Xipamid

Xipamide is a diuretic of the thiazide-like class used in the treatment of edema and, in some countries, hypertension. It is a sulfonamide derivative administered orally.

Its primary action is in the distal convoluted tubule, where it inhibits the luminal Na+-Cl- cotransporter. This reduces sodium reabsorption, increasing excretion of sodium, chloride, and water. The diuretic effect is accompanied by potassium loss, so electrolyte levels, particularly potassium, are monitored during therapy.

Xipamide is absorbed after oral dosing and reaches peak plasma concentrations within a few hours. It is mainly excreted by the kidneys, and dose adjustments may be required in renal impairment.

Indications include edema due to heart failure, liver cirrhosis, and nephrotic syndrome. In some countries it is also used for hypertension, either alone or in combination with other agents.

Adverse effects commonly involve electrolyte disturbances such as hyponatremia and hypokalemia, dehydration, dizziness, and elevated uric acid levels, which can precipitate gout. Hypersensitivity to sulfonamides is a potential concern for susceptible individuals.

Contraindications include anuria and significant renal impairment; caution is advised in patients with gout, preexisting electrolyte disturbances, and pregnancy. Interactions include enhanced hypotensive effects with other antihypertensives and reduced diuretic efficacy with NSAIDs; caution with lithium due to potential interactions.

First introduced in the mid-20th century, xipamide has been marketed in several regions but is less common in some national formularies today.