Indapamid

Indapamide is a thiazide-like diuretic used in the management of hypertension and edema. It belongs to the class of diuretics that are structurally related to thiazides and is a sulfonamide derivative.

Indapamide exerts its diuretic effect by inhibiting the sodium–chloride cotransporter in the distal convoluted tubule, leading to increased excretion of sodium and water. In addition to its renal effects, indapamide is believed to have a mild vasodilatory action that reduces peripheral vascular resistance, contributing to its antihypertensive effect. The drug is typically characterized by a relatively long duration of action compared with other diuretics.

Indapamide is indicated for essential hypertension and for edema associated with heart failure, liver cirrhosis, or nephrotic syndrome. It is usually given once daily, often in the morning, and is available in immediate-release and sustained-release formulations. As with other diuretics, dosing is individualized based on response and tolerance.

Pharmacokinetically, indapamide is well absorbed after oral administration. Peak plasma concentrations occur within a few hours for immediate-release forms, while sustained-release forms provide a longer duration of action. It is highly protein-bound and is eliminated mainly by the kidneys, with a terminal half-life that supports once-daily dosing.

Common adverse effects include electrolyte disturbances such as hyponatremia and hypokalemia, dehydration, dizziness, and orthostatic hypotension. Hyperuricemia and potential hyperglycemia may occur, and photosensitivity can be seen with sun exposure. It should be avoided in anuria and certain severe renal impairments; caution is advised during pregnancy and breastfeeding. Drug interactions can occur with NSAIDs, other antihypertensives, and lithium.