How does this medication work? What will it do for me?

Indapamide belongs to the family of medications called diuretics ("water pills"). It is used alone or in combination with other medications to treat mild to moderate high blood pressure. This medication works by making the body lose excess water and salt.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

1.25 mg
Each round, orange, film-coated tablet, with "S" marked on one side, contains indapamide 1.25 mg. Nonmedicinal ingredients: glycerol, hydroxypropyl methylcellulose, lactose monohydrate, macrogol 6000, magnesium stearate, maize starch, microcrystalline cellulose, pregelatinized starch, sunset yellow S Aluminium Lake, talc, and titanium dioxide.

2.5 mg
Each pink, sugar-coated tablet contains indapamide 2.5 mg. Nonmedicinal ingredients: colloidal silica, corn starch, ethylcellulose, FD&C Red No. 3 lake, FD&C Yellow No. 6 lake, glycerol monooleate, lactose, magnesium stearate, polysorbate, povidone, pregelatinized corn starch, sodium benzoate, sodium carboxymethylcellulose, sucrose, talc, titanium dioxide, and white beeswax.

How should I use this medication?

The recommended starting dose of indapamide is 1.25 mg once daily in the morning. After 4 to 8 weeks, your doctor may increase this to 2.5 mg once daily, depending on the effect of the medication. If a dose of 2.5 mg daily does not reduce your blood pressure sufficiently, your doctor will likely add another blood-pressure-lowering medication that is not a diuretic or may try a different diuretic. Do not take more than 2.5 mg daily.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take indapamide if you:

  • are allergic to indapamide or any ingredients of this medication
  • are allergic to sulfa (sulfonamide) medications (e.g., sulfamethoxazole)
  • are breast-feeding
  • are pregnant
  • are taking certain medications that can increase the risk of a type of abnormal heart rhythm called torsades de pointes
  • have low levels of potassium in your blood
  • have severe kidney failure
  • have severe liver impairment, including possible brain involvement
  • have lactose or galactose intolerance or malabsorption

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • constipation
  • cough
  • diarrhea
  • dizziness or lightheadedness, especially when rising from a lying or sitting position
  • dry mouth
  • headache
  • heartburn
  • loss of appetite
  • nausea
  • sensation of spinning
  • trouble sleeping
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • blurred vision
  • faster, slower or irregular heartbeat
  • flu-like symptoms (e.g., sudden lack of energy, fever, cough, sore throat)
  • increased infections
  • unexplained muscle cramps or pain
  • pain in the stomach, back or chest
  • rash or itching
  • signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
  • signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
  • signs of gout (e.g., joint pain, swelling and warmth of joints)
  • signs and symptoms of imbalance of water, sodium or potassium in the body (e.g., muscle pain or cramps, weakness, irregular heart beat
  • signs of high blood calcium levels (e.g., loss of appetite, nausea, vomiting, constipation or stomach pain)
  • signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine, swelling, fatigue, abdominal pain)
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
  • unusual tiredness or weakness

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abnormal heart rhythms: This medication can cause abnormal heart rhythms. Certain medications (e.g., sotalol, quinidine, thioridazine, chlorpromazine, droperidol, pimozide, gatifloxacin, moxifloxacin, mefloquine, pentamidine, arsenic trioxide, dolasetron mesylate, probucol, tacrolimus) can increase the risk of a type of abnormal heart rhythm called torsades de pointes and should be used with caution with indapamide.

If you are taking medication for abnormal heart rhythms, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Allergy: Some people who are allergic to sulfonamides also experience allergic reactions to indapamide, as it has a sulfonamide component. Before you take indapamide, inform your doctor about any previous adverse reactions you have had to medications, especially sulfonamide (sulfa) antibiotics. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing or swelling of the face and throat.

Diabetes: Although indapamide has very little effect on blood sugar control, people with diabetes may need additional insulin to keep blood sugar levels steady. High blood sugar and sugar in the urine may occur for people who have risk factors for developing diabetes.

If you have diabetes, or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dizziness: Indapamide can cause severe dizziness, especially when rising from a sitting or lying position. This is more likely to occur when starting to take indapamide or increasing the dose being taken, particularly when other medications with similar side effects are being taken. If you are taking medications that can cause dizziness, rise slowly from sitting or lying down to reduce the possibility of severe dizziness or fainting.

Electrolytes: Changes in the blood levels of electrolytes such as potassium and magnesium become severe at doses above 2.5 mg per day. Do not take more than 2.5 mg per day.

Abnormally low blood potassium levels may occur at all doses causing weakness, cramps, and abnormal heart rhythms. The warning signs of electrolyte imbalance are:

  • drowsiness
  • dry mouth
  • frequent urination
  • low blood pressure
  • muscle fatigue
  • muscle pains or cramps
  • racing heartbeat
  • restlessness
  • stomach problems (e.g., nausea, vomiting)
  • thirst
  • tiredness
  • weakness

Galactose intolerance: Indapamide medications are prepared with lactose. If you have lactose or galactose intolerance you should not take these medications.

Gout: Indapamide may increase the level of uric acid in the body. If you develop painful, warm and swollen joints contact your doctor as soon as possible. If you have a history of gout, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: This medication is not helpful for people with severely reduced kidney function. If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you experience a decrease in the amount of urine your body is producing, contact your doctor as soon as possible.

Liver function: If you have liver disease or reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you have severely reduced liver function you should not take indapamide because this increases the risk for developing liver-caused brain disease.

Skin sensitivity: Like other sulfonamide medications, indapamide may cause increased sensitivity to the effects of exposure to the sun. If you experience a severe sunburn-like reaction while taking indapamide, contact your doctor immediately. Regardless, you should take measures to protect yourself from the sun, such as use of an appropriate sunscreen and keeping exposed skin covered, while taking indapamide.

Pregnancy: In general, diuretics should not be used during pregnancy, due to the risk of reducing the growth of the fetus. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking indapamide, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of indapamide for use by children have not been established.

Seniors: Seniors may be at an increased risk of developing side effects to indapamide. Lower doses may be appropriate when using this medication to treat high blood pressure for seniors.

What other drugs could interact with this medication?

There may be an interaction between indapamide and any of the following:

  • aclinidium
  • alcohol
  • alpha agonists (e.g., clonidine, methyldopa)
  • alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
  • allopurinol
  • amifostine
  • amiodarone
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • anagrelide
  • angiotensin converting enzyme inhibitors (ACEIs; e.g., captopril, lisinopril, ramipril)
  • angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • atropine
  • baclofen
  • barbiturates (e.g., butalbital, phenobarbital)
  • benztropine
  • beta2-agonists (e.g., formoterol, salbutamol)
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • brimonidine
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • calcium supplements (e.g., calcium carbonate, calcium citrate)
  • carbamazepine
  • chloroquine
  • cholestyramine
  • cisapride
  • colestipol
  • inhaled corticosteroids (e.g., budesonide, ciclesonide, fluticasone)
  • oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
  • diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, nateglinide, rosiglitazone)
  • diazoxide
  • disopyramide
  • diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
  • domperidone
  • dronedarone
  • flavoxate
  • flecanide
  • glycopyrrolate
  • ipratropium
  • licorice
  • lithium
  • lopinavir
  • macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin)
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • multiple vitamins/minerals
  • narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
  • nilotinib
  • nonsteroidal anti-inflammatory medications (NSAIDs; e.g., ibuprofen, ketorolac, naproxen)
  • orphenadrine
  • oxybutynin
  • paliperidone
  • pentamidine
  • pentoxifylline
  • phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
  • pimozide
  • procainamide
  • propafenone
  • quetiapine
  • quinidine
  • quinine
  • quinolone antibiotics (e.g., levofloxacin, norfloxacin)
  • rituximab
  • scopolamine
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine)
  • serotonin blockers (e.g., dolasetron, granisetron, ondansetron)
  • sodium phosphates
  • sotalol
  • tetrabenazine
  • tiotropium
  • tolterodine
  • topiramate
  • trazodone
  • tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine)
  • vandetanib
  • vemurafenib
  • voriconazole
  • ziprasidone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.