Lozol


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Related to Lozol: Zebeta

indapamide

Apo-Indapamide (CA), Dom-Indapamide (CA), Gen-Indapamide (CA), Lozide (CA), Lozol, Natrilix (UK), Nindaxa (UK), Novo-Indapamide (CA), Nu-Indapamide (CA), PHL-Indapamide (CA), PMS-Indapamide (CA), Riva-Indapamide (CA)

Pharmacologic class: Thiazide-like diuretic

Therapeutic class: Diuretic, antihypertensive

Pregnancy risk category B

Action

Increases sodium and water excretion by inhibiting sodium reabsorption in distal tubule; enhances excretion of sodium, chloride, potassium, and water. May cause arteriolar vasodilation.

Availability

Tablets: 1.25 mg, 2.5 mg

Indications and dosages

Edema caused by heart failure

Adults: 2.5 mg P.O. daily in morning. After 1 week, may increase to 5 mg/day.

Mild to moderate hypertension

Adults: 1.25 mg P.O. daily in morning. May increase q 4 weeks, up to 5 mg/day.

Contraindications

• Hypersensitivity to drug, other thiazide-like drugs, or tartrazine
• Anuria

Precautions

Use cautiously in:
• renal or severe hepatic impairment, ascites, fluid or electrolyte imbalances, gout, systemic lupus erythematosus, impaired glucose tolerance, hyperparathyroidism, bipolar disorder
• pregnant or breastfeeding patients.

Administration

• Administer with food or milk to reduce GI upset.
• Give early in day to avoid nocturia.

Adverse reactions

CNS: dizziness, light-headedness, headache, restlessness, insomnia, lethargy, fatigue, drowsiness, asthenia, depression, anxiety, nervousness, paresthesia, irritability, agitation

CV: orthostatic hypotension, palpitations, premature ventricular contractions, arrhythmias

EENT: blurred vision, rhinorrhea

GI: nausea, vomiting, diarrhea, constipation, bloating, epigastric distress, gastric irritation, abdominal pain or cramps, dry mouth, anorexia

GU: nocturia, polyuria, glycosuria, erectile dysfunction

Metabolic: dehydration, gout, hyperglycemia, hypokalemia, hypocalcemia, hypomagnesemia, hyponatremia, hypovolemia, hypophosphatemia, hyperuricemia, hypochloremic alkalosis

Musculoskeletal: muscle cramps and spasms

Skin: flushing, rash, urticaria, pruritus, photosensitivity, cutaneous vasculitis, necrotizing vasculitis

Other: weight loss

Interactions

Drug-drug.Amphotericin B, corticosteroids: additive hypokalemia

Antihypertensives, nitrates: additive hypotension

Cholestyramine, colestipol: decreased indapamide absorption

Lithium: decreased lithium excretion, increased risk of lithium toxicity

Sulfonylureas: decreased hypoglycemic efficacy

Drug-diagnostic tests.Bilirubin, blood and urine glucose (in diabetic patients), blood urea nitrogen (BUN), calcium, creatinine, uric acid: increased values Cholesterol, low-density lipoproteins, magnesium, potassium, protein-bound iodine, sodium, triglycerides, urinary calcium: decreased values

Drug-herbs.Ginkgo: decreased antihypertensive effect

Licorice, stimulant laxative herbs (aloe, cascara sagrada, senna): increased risk of hypokalemia

Drug-behaviors.Acute alcohol ingestion: additive hypotension

Sun exposure: increased risk of photosensitivity

Patient monitoring

Assess for signs and symptoms of hypokalemia, including ventricular arrhythmias, muscle weakness, and cramping.
• Monitor BUN, creatinine, and electrolyte levels.
• Assess daily weight and fluid intake and output.
• Monitor blood pressure response to drug.
• Watch for signs and symptoms of orthostatic hypotension.

Patient teaching

• Advise patient to consume potassium-rich foods, such as oranges, bananas, potatoes, and spinach.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.
• Tell patient to weigh himself daily on same scale at same time of day while wearing similar clothing. Instruct him to report gain of more than 2 lb (0.9 kg) in 1 day or 5 lb (2.2 kg) in 1 week.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

indapamide

(in-dap-a-mide) ,

Lozol

(trade name),

Lozide

(trade name)

Classification

Therapeutic: antihypertensives
Pharmacologic: thiazide like diuretics
Pregnancy Category: B

Indications

Mild to moderate hypertension.Edema associated with HF and other causes.

Action

Increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule.
Promotes excretion of chloride, potassium, magnesium, and bicarbonate.
May produce arteriolar dilation.

Therapeutic effects

Lowering of BP in hypertensive patients and diuresis with subsequent mobilization of edema.

Pharmacokinetics

Absorption: Well absorbed from the GI tract after oral administration.
Distribution: Widely distributed.
Metabolism and Excretion: Mostly metabolized by the liver. Small amounts (7%) excreted unchanged by the kidneys.
Half-life: 14–18 hr.

Time/action profile (antihypertensive effect)

ROUTEONSETPEAKDURATION
PO (single dose)unknown24 hrunknown
PO (multiple dose)1–2 wk8–12 wkup to 8 wk

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Cross-sensitivity with sulfonamides may occur; Anuria.
Use Cautiously in: Renal or severe hepatic impairment; Lactation: May be taken while breastfeeding although higher doses followed by significant diuresis may ↓ milk production; Pediatric: Safety not established; Geriatric: ↑ sensitivity to drug effects.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • drowsiness
  • lethargy

Cardiovascular

  • arrhythmias
  • hypotension

Gastrointestinal

  • anorexia
  • cramping
  • nausea
  • vomiting

Dermatologic

  • photosensitivity
  • rashes

Endocrinologic

  • hyperglycemia

Fluid and Electrolyte

  • hypokalemia (most frequent)
  • dehydration
  • hypochloremic alkalosis
  • hyponatremia
  • hypovolemia

Metabolic

  • hyperuricemia (most frequent)

Musculoskeletal

  • muscle cramps

Interactions

Drug-Drug interaction

Additive hypotension with other antihypertensives, nitrates, or acute ingestion of alcohol.Additive hypokalemia with corticosteroids, amphotericin B, piperacillin, or ticarcillin.↓ excretion of lithium ; may cause toxicity.Hypokalemia may ↑ risk of digoxin toxicity.Licorice and stimulant laxative herbs (aloe, senna) may ↑ risk of potassium depletion.

Route/Dosage

Oral (Adults) Hypertension—1.25–5 mg once daily in the morning; may be ↑ at 4-wk intervals up to 5 mg/day. Edema secondary to HF—2.5 mg once daily in the morning; may be ↑ after 1 wk to 5 mg/day.

Availability (generic available)

Tablets: 1.25 mg, 2.5 mg

Nursing implications

Nursing assessment

  • Monitor BP, intake and output, and daily weight and assess feet, legs, and sacral area for edema daily.
  • Assess patient, especially if taking digoxin, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion; report signs of electrolyte imbalance. Patients taking digoxin have an increased risk of digitalis toxicity due to the potassium-depleting effect of the diuretic.
  • Assess patient for allergy to sulfonamides.
  • Lab Test Considerations: Monitor electrolytes (especially potassium), blood glucose, BUN, serum creatinine, and uric acid levels periodically during therapy. May cause ↓ potassium, sodium, and chloride concentrations. May ↑ serum glucose; diabetic patients may require ↑ oral hypoglycemic or insulin dose. ↑ uric acid level an average of 1.0 mg/100 mL; may precipitate an episode of gout.

Potential Nursing Diagnoses

Excess fluid volume (Indications)
Risk for deficient fluid volume (Side Effects)

Implementation

  • Administer in the morning to prevent disruption of sleep cycle.
  • Oral: May be given with food or milk to minimize GI irritation.

Patient/Family Teaching

  • Instruct patient to take this medication at the same time each day. Take missed doses as soon as remembered but not just before next dose is due. Do not double doses. Advise patients using indapamide for hypertension to continue taking the medication even if feeling well. Indapamide controls but does not cure hypertension.
    • Caution patient to change positions slowly to minimize orthostatic hypotension. This may be potentiated by alcohol.
    • Advise patient to use sunscreen (avoid those containing PABA) and protective clothing when in the sun to prevent photosensitivity reactions.
    • Instruct patient to follow a diet high in potassium (see ).
    • Advise patient to report muscle weakness, cramps, nausea, or dizziness to health care professional.
    • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products,.
    • Emphasize the importance of routine follow-up exams.
  • Hypertension: Instruct patient and family on proper technique of BP monitoring. Advise them to check BP at least weekly and to report significant changes.
    • Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, regular exercise, smoking cessation, moderation of alcohol consumption, and stress management).

Evaluation/Desired Outcomes

  • Control of hypertension.
  • Decrease in edema secondary to HF.

Lozol

(lō′zôl′)
A trademark for the drug indapamide.