Drug Action
Indapamide is a thiazide-like diuretic with antihypertensive effects. At lower doses, vasodilatation is more prominent than diuresis; the diuretic effect becomes more apparent with higher doses.
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Individual generic drug information
Extracted information for Indapamide only.
Indapamide is a thiazide-like diuretic with antihypertensive effects. At lower doses, vasodilatation is more prominent than diuresis; the diuretic effect becomes more apparent with higher doses.
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Essential hypertension ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: 2.5 mg daily, dose to be taken in the morning ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: 1.5 mg daily, dose to be taken preferably in the morning
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Acute porphyrias p. 1120 Afro-Caribbean patients (may respond less well to ACE inhibitors). concomitant diuretics. diabetes (may lower blood glucose). first dose hypotension (especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure). peripheral vascular disease or generalised atherosclerosis (risk of clinically silent renovascular disease). primary aldosteronism (patients may respond less well to ACE inhibitors). the risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). use with care (or avoid) in those with a history of idiopathic or hereditary angioedema. use with care in patients with hypertrophic cardiomyopathy. use with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) CAUTIONS, FURTHER INFORMATION ▶Anaphylactoid reactions To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low- density lipoprotein apheresis with dextran sulfate; they should also be withheld before desensitisation with wasp or bee venom. ▶Elderly Prescription potentially inappropriate (STOPP criteria): . with hyperkalaemia . with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls) See also Prescribing in the elderly p. 33.
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Contra-indicated if history of hypersensitivity to sulfonamides. ACE inhibitors are contra-indicated in patients with hypersensitivity to ACE inhibitors (including angioedema).
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The combination of an ACE inhibitor with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m2. the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus
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Extracted information for Indapamide only.
→Appendix 1: thiazide diuretics
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▶Common or very common Hypersensitivity ▶Rare or very rare Angioedema. arrhythmias. haemolytic anaemia. hepatic disorders. renal failure. severe cutaneous adverse reactions (SCARs). vertigo ▶Frequency not known Hepatic encephalopathy. QT interval prolongation. syncope. systemic lupus erythematosus exacerbated. vision disorders ▶Common or very common Alopecia. angina pectoris. angioedema (may be delayed; more common in Afro- Caribbean patients). arrhythmias. asthenia. chest pain. constipation. cough. diarrhoea. dizziness. drowsiness. dry mouth. dyspnoea. electrolyte imbalance. gastrointestinal discomfort. headache. hypotension. myalgia. nausea. palpitations. paraesthesia. renal impairment. rhinitis. skin reactions. sleep disorder. syncope. taste altered. tinnitus. vertigo. vomiting ▶Uncommon Arthralgia. confusion. eosinophilia. erectile dysfunction. fever. haemolytic anaemia. hyperhidrosis. myocardial infarction. pancreatitis. peripheral oedema. photosensitivity reaction. respiratory disorders. stroke ▶Rare or very rare Agranulocytosis. hepatitis. leucopenia. neutropenia. pancytopenia. Stevens-Johnson syndrome. thrombocytopenia SIDE-EFFECTS, FURTHER INFORMATION In light of reports of cholestatic jaundice, hepatitis, fulminant hepatic necrosis, and hepatic failure, ACE inhibitors should be discontinued if marked elevation of hepatic enzymes or Cardiovascular system jaundice occur.
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Present in milk—manufacturer advises avoid. Information on the use of ACE inhibitors in breast-feeding is limited.
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ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported.
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Dose adjustments Use with caution, starting with low dose, and adjust according to response. Hyperkalaemia and other side-effects of ACE inhibitors are more common in those with impaired renal function and the dose may need to be reduced.
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Renal function and electrolytes should be checked before starting ACE inhibitors (or increasing the dose) and monitored during treatment (more frequently if side effects mentioned are present).
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Extracted information for Indapamide only.
There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension Modified-release tablet CAUTIONARY AND ADVISORY LABELS 25 ▶Alkapamid XL (HBS Healthcare Ltd, Rivopharm (UK) Ltd) Indapamide 1.5 mg Alkapamid XL 1.5mg tablets | 30 tablet P £2.20–£3.40 DT = £3.40 ▶Cardide SR (Teva UK Ltd) Indapamide 1.5 mg Cardide SR 1.5mg tablets | 30 tablet P £4.32 DT = £3.40 ▶Indipam XL (Actavis UK Ltd) Indapamide 1.5 mg Indipam XL 1.5mg tablets | 30 tablet P £1.99 DT = £3.40 ▶Lorvacs XL (Torrent Pharma (UK) Ltd) Indapamide 1.5 mg Lorvacs XL 1.5mg tablets | 30 tablet P £4.32 DT = £3.40 ▶Natrilix SR (Servier Laboratories Ltd) Indapamide 1.5 mg Natrilix SR 1.5mg tablets | 30 tablet P £3.40 DT = £3.40 ▶Rawel XL (Consilient Health Ltd) Indapamide 1.5 mg Rawel XL 1.5mg tablets | 30 tablet P £2.89 DT = £3.40 ▶Tensaid XL (Mylan) Indapamide 1.5 mg Tensaid XL 1.5mg tablets | 30 tablet P £3.40 DT = £3.40 Tablet ▶Indapamide (Non-proprietary) Indapamide hemihydrate 2.5 mg Indapamide 2.5mg tablets | 28 tablet P £6.34 DT = £3.25 | 56 tablet P £4.02–£12.68 ▶Natrilix (Servier Laboratories Ltd) Indapamide hemihydrate 2.5 mg Natrilix 2.5mg tablets | 30 tablet P £3.40 | 60 tablet P £6.80 Combinations available: Perindopril arginine with indapamide, p. 183 DRUGS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM › ACE INHIBITORS Angiotensin-converting enzyme f inhibitors
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For hypertension the first dose should preferably be given at bedtime. eiiii F above
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Filter the extracted dose blocks for this individual drug.
First line only; read the complete Indications and dose section above.
2.5 mg daily, dose to be taken in the morning
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 200
First line only; read the complete Indications and dose section above.
1.5 mg daily, dose to be taken preferably in the
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 200