Indapamide

A to Z Drug Facts

Indapamide

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(IN-DAP-uh-mide)

Lozol, Apo-Indapamide, Novo-Indapamide, Nu-Indapamide

Class: Thiazide diuretic

Action Enhances excretion of sodium, chloride, and water by interfering with transport of sodium ions across renal tubular epithelium.

Indications Treatment of edema associated with CHF, hepatic cirrhosis, renal dysfunction, and corticosteroid or estrogen therapy; management of hypertension. Unlabeled use(s): Treatment of calcium nephrolithiasis, osteoporosis, or diabetes insipidus.

Contraindications Hypersensitivity to thiazides, related diuretics, or sulfonamide-derived drugs; anuria.

Route/Dosage

ADULTS: PO 1.25 to 5 mg q morning. Maximum 5 mg/day.

Interactions

Bile acid sequestrants: May reduce thiazide absorption; give thiazide ³ 2 hr before resin. Diazoxide: Hyperglycemia may occur. Digitalis glycosides: Diuretic-induced hypokalemia and hypomagnesemia may precipitate digitalis-induced arrhythmias. Lithium: May decrease renal excretion of lithium; monitor lithium levels. Loop diuretics: May result in synergistic effects and result in profound diuresis and serious electrolyte abnormalities. Sulfonylureas, insulin: May decrease hypoglycemic effect of sulfonylureas. May need to adjust dosage of sulfonylureas or insulin.

Lab Test Interferences May decrease serum protein-bound iodine levels without signs of thyroid disturbance. May cause diagnostic interference of serum electrolyte levels, blood and urine glucose levels, serum bilirubin levels and serum uric acid levels. May increase serum magnesium levels in uremic patients.

Adverse Reactions

CV: Orthostatic hypotension; palpitations. CNS: Dizziness; lightheadedness; vertigo; headache; weakness; restlessness; insomnia; drowsiness; fatigue; lethargy; anxiety; depression; nervousness. DERM: Rash; necrotizing angiitis; vasculitis; cutaneous vasculitis; pruritus. EENT: Blurred vision. GI: Anorexia; gastric irritation; epigastric distress; nausea; vomiting; abdominal pain/cramping/bloating; diarrhea; constipation; dry mouth. GU: Nocturia; impotence/reduced libido. HEMA: Neutropenia. META: Hyperglycemia; glycosuria; hyperuricemia. RESP: Rhinorrhea. OTHER: Muscle cramp or spasm; acute gout.

Precautions

Pregnancy: Category B. Lactation: May be excreted in breast milk. Hypersensitivity: May occur in patients with or without history of allergy or bronchial asthma; cross-sensitivity with sulfonamides may also occur. Electrolyte balance: Severe hyponatremia and hypokalemia may infrequently occur with recommended doses; more common in elderly females. Hepatic impairment: Minor alterations of fluid and electrolyte balance may precipitate hepatic coma; use with caution. Lipids: May cause increased concentrations of total triglycerides and LDL in some patients. Lupus erythematosus: Exacerbation or activation may occur. Postsympathectomy patients: Antihypertensive effects may be enhanced. Renal impairment: May precipitate azotemia; use with caution.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer as morning dose to prevent nocturia.
Give with food or milk if nausea occurs.
Store in tightly closed, light-resistant container at room temperature.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Weigh patient daily.
Assess feet, legs, and sacral area for edema daily.
Measure I&O throughout therapy.
Monitor BP, with patient lying and standing.
Monitor renal function (nonprotein nitrogen, BUN, creatinine, glomerular filtration) and serum potassium, sodium, calcium, magnesium, blood pH, and uric acid as ordered.
Assess for signs of metabolic alkalosis and hypokalemia.
Report to physician signs of renal dysfunction (eg, anuria, oliguria); liver dysfunction (eg, dark urine, jaundice, pruritus); gout (eg, rising serum uric acid, joint pain); muscle weakness; cramps, nausea; dizziness; numbness; irregular heartbeat; irritability.

OVERDOSAGE: SIGNS & SYMPTOMS
	Orthostatic or general hypotension, syncope, electrolyte abnormalities, potassium deficiency, vomiting, respiratory depression, lethargy, shock, weakness, confusion, dizziness, cramps of calf muscles, thirst, polyuria, anuria

Patient/Family Education

Tell patient to take medication early in day to prevent sleep problems.
Instruct patient to take drug with food or milk to minimize GI irritation.
Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
Instruct patients with diabetes to report increased blood glucose levels.
Caution patients to avoid sudden position changes to prevent orthostatic hypotension.
Advise patients to include in diet foods that are high in potassium (eg, bananas, broccoli, dried fruits, grapefruit, lima beans, nuts, oranges).
Tell patient to report decrease in urinary output, jaundice, muscle cramps, weakness, nausea, blurred vision, or dizziness.
For patients being treated for hypertension, explain benefits of weight reduction, exercise, reduction of alcohol and sodium intake, cessation of smoking.