From the Guidelines
Indapamide can cause several side effects, including low potassium levels (hypokalemia), dizziness, headache, and increased urination, and patients should be aware of these potential side effects before starting treatment. The most recent and highest quality study 1 suggests that thiazide and thiazide-like diuretics, such as indapamide, can cause hypokalemia, which may lead to muscle weakness or cramps. Other common side effects include dizziness, especially when standing up quickly, headache, and increased urination. Some patients may experience gastrointestinal issues like nausea, vomiting, or diarrhea. Less common but more serious side effects include severe allergic reactions (rash, itching, swelling), irregular heartbeat, severe dizziness, fainting, muscle pain or weakness, and signs of kidney problems.
Key Side Effects
- Low potassium levels (hypokalemia)
- Dizziness
- Headache
- Increased urination
- Gastrointestinal issues (nausea, vomiting, diarrhea)
- Severe allergic reactions
- Irregular heartbeat
- Severe dizziness
- Fainting
- Muscle pain or weakness
- Signs of kidney problems
Monitoring and Prevention
Regular blood tests are recommended to monitor electrolyte levels, particularly potassium, as this diuretic works by increasing salt and water excretion through the kidneys, which can disrupt the body's electrolyte balance. Patients should stay hydrated while taking this medication and report any concerning symptoms to their healthcare provider immediately. The study 1 also suggests that the concurrent use of potassium-sparing antihypertensives with thiazides or thiazide-like drugs may modify the risk of hypokalemia in a complex and drug-specific manner.
Clinical Considerations
The guidelines 2 recommend that patient adherence is critical to achieving blood pressure control, and that the simplest treatment regimen should be utilized to establish and maintain persistence. As such, longer-acting drugs that only require once-daily dosing are preferred. Patient education is also a recognized factor in achieving a high level of persistence. The study 3 suggests that thiazide and thiazide-like diuretics, such as indapamide, can adequately lower blood pressure and significantly reduce the risk of cardiovascular morbidity and mortality. However, they may have dyslipidaemic and diabetogenic effects, particularly when used at high doses.
From the FDA Drug Label
The Clinical Adverse Reactions listed in Table 1 represent data from Phase II/III placebo-controlled studies (306 patients given indapamide 1.25 mg). The reactions are arranged into two groups: 1) a cumulative incidence equal to or greater than 5%; 2) a cumulative incidence less than 5%. Reactions are counted regardless of relation to drug. TABLE 1: Adverse Reactions from Studies of 1. 25 mg Incidence ≥ 5% Incidence < 5% BODY AS A WHOLE Headache Asthenia Infection Flu Syndrome Pain Abdominal Pain Back Pain Chest Pain GASTROINTESTINAL SYSTEM Constipation Diarrhea Dyspepsia Nausea METABOLIC SYSTEM Peripheral Edema CENTRAL NERVOUS SYSTEM Nervousness Dizziness Hypertonia RESPIRATORY SYSTEM Cough Rhinitis Pharyngitis Sinusitis SPECIAL SENSES Conjunctivitis OTHER All other clinical adverse reactions occurred at an incidence of < 1%. TABLE 2: Adverse Reactions from Studies of 2. tension, anxiety, irritability, or agitation GASTROINTESTINAL SYSTEM Constipation Nausea Vomiting Diarrhea Gastric irritation Abdominal pain or cramps Anorexia CARDIOVASCULAR SYSTEM Orthostatic hypotension Premature ventricular contractions Irregular heart beat Palpitations GENITOURINARY SYSTEM Frequency of urination Nocturia Polyuria DERMATOLOGIC/HYPERSENSITIVITY Rash Hives Pruritus Vasculitis OTHER Impotence or reduced libido Rhinorrhea Flushing Hyperuricemia Hyperglycemia Hyponatremia Hypochloremia Increase in serum urea nitrogen (BUN) or creatinine Glycosuria Weight loss Dry mouth Tingling of extremities
The side effects of Indapamide (Lozol) include:
- Common side effects: + Headache + Constipation + Diarrhea + Nausea + Dizziness + Peripheral edema
- Less common side effects: + Hypokalemia + Hyperuricemia + Hyperglycemia + Hyponatremia + Hypochloremia + Increase in serum urea nitrogen (BUN) or creatinine + Glycosuria + Weight loss + Dry mouth + Tingling of extremities
- Rare but serious side effects: + Jaundice (intrahepatic cholestatic jaundice) + Hepatitis + Pancreatitis + Abnormal liver function tests + Erythema multiforme + Stevens-Johnson Syndrome + Bullous eruptions + Purpura + Photosensitivity + Fever + Pneumonitis + Anaphylactic reactions + Agranulocytosis + Leukopenia + Thrombocytopenia + Aplastic anemia 4, 5
From the Research
Side Effects of Indapamide (Lozol)
The side effects of Indapamide (Lozol) include:
- Hypokalemia (low potassium levels) 6, 7
- Increased serum uric acid levels 6, 8
- Hyponatremia (low sodium levels) 7
- Hypophosphatemia (low phosphate levels) 7
- Hypocalcemia (low calcium levels) 7
- Dizziness 8
- Fatigue 8
- Seizures (in rare cases) 7
- Rhabdomyolysis (in rare cases) 7
- Acute kidney injury (in rare cases) 7
Effects on Blood Parameters
Indapamide may affect the following blood parameters:
- Decreased potassium levels 6, 9, 7
- Increased uric acid levels 6, 8, 9
- Increased triglyceride levels 8
- Decreased parathyroid hormone (PTH) levels 8
- No effect on glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), noradrenaline, adrenaline 9
- No effect on lipid profiles, glucose metabolism, and biochemical data including serum sodium, chloride, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine 10
Special Considerations
Indapamide should be used with caution in patients with: