Indapamide

What is indapamide?

Indapamide is a type of medicine called a diuretic that is used to treat high blood pressure. It can also be used to reduce the build-up of fluid in the body caused by heart failure.

How does indapamide work?

Indapamide works by increasing the body's production of urine, allowing it to flush out excess fluids and salts. This helps to reduce blood pressure and other symptoms like swollen ankles and shortness of breath.

How long does indapamide take to work?

Indapamide will start to work within two hours but it will usually take a week for it to have a noticeable effect on your blood pressure, and up to 12 weeks for full effect. High blood pressure does not usually cause symptoms so you may not feel any different after taking indapamide. This does not mean that the medication isn't working.

What are the risks of having high blood pressure?

High blood pressure, also known as hypertension, puts additional strain on your heart, blood vessels and organs, making it harder for blood to be pumped around the body. This can increase your risk of experiencing serious conditions like: 

• Heart disease 
• Heart attacks 
• Strokes 
• Heart failure 
• Peripheral arterial disease 
• Aortic aneurysms 
• Kidney disease 
• Vascular dementia 

Taking medication to get your blood pressure under control will lower your risk of experiencing any of these conditions.

What causes high blood pressure?

There are a number of factors that can contribute to developing high blood pressure. These include: 

• Being overweight 
• Smoking 
• Having a family history of high blood pressure 
• Being over the age of 65 
• People of African or Caribbean origin 
• Eating too much salt 
• Not eating enough fruit or vegetables 
• Lack of exercise 
• Drinking too much alcohol or caffeine-based drinks 
• Poor quality of sleep 

 Underlying health conditions can trigger high blood pressure: 

• Kidney disease 
• Kidney infections
• Diabetes 
• Obstructive sleep apnoea 
• Glomerulonephritis 
• Underactive or overactive thyroid 
• Cushing's syndrome 
• Acromegaly 
• Phaeochromocytoma 
• Lupus 
• Scleroderma 

Certain medications can also increase your blood pressure. These include: 

• Combined hormonal contraceptives e.g. the pill, patch or ring
• Steroids 
• Non-steroidal anti-inflammatories 
• Certain cold and cough remedies 
• Herbal remedies containing liquorice 
• Recreational drugs 
• Some types of selective serotonin-noradrenaline reuptake inhibitors (antidepressants)

Active ingredients

The active ingredient in Indapamide is Indapamide hemihydrate. 

Inactive ingredients

The other ingredients are microcrystalline cellulose, magnesium stearate, lactose, croscarmellose sodium, hypromellose, macrogol 400 and titanium dioxide.

Please note: different manufacturers of indapamide may use different inactive ingredients, so you should always check the patient information leaflet to be aware of any allergens.

Which ingredients can cause an allergic reaction?

While it is possible to have a severe allergic reaction to indapamide, it is still rare. If you do have a severe allergic reaction to this medication, it will present with lip or facial swelling, difficulty breathing, hives, severe dizziness and chest tightness. Please make sure to get medical attention if you notice any of these symptoms shortly after taking Indapamide.

How long do I need to take indapamide for?

It is likely that you will need to take indapamide long term. Many people will take it for the rest of their lives.

Is indapamide safe for long term use?

Indapamide is designed for long term use so it's safe to use in this way. You will need to see your GP or nurse regularly for checkups to make sure the medication is working correctly.

How to take indapamide?

Indapamide is usually taken once a day in the morning. It should be swallowed whole with a glass of water and can be taken with or without food.

What should I do if I forget to take indapamide?

If you forget to take Indapamide, you should miss out the forgotten dose and take the next one as usual. Do not take double the dose to make up for a missed one.

What should I do if I take too much Indapamide?

If you take too much indapamide seek medical assistance right away. Take the medication with you so that the hospital know what it is you have taken.

Common side effects of indapmide may include: 

• Raised skin rash 
• Allergic skin reactions 

Uncommon side effects may include: 

• Vomiting 
• Purpura (red pinpoint rash)

Rare side effects may include: 

• Tiredness 
• Headaches 
• Vertigo 
• Pins and needles 
• Constipation 
• Dry mouth 
• Heart palpitations 
• Low blood pressure 
• Kidney disease 
• Changes in blood cells 
• A heightened level of calcium in the blood 
• Fainting 
• Visual impairment 
• Dizziness 
• Hepatitis 
• Low potassium in the blood 

If you experience any of the following serious side effects, seek immediate medical assistance and stop taking the medication: 

• Angioedema (swollen skin around the eyes, mouth, hands or feet)
• Severe skin reactions 
• Flu-like symptoms or fever 
• An irregular heartbeat 
• Severe abdominal pain 
• Abnormal liver function 

Tell your doctor if you experience: 

• Weakness, tiredness and confusion with aching or stiff muscles 
• Irritability and muscle twitching 
• A rash that is itchy and raised that may accompany a headache, sore throat and high temperature 
• Increased level of infections or bruising 
• Increased hunger, thirst and weight loss

Contraindications

Do not take Indapamide if you: 

• Are allergic to any of the ingredients in the medication 
• Have severe kidney disease 
• Have severe liver disease 
• Have hypokalaemia (low potassium)
• Have hypercalcaemia (high calcium)
• Have Addison’s disease
• Are pregnant or breastfeeding

Talk to your doctor if you have: 

• Diabetes 
• Gout
• Kidney problems
• An overactive thyroid
• Liver problems
• Experienced photosensitivity in response to medication before

Drug interactions

The following medications may interfere with the way Indapamide works. Tell your doctor if you are taking: 

• Lithium 
• Medications to treat heart rhythm problems 
• Bepridil 
• Stimulant laxatives 
• Medications used to treat mental health conditions 
• Sparfloxacin 
• Moxifloxacin 
• Erythromycin 
• Vincamine by injection 
• Pentamidine 
• Halofantrine 
• Mizolastine 
• Non-steroidal anti-inflammatory medications e.g. Ibuprofen
• High doses of Aspirin 
• ACE inhibitors 
• Amphotericin B by injection 
• Oral corticosteroids 
• Baclofen 
• Amiloride 
• Spironolactone 
• Triamterene 
• Metformin 
• Calcium tablets 
• Ciclosporin 
• Tacrolimus 
• Tetracosactide 
• Cisapride 
• Diphemanil

Indapamide and alcohol

It's best to avoid alcohol when you first start taking indapamide as alcohol can lower your blood pressure and increase the effect of the medication. Once you have got used to the medication you may be able to drink alcohol in moderation. Drinking large quantities can affect your blood pressure, causing dehydration and dizziness.

Indapamide and pregnancy

Indapamide is not recommended during pregnancy. Speak to your doctor if you think you might be pregnant or if you are trying to start a family.

Can I drive while taking indapamide?

Indapamide can make you feel dizzy and tired which can affect your reactions while driving. This is more likely to happen when you first start taking the medication. Do not drive or operate machinery until you have got used to the medication and know how it affects you.

Will indapamide affect my fertility?

Indapamide will not have an impact on your fertility but if you are trying to get pregnant then this medication may not be suitable.

Will indapamide affect my Contraception?

Indapamide will not affect hormonal contraceptives. The combined pill is not usually suitable for women with high blood pressure however so it's important that you discuss this with your doctor if you are taking the pill. 

Alternatives to indapamide

Other diuretics include bendroflumethiazide and furosemide which work in a similar way to Indapamide to treat high blood pressure. There are also other types of medicines given to treat high blood pressure: 

• ACE inhibitors: these work by relaxing the blood vessels to make it easier for the blood to flow. These will usually be prescribed in the first instance for patients under the age of 55
• ARBs (angiotensin receptor blockers): also relax the blood vessels in a similar way to ACE inhibitors. 
• Calcium channel blockers: these work by widening the blood vessels to lower blood pressure. They may be more effective as first-line therapy in those over the age of 55
• Beta-blockers: these are usually prescribed if other treatments haven't been successful and work by slowing the heart rate and relaxing the blood vessels

Can lifestyle changes help?

Everyone with high blood pressure is encouraged to make lifestyle changes to improve their overall health and lower their blood pressure. This includes: 

• Eating a low salt diet with a maximum of 6 g per day 
• Eating a healthy diet with at least 5 portions of fruit and vegetables per day 
• Exercise regularly 
• Reduce alcohol consumption 
• Quit smoking 
• Maintain a healthy weight 
• Cut down on caffeine 
• Get plenty of sleep 

These changes can help you to prevent high blood pressure from occurring and reduce your need for medication.