indapamide
Brand: Lozol
Prototype: hydrochlorothiazide
Drug Class: thiazide-like diuretic
Drug Family: diuretic
Subclass: indoline thiazide-like diuretic
Organ Systems: cardiovascular
Mechanism of Action
Thiazide-like diuretic with additional vasodilatory properties; maintains efficacy in mild-moderate CKD better than HCTZ.
NCC cotransporter
Indications
- hypertension
- edema
Contraindications
- anuria
- sulfonamide allergy
Adverse Effects
Common
- hypokalemia
- headache
- dizziness
Serious
- severe electrolyte disturbances
- QT prolongation
Pharmacokinetics (ADME)
| Absorption | 93% oral |
| Distribution | large Vd |
| Metabolism | extensive hepatic CYP3A4 |
| Excretion | renal 60% |
| Half-life | ~14 hours |
| Onset | ~2 hours |
| Peak | ~2 hours |
| Duration | 24 hours |
| Protein Binding | 75% |
| Vd | 25 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| digoxin | hypokalemia → toxicity | major |
Nursing Considerations
- Monitor K+; QT prolongation risk
- Has vasodilatory properties reducing peripheral resistance beyond diuresis
- Maintains efficacy at lower GFR than HCTZ
Clinical Pearls
- Has calcium channel blocking activity in addition to NCC inhibition
- Active in mild CKD (GFR 30-60) unlike HCTZ
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
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