What are the differences between indapamide and thiazide diuretics?
- Indapamide and thiazides are diuretics (water pills) used to treat hypertension (high blood pressure) and accumulation of excess fluid (edema), which may result from congestive heart failure.
- Side effects of indapamide and thiazide diuretics that are similar include low blood potassium (hypokalemia), muscle weakness, low blood magnesium (hypomagnesemia), increased uric acid levels in the blood, dizziness, lightheadedness, headache, blurred vision, sexual dysfunction/impotence, and photosensitivity (skin rashes due to sunlight).
- Side effects of indapamide that are different from thiazide diuretics include dehydration, low blood pressure, excessive loss of sodium, increased cholesterol, increased blood glucose, tingling of the extremities, nervousness, rash, fatigue, irritability, and agitation.
- Side effects of thiazide diuretics that are different from indapamide include loss of appetite, itching, and stomach upset.
What are indapamide and thiazide diuretics?
Indapamide is a thiazide diuretic (water pill) used to treat high blood pressure (hypertension). It works by preventing the kidney from reabsorbing (retaining in the body) salt and water that is destined to be eliminated in the urine. This results in increased urine output (diuresis). Indapamide also is thought to reduce the salt in the smooth muscle of the walls of blood vessels. (The salt ultimately is eliminated in the urine.) The loss of salt from the muscle causes the muscle to relax, and the relaxation of the vessels results in reduced blood pressure.
Thiazide diuretics (water pills) are medications used to treat high blood pressure (hypertension) and reduce fluid accumulation in the body. They work by reducing the ability of the kidneys to reabsorb salt and water from the urine and into the body, thereby increasing the production and output of urine (diuresis). Some examples of thiazide diuretics include chlorthalidone (Thalitone), hydrochlorothiazide (Microzide), and methyclothiazide.
Salt and sodium are the same.
What are the side effects of indapamide and thiazide diuretics?
Common adverse side effects of indapamide are dehydration, and hypokalemia (low blood potassium due to elimination of potassium in the urine), which causes abnormal cardiac rhythms The most common symptom associated with hypokalemia is muscle weakness. Patients receiving indapamide may need potassium supplements to prevent hypokalemia. Hypomagnesemia (low blood magnesium) also may occur.
Other important side effects include:
- Low blood pressure
- Excessive loss of sodium (particularly of concern in elderly patients)
- Increased cholesterol (this effect tends to diminish with continued use)
- Increased blood glucose
- Increased uric acid concentrations in the blood
- Blurred vision
- Tingling of the extremities
- Photosensitivity (skin rashes due to sunlight)
Side effects of thiazide diuretics are dose related and include:
- Dizziness and lightheadedness
- Blurred vision
- Loss of appetite
- Stomach upset
Other side effects and adverse reactions include an increased sensitivity to sunlight, therefore avoid prolonged sun exposure.
Owing to their ability to increase the production of urine, these drugs may lower levels in the body of potassium and magnesium which also are present in urine.
Thiazide diuretics may increase uric acid levels in blood.
Like other antihypertensive medications, thiazides cause sexual dysfunction.
What is the dosage of indapamide vs. thiazide diuretics?
Indapamide is taken as a single daily dose, generally in the morning before breakfast. The recommended dose range is 1.25 to 5 mg once daily. It can be taken with or without food. Antacids have no effect on the activity of indapamide.
Thiazide diuretics may come in oral tablet form. For example, Thalitone (chlorthalidone) is a common thiazide diuretic.
The optimal dose of Thalitone varies greatly from patient to patient. For high blood pressure, the recommended dose range is 25 to 100 mg daily. Most patients receive 12.5 to 25 mg daily.
Edema is treated with 50 to 100 mg daily or 100 mg every other day and the maximum dose is 200 mg daily.
Heart failure is treated with 12.5 to 100 mg daily.
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What drugs interact with indapamide and thiazide diuretics?
Like other diuretics, indapamide can cause hypokalemia (low potassium) and hypomagnesemia (low magnesium). These changes can increase the risk of digoxin (Lanoxin) toxicity, possibly resulting in fatal abnormal heart rhythms. Use of amiodarone (Cordarone) and indapamide also can lead to cardiac arrhythmias. The ability of the kidney to eliminate lithium (Lithobid, Eskalith) is decreased in patients receiving diuretics, including indapamide. The use of these two drugs together could result in lithium toxicity.
Thiazide diuretics can lower potassium and magnesium blood levels since they are both eliminated in urine. Low levels of potassium and magnesium in the blood can result in abnormal heart rhythms, particularly in those who are also taking digoxin (Lanoxin) in addition to a thiazide. Thiazide diuretics can increase the risk of lithium (Eskalith, Lithobid) toxicity by reducing the kidney's ability to eliminate lithium in the urine.
Drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin), naproxen (Naprosyn), and nabumetone (Relafen) can reduce the effectiveness of thiazide diuretics in lowering blood pressure because they may reduce the ability of the kidneys to make urine, particularly in patients who have reduced kidney function.
It is not recommended to use thiazide diuretics with dofetilide (Tikosyn), a drug used for treating abnormal heart rhythms, as this may increase the blood levels of dofetilide (Tikosyn) and cause abnormal heart rhythms. Thiazide diuretics can reduce how the body responds to norepinephrine and render norepinephrine less effective.
Are indapamide and thiazide diuretics safe to use while pregnant or breastfeeding?
The use of indapamide in pregnancy has not been well studied. Physicians may elect to use it if its benefits are judged to outweigh its potential risks. The use of indapamide in nursing mothers has not been studied.
Thiazide diuretics including Thalitone (chlorthalidone) cross the placenta and can cause jaundice in the fetus or newborn. Therefore, thiazide diuretics such as Thalitone should not be used during pregnancy unless absolutely necessary.