyte disturbances.