Indapamide

Thiazide-like diuretics

ATC code: C03BA11 (Indapamide)

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.

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

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

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

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.

Major

Amiodarone

Class 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). Check potassium and magnesium every 3 months; if potassium drops below 4.0 mmol/L, add a potassium-sparing diuretic or potassium supplement.

Sources

FDA: Cordarone (amiodarone HCl) prescribing information (2018)

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Major

Dronedarone

Class 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

FDA: Multaq (dronedarone) prescribing information (2020)

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Major

Lithium

Psycholeptics. 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

FDA: Eskalith (lithium carbonate) prescribing information (2005)

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Moderate

Allopurinol

Xanthine 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

FDA: Zyloprim (allopurinol) prescribing information (2018)

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Moderate

Alprazolam

Benzodiazepines. 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)

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Moderate

Amitriptyline

Tricyclic 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

FDA: Amitriptyline HCl tablets prescribing information (2014)

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Moderate

Bisoprolol

Selective 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: Zebeta (bisoprolol) prescribing information (2016)

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Official sources

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

AEMPS / CIMA

Spanish Medicines Information Centre (CIMA)

Label dated: 03/06/2026

FDA / DailyMed

FDA — DailyMed Drug Labels

Label dated: 05/13/2026

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

PregnancyFDA B

FDA category B. However, diuretics in general are not recommended in pregnancy as they may reduce uteroplacental blood flow. Not a drug of choice in pregnancy. Methyldopa, labetalol, and nifedipine are preferred.

Breastfeeding

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.

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?

FDA category B. FDA category B. However, diuretics in general are not recommended in pregnancy as they may reduce uteroplacental blood flow. Not a drug of choice in pregnancy. Methyldopa, labetalol, and nifedipine are preferred.

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.

Mechanism of action

Practical notes

Timing and administration

Monitoring

Drug–drug interactions

7 pairs found. Sorted from critical to minor.

Major

Amiodarone

Class III antiarrhythmics (Vaughan Williams)

Mechanism

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

Symptoms

Management

Sources

FDA: Cordarone (amiodarone HCl) prescribing information (2018)

Pair details →

Major

Dronedarone

Class 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

Sources

FDA: Multaq (dronedarone) prescribing information (2020)

Pair details →

Major

Lithium

Psycholeptics. Lithium

Mechanism

Symptoms

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

FDA: Eskalith (lithium carbonate) prescribing information (2005)

Pair details →

Moderate

Allopurinol

Xanthine oxidase inhibitors

Mechanism

Symptoms

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

Management

Sources

FDA: Zyloprim (allopurinol) prescribing information (2018)

Pair details →

Moderate

Alprazolam

Benzodiazepines. 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 →

Moderate

Amitriptyline

Tricyclic 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

FDA: Amitriptyline HCl tablets prescribing information (2014)

Pair details →

Moderate

Bisoprolol

Selective 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: Zebeta (bisoprolol) prescribing information (2016)

Pair details →

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

PregnancyFDA B

Breastfeeding

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.

Frequently asked

What is Indapamide used for?

What are the side effects of Indapamide?

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?