Indapamide

Thiazide-like diuretics

ATC code: C03BA11

Updated 12 Aug 2026 · Methodology

Indications

Hypertension

First line

Indapamide is the preferred thiazide-like diuretic per 2024 and . Dose 1.5 mg (sustained release) or 2.5 mg (immediate release) once daily. Antihypertensive efficacy is comparable to amlodipine and ACE inhibitors. Metabolically preferable to hydrochlorothiazide – less impact on potassium, glucose, and lipids.

Sources

ESC: 2024 ESC Guidelines for the management of elevated blood pressure and hypertension (2024)
Cochrane Database of Systematic Reviews: First-line drugs for hypertension (2018)
NICE: Hypertension in adults: diagnosis and management (NG136) (2023)
New England Journal of Medicine: Treatment of Hypertension in Patients 80 Years of Age or Older (2008)
Hypertension: Chlorthalidone Compared With Hydrochlorothiazide in Reducing Cardiovascular Events (2012)

ICD-10: I10 · ICD-11: BA00

Isolated systolic hypertension in the elderly

First line

In elderly patients with isolated systolic hypertension, thiazide-like diuretics are first-line. The HYVET trial showed a 30% stroke reduction and 21% all-cause mortality reduction with indapamide (with possible perindopril addition) in patients over 80. The PROGRESS trial confirmed reduced recurrent stroke risk with indapamide plus perindopril.

Sources

ICD-10: I10 · ICD-11: BA00

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Body detoxification and cleansing

Not recommended

Indapamide is a thiazide-like diuretic. It is prescribed for hypertension ( 2023, SEH-LELHA). In alt detox circles, indapamide is occasionally promoted to remove excess fluid in people with normal blood pressure. In people without hypertension, no clinical studies of such use exist; a diuretic in healthy people causes volume imbalance. The drug has specific risks: hypokalemia, hyponatremia (especially in older adults, sometimes severe, described after several weeks of use), hyperuricemia with gout flare risk, elevated glucose and lipids, and photosensitivity. If indapamide was prescribed for detox in a healthy person, consider seeking a second opinion.

Sources

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Inhibits sodium reabsorption at the distal convoluted tubule via the sodium-chloride cotransporter. Beyond its diuretic effect, it has direct vasodilatory action – reduces vascular smooth muscle tone. Metabolically more neutral than hydrochlorothiazide: less impact on glucose, cholesterol, and uric acid levels.

Safety

Contraindications

Severe renal impairment (eGFR below 30) – loses efficacy
Severe hepatic impairment, hepatic encephalopathy
Hypokalemia
Hypersensitivity to sulfonamides

Serious adverse effects

Severe hyponatremia (especially in elderly patients in hot weather)
Gout provocation (uric acid elevation)
Glucose intolerance (less common than with hydrochlorothiazide)

Common adverse effects

Hypokalemia (less common than with hydrochlorothiazide)
Hyponatremia
Hyperuricemia
Dizziness, orthostatic hypotension

Pregnancy: can you take Indapamide?

AEMPS summary of product characteristics (section 4.6): there are no or limited data (fewer than 300 pregnancy outcomes) on the use of indapamide in pregnant women. Prolonged exposure to a thiazide in the third trimester may reduce maternal plasma volume and uteroplacental blood flow, which can cause fetoplacental ischaemia and growth retardation. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. As a precaution, it is preferable to avoid indapamide during pregnancy.

Breastfeeding: can you take Indapamide?

Limited data on excretion in breast milk. Diuretics may reduce lactation. Not prescribed to breastfeeding mothers unless essential.

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Take in the morning, once daily, with or without food. Evening dosing is undesirable due to the diuretic effect. Full antihypertensive effect develops over 1–2 weeks. Sustained-release form (SR, 1.5 mg) provides a smoother effect and causes less hypokalemia.

Monitoring

Check potassium, sodium, creatinine, and uric acid 2–4 weeks after initiation, then every 6 months. Hypokalemia is the main electrolyte side effect, although less pronounced than with hydrochlorothiazide. If potassium drops below 3.5 mmol/L, add potassium supplements or switch to a combination with a potassium-sparing diuretic. Monitor glucose in prediabetic patients.

Drug–drug interactions

7 pairs found. Sorted from critical to minor.

MajorAmiodaroneClass III antiarrhythmics (Vaughan Williams)

Mechanism

Indapamide (thiazide-like diuretic) increases potassium and magnesium loss. Low levels amplify amiodarone's QT-prolonging effect.

Symptoms

QT prolongation on ECG. Clinically: dizziness, syncope, palpitations. Severe cases progress to polymorphic ventricular tachycardia (torsades de pointes) with risk of ventricular fibrillation and sudden cardiac death. Risk is higher with hypokalaemia, hypomagnesaemia, bradycardia, and ischaemic heart disease.

Management

The combination is common (hypertension plus atrial fibrillation) but needs monitoring. Check potassium and magnesium before starting and correct any deficit. Recheck potassium within the first week after indapamide is started (per the label) and more often than usual afterwards, because amiodarone prolongs the QT interval. Monitor the ECG and QT interval. If hypokalaemia cannot be controlled, replace indapamide with a drug that does not raise the risk of torsades de pointes.

Sources

Pair details →Amiodarone →

MajorDronedaroneClass III antiarrhythmic

Mechanism

Indapamide (thiazide-like diuretic) increases urinary potassium loss. Low potassium amplifies dronedarone's QT effect.

Symptoms

QT prolongation on ECG. Dizziness, syncope, palpitations. Severe cases: polymorphic ventricular tachycardia (torsades de pointes). Risk is higher with hypokalaemia and hypomagnesaemia.

Management

The combination is common (hypertension + atrial fibrillation). Check potassium and magnesium every 3 months; if potassium drops below 4.0 mmol/L, add a potassium-sparing diuretic or potassium supplement.

Sources

Pair details →Dronedarone →

MajorLithiumPsycholeptics. Lithium

Mechanism

Indapamide is a thiazide-like diuretic. The lithium-raising mechanism is the same as hydrochlorothiazide: enhanced lithium reabsorption in the proximal tubules via subclinical volume depletion. Serum lithium rises.

Symptoms

Tremor, muscle twitching, nausea, diarrhoea, confusion, ataxia. Severe cases include seizures, coma, and nephrogenic diabetes insipidus with dehydration. Symptoms emerge when serum lithium exceeds 1.2 mmol/L.

Management

Reduce lithium dose by 25–30% when starting indapamide; check serum lithium at 1 week, then monthly. Alternatives: amlodipine or a beta-blocker without lithium effects.

Sources

Pair details →Lithium →

ModerateAllopurinolXanthine oxidase inhibitors

Mechanism

Indapamide (thiazide-like diuretic) raises allopurinol and oxypurinol levels, increasing hypersensitivity risk. The effect is weaker than with hydrochlorothiazide but clinically significant in older patients and chronic kidney disease.

Symptoms

Rash, fever, facial oedema, lymphadenopathy, abnormal liver function. Reactions develop 2–8 weeks after starting allopurinol.

Management

Dose allopurinol by creatinine clearance (start 100 mg/day if clearance below 60 mL/min). In Asian patients, HLA-B*58:01 testing is recommended. In significant hyperuricaemia, replacing indapamide with losartan lowers uric acid by 10–15%.

Sources

Pair details →Allopurinol →

ModerateAlprazolamBenzodiazepines. Short-to-medium-acting anxiolytics

Mechanism

Additive hypotension and fall risk in older patients. Additional delirium risk with diuretic-induced hypovolaemia.

Symptoms

Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.

Management

In older patients, check standing and sitting blood pressure 1–2 weeks after start; assess fluid and electrolyte balance. Alternative anxiolytic: hydroxyzine or a short lorazepam course.

Sources

FDA: Xanax (alprazolam) prescribing information (2016)

Pair details →Alprazolam →

ModerateAmitriptylineTricyclic antidepressants (TCA)

Mechanism

Additive orthostatic hypotension and hypokalaemia risk. Older patients: delirium risk with thiazide-like diuretic hypovolaemia.

Symptoms

Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk.

Management

In older patients, check standing and sitting blood pressure, assess potassium and sodium. For neuropathic pain, alternative: gabapentin or pregabalin.

Sources

Pair details →Amitriptyline →

ModerateBisoprololSelective beta-adrenergic blockers

Mechanism

Standard combination in hypertension – additive antihypertensive effect. Indapamide (thiazide-like diuretic) causes hypokalaemia.

Symptoms

Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk. With additional antihypertensives: bradycardia (pulse below 60/min).

Management

Standard combination. Check potassium 2–4 weeks after start and then annually. If potassium drops below 4.0 mmol/L, add a potassium-sparing component.

Sources

FDA: Bisoprolol tablet (Micro Labs Limited) – Prescribing Information (2016)

Pair details →Bisoprolol →

Label mentions33 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

Majorinhibidores de la ECAclass named in the label
«Inhibidores de la enzima de conversión de la angiotensina (IECA): En la insuficiencia cardiaca congestiva , comenzar con una dosis muy baja del IECA eventualmente después de disminuir la dosis del…»
AEMPS, section 4.5 · Open on CIMA
MajorLithium
«Litio: Aumento de la concentración sanguínea de litio con signos de sobredosis, como en el caso de un régimen sin sodio (disminución de la excreción urinaria del litio). Sin embargo, en los casos en…»
AEMPS, section 4.5 · Open on CIMA
MajorMetformin
«Metformina: Mayor riesgo de acidosis láctica debida a la metformina, debido a una eventual insuficiencia renal funcional vinculada a los diuréticos y más especialmente a los diuréticos del asa.»
AEMPS, section 4.5 · Open on CIMA
ModerateAcetylsalicylic acid
«AINE (sistémicos) incluy endo los inhibidores selectivos de la COX-2, dosis elevadas de ácido acetilsalicílico ( ≥ 3g/día):»
AEMPS, section 4.5 · Open on CIMA
ModerateAINEclass named in the label
«AINE (sistémicos) incluy endo los inhibidores selectivos de la COX-2, dosis elevadas de ácido acetilsalicílico ( ≥ 3g/día):»
AEMPS, section 4.5 · Open on CIMA
ModerateAllopurinol
«Alopurinol: El tratamiento concomitante con indapamida puede aumentar la incidencia de reacciones de hipersensibilidad a alopurinol.»
AEMPS, section 4.5 · Open on CIMA
ModerateAmiodarone
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: - antiarrítmicos del grupo III (ej. amiodarona, sotalol, dofetilida, ibutilida, bretilio),»
AEMPS, section 4.5 · Open on CIMA
ModerateAmisulpride
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: benzamidas (ej. amisulprida, sulpirida, sultoprida, tiaprida),»
AEMPS, section 4.5 · Open on CIMA
ModerateAmphotericin B
«Otros fármacos que causan hipopotasemia: anfotericina B (IV), gluco y mineralocorticoides (sistémicos), tetracosactida, laxantes estimulantes:»
AEMPS, section 4.5 · Open on CIMA
Moderateantiarrítmicosclass named in the label
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: - antiarrítmicos del grupo Ia (ej. quinidina, hidroquinidina, disopiramida),»
AEMPS, section 4.5 · Open on CIMA
Moderateantipsicóticosclass named in the label
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: - algunos antipsicóticos:»
AEMPS, section 4.5 · Open on CIMA
ModerateChlorpromazine
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: fenotiazinas (ej. clorpromazina, ciamemazina, levomepromazina, tioridazina, trifluoperazina),»
AEMPS, section 4.5 · Open on CIMA
ModerateCisapride
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: otros fármacos: (ej. bepridil, cisaprida, difemanil, eritromicina IV, halofantrina, mizolastina, pentamidina, esparfloxacino…»
AEMPS, section 4.5 · Open on CIMA
Moderatecorticosteroidesclass named in the label
«Otros fármacos que causan hipopotasemia: anfotericina B (IV), gluco y mineralocorticoides (sistémicos), tetracosactida, laxantes estimulantes:»
AEMPS, section 4.5 · Open on CIMA
Moderatedigitálicosclass named in the label
«- Equilibrio hidroelectrolítico: La depleción potásica con hipopotasemia constituye el mayor riesgo de los diuréticos tiazídicos y similares. La hipopotasemia puede provocar trastornos musculares. Se…»
AEMPS, section 4.4 · Open on CIMA
ModerateDisopyramide
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: - antiarrítmicos del grupo Ia (ej. quinidina, hidroquinidina, disopiramida),»
AEMPS, section 4.5 · Open on CIMA
Moderatediuréticos ahorradores de potasioclass named in the label
«Diuréticos ahorradores de potasio (amilorida, espironolactona, triamtereno): Mientras que las asociaciones racionales son útiles en algunos pacientes, aún puede producirse hipopotasemia o…»
AEMPS, section 4.5 · Open on CIMA
ModerateDofetilide
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: - antiarrítmicos del grupo III (ej. amiodarona, sotalol, dofetilida, ibutilida, bretilio),»
AEMPS, section 4.5 · Open on CIMA
ModerateDroperidol
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: butirofenonas (ej. droperidol, haloperidol),»
AEMPS, section 4.5 · Open on CIMA
ModerateErythromycin
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: otros fármacos: (ej. bepridil, cisaprida, difemanil, eritromicina IV, halofantrina, mizolastina, pentamidina, esparfloxacino…»
AEMPS, section 4.5 · Open on CIMA
ModerateHaloperidol
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: butirofenonas (ej. droperidol, haloperidol),»
AEMPS, section 4.5 · Open on CIMA
Moderatelaxantesclass named in the label
«Otros fármacos que causan hipopotasemia: anfotericina B (IV), gluco y mineralocorticoides (sistémicos), tetracosactida, laxantes estimulantes:»
AEMPS, section 4.5 · Open on CIMA
Moderatemedicamentos que prolongan el QTclass named in the label
«- Equilibrio hidroelectrolítico: Asimismo, presentan una situación de riesgo las personas con alargamiento del intervalo QT, independientemente de que el mismo sea de origen congénito o iatrogénico…»
AEMPS, section 4.4 · Open on CIMA
ModerateMethadone
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: otros fármacos: (ej. bepridil, cisaprida, difemanil, eritromicina IV, halofantrina, mizolastina, pentamidina, esparfloxacino…»
AEMPS, section 4.5 · Open on CIMA
ModerateMoxifloxacin
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: otros fármacos: (ej. bepridil, cisaprida, difemanil, eritromicina IV, halofantrina, mizolastina, pentamidina, esparfloxacino…»
AEMPS, section 4.5 · Open on CIMA
ModeratePimozide
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: otros antipsicóticos (ej. pimozida),»
AEMPS, section 4.5 · Open on CIMA
ModerateQuinidine
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: - antiarrítmicos del grupo Ia (ej. quinidina, hidroquinidina, disopiramida),»
AEMPS, section 4.5 · Open on CIMA
ModerateSotalol
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: - antiarrítmicos del grupo III (ej. amiodarona, sotalol, dofetilida, ibutilida, bretilio),»
AEMPS, section 4.5 · Open on CIMA
ModerateSpironolactone
«Diuréticos ahorradores de potasio (amilorida, espironolactona, triamtereno): Mientras que las asociaciones racionales son útiles en algunos pacientes, aún puede producirse hipopotasemia o…»
AEMPS, section 4.5 · Open on CIMA
ModerateTriamterene
«Diuréticos ahorradores de potasio (amilorida, espironolactona, triamtereno): Mientras que las asociaciones racionales son útiles en algunos pacientes, aún puede producirse hipopotasemia o…»
AEMPS, section 4.5 · Open on CIMA
Ciclosporin
«Ciclosporina, tacrolimus: Riesgo de aumento de la creatinina plasmática sin modificación de las tasas circulantes de ciclosporina, incluso en ausencia de depleción de sodio y agua.»
AEMPS, section 4.5 · Open on CIMA
Lithium
«Drug Interactions: Lithium: See WARNINGS .»
FDA, section 7 · Open on DailyMed
Tacrolimus
«Ciclosporina, tacrolimus: Riesgo de aumento de la creatinina plasmática sin modificación de las tasas circulantes de ciclosporina, incluso en ausencia de depleción de sodio y agua.»
AEMPS, section 4.5 · Open on CIMA

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Frequently asked

What is Indapamide used for?

Indapamide is evaluated for the following indications with varying evidence strength: Isolated systolic hypertension in the elderly (evidence tier A), Hypertension (evidence tier A), Body detoxification and cleansing (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Indapamide?

Common side effects of Indapamide (≥ 1 in 100): Hypokalemia (less common than with hydrochlorothiazide), Hyponatremia, Hyperuricemia, Dizziness, orthostatic hypotension. See the Safety section for uncommon and serious reactions.

Is Indapamide safe during pregnancy?

Is Indapamide compatible with breastfeeding?

Limited data on excretion in breast milk. Diuretics may reduce lactation. Not prescribed to breastfeeding mothers unless essential.

Who should not take Indapamide?

Indapamide is contraindicated in: Severe renal impairment (eGFR below 30) – loses efficacy; Severe hepatic impairment, hepatic encephalopathy; Hypokalemia; Hypersensitivity to sulfonamides. Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMA
FDA / DailyMedLabel dated 05/13/2026

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Indications

Hypertension

Isolated systolic hypertension in the elderly

Body detoxification and cleansing

Mechanism of action

Safety

Contraindications

Serious adverse effects

Common adverse effects

Pregnancy: can you take Indapamide?

Practical notes

Timing and administration

Monitoring

Drug–drug interactions

From this drug’s label

Check interaction with another drug

Frequently asked

Official sources

Other drugs in this group

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