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Pharmacologic class: Thiazide-like diuretic
Therapeutic class: Diuretic, antihypertensive
Pregnancy risk category B
Increases sodium and water excretion by inhibiting sodium reabsorption in distal tubule; enhances excretion of sodium, chloride, potassium, and water. May cause arteriolar vasodilation.
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.
• Hypersensitivity to drug, other thiazide-like drugs, or tartrazine
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.
• Administer with food or milk to reduce GI upset.
• Give early in day to avoid nocturia.
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
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
☞ 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.
• 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.