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- What are the differences between indapamide and thiazide diuretics?
- What are indapamide and thiazide diuretics?
- What are the side effects of indapamide and thiazide diuretics?
- What is the dosage of indapamide vs. thiazide diuretics?
- What drugs interact with indapamide and thiazide diuretics?
- Are indapamide and thiazide diuretics safe to use while pregnant or breastfeeding?
What are the differences between indapamide and thiazide diuretics?
- Indapamide and thiazides are diuretics (water pills) used to treat hypertension (high blood pressure) and accumulation of excess fluid (edema), which may result from congestive heart failure.
- Side effects of indapamide and thiazide diuretics that are similar include low blood potassium (hypokalemia), muscle weakness, low blood magnesium (hypomagnesemia), increased uric acid levels in the blood, dizziness, lightheadedness, headache, blurred vision, sexual dysfunction/impotence, and photosensitivity (skin rashes due to sunlight).
- Side effects of indapamide that are different from thiazide diuretics include dehydration, low blood pressure, excessive loss of sodium, increased cholesterol, increased blood glucose, tingling of the extremities, nervousness, rash, fatigue, irritability, and agitation.
- Side effects of thiazide diuretics that are different from indapamide include loss of appetite, itching, and stomach upset.
What are indapamide and thiazide diuretics?
Indapamide is a thiazide diuretic (water pill) used to treat high blood pressure (hypertension). It works by preventing the kidney from reabsorbing (retaining in the body) salt and water that is destined to be eliminated in the urine. This results in increased urine output (diuresis). Indapamide also is thought to reduce the salt in the smooth muscle of the walls of blood vessels. (The salt ultimately is eliminated in the urine.) The loss of salt from the muscle causes the muscle to relax, and the relaxation of the vessels results in reduced blood pressure.
Thiazide diuretics (water pills) are medications used to treat high blood pressure (hypertension) and reduce fluid accumulation in the body. They work by reducing the ability of the kidneys to reabsorb salt and water from the urine and into the body, thereby increasing the production and output of urine (diuresis). Some examples of thiazide diuretics include chlorthalidone (Thalitone), hydrochlorothiazide (Microzide), and methyclothiazide.
What are the side effects of indapamide and thiazide diuretics?
Common adverse side effects of indapamide are dehydration, and hypokalemia (low blood potassium due to elimination of potassium in the urine), which causes abnormal cardiac rhythms The most common symptom associated with hypokalemia is muscle weakness. Patients receiving indapamide may need potassium supplements to prevent hypokalemia. Hypomagnesemia (low blood magnesium) also may occur.
Other important side effects include:
- Low blood pressure
- Excessive loss of sodium (particularly of concern in elderly patients)
- Increased cholesterol (this effect tends to diminish with continued use)
- Increased blood glucose
- Increased uric acid concentrations in the blood
- Blurred vision
- Tingling of the extremities
- Photosensitivity (skin rashes due to sunlight)
Side effects of thiazide diuretics are dose related and include:
Other side effects and adverse reactions include an increased sensitivity to sunlight, therefore avoid prolonged sun exposure.
Owing to their ability to increase the production of urine, these drugs may lower levels in the body of potassium and magnesium which also are present in urine.
Thiazide diuretics may increase uric acid levels in blood.
Like other antihypertensive medications, thiazides cause sexual dysfunction.
What is the dosage of indapamide vs. thiazide diuretics?
Indapamide is taken as a single daily dose, generally in the morning before breakfast. The recommended dose range is 1.25 to 5 mg once daily. It can be taken with or without food. Antacids have no effect on the activity of indapamide.
Thiazide diuretics may come in oral tablet form. For example, Thalitone (chlorthalidone) is a common thiazide diuretic.
The optimal dose of Thalitone varies greatly from patient to patient. For high blood pressure, the recommended dose range is 25 to 100 mg daily. Most patients receive 12.5 to 25 mg daily.
Edema is treated with 50 to 100 mg daily or 100 mg every other day and the maximum dose is 200 mg daily.
Heart failure is treated with 12.5 to 100 mg daily.
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What drugs interact with indapamide and thiazide diuretics?
Like other diuretics, indapamide can cause hypokalemia (low potassium) and hypomagnesemia (low magnesium). These changes can increase the risk of digoxin (Lanoxin) toxicity, possibly resulting in fatal abnormal heart rhythms. Use of amiodarone (Cordarone) and indapamide also can lead to cardiac arrhythmias. The ability of the kidney to eliminate lithium (Lithobid, Eskalith) is decreased in patients receiving diuretics, including indapamide. The use of these two drugs together could result in lithium toxicity.
Thiazide diuretics can lower potassium and magnesium blood levels since they are both eliminated in urine. Low levels of potassium and magnesium in the blood can result in abnormal heart rhythms, particularly in those who are also taking digoxin (Lanoxin) in addition to a thiazide. Thiazide diuretics can increase the risk of lithium (Eskalith, Lithobid) toxicity by reducing the kidney's ability to eliminate lithium in the urine.
Drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin), naproxen (Naprosyn), and nabumetone (Relafen) can reduce the effectiveness of thiazide diuretics in lowering blood pressure because they may reduce the ability of the kidneys to make urine, particularly in patients who have reduced kidney function.
It is not recommended to use thiazide diuretics with dofetilide (Tikosyn), a drug used for treating abnormal heart rhythms, as this may increase the blood levels of dofetilide (Tikosyn) and cause abnormal heart rhythms. Thiazide diuretics can reduce how the body responds to norepinephrine and render norepinephrine less effective.
Are indapamide and thiazide diuretics safe to use while pregnant or breastfeeding?
The use of indapamide in pregnancy has not been well studied. Physicians may elect to use it if its benefits are judged to outweigh its potential risks. The use of indapamide in nursing mothers has not been studied.
Thiazide diuretics including Thalitone (chlorthalidone) cross the placenta and can cause jaundice in the fetus or newborn. Therefore, thiazide diuretics such as Thalitone should not be used during pregnancy unless absolutely necessary.
Indapamide and thiazides are diuretics (water pills) used to treat hypertension (high blood pressure) and accumulation of excess fluid (edema), which may result from congestive heart failure. Side effects of indapamide and thiazide diuretics that are similar include low blood potassium (hypokalemia), muscle weakness, low blood magnesium (hypomagnesemia), increased uric acid levels in the blood, dizziness, lightheadedness, headache, blurred vision, sexual dysfunction/impotence, and photosensitivity (skin rashes due to sunlight).
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Related Disease Conditions
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms. Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure. The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater. If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
Congestive Heart Failure (CHF)
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Pulmonary edema (swelling or fluid in the lungs) can either be caused by cardiogenic causes (congestive heart failure, heart attacks, abnormal heart valves) or noncardiogenic causes such as ARDS, kidney failure, high altitude, pneumothorax, pleural effusion, aspirin overdose, pulmonary embolism, and infections. The treatment of pulmonary edema depends on the cause of the condition.
Portal hypertension is most commonly caused by cirrhosis, a disease that results from scarring of the liver. Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from the liver to the heart, and a parasitic infection called schistosomiasis. Symptoms of portal hypertension include varices (enlarged veins), vomiting blood, blood in the stool, black and tarry stool, ascites (abnormal fluid collection within the peritoneum, the sac that contains the intestines within the abdominal cavity), confusion and lethargy, splenomegaly or enlargement of the spleen, and decreased white blood cell counts.
Pulmonary hypertension is elevated pressure in the pulmonary arteries that carry blood from the lungs to the heart. The most common symptoms are fatigue and difficulty breathing. If the condition goes undiagnosed, more severe symptoms may occur. As pulmonary hypertension worsens, some people with the condition have difficulty performing any activities that require physical exertion. While there is no cure for pulmonary hypertension, it can be managed and treated with medications and supplemental oxygen to increase blood oxygen levels.
Hypertensive Kidney Disease
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
Preeclampsia (Pregnancy Induced Hypertension)
Preeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.
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