Indapamide

Commonly reported side effects of indapamide include: hypokalemia. See below for a comprehensive list of adverse effects.

Applies to indapamide: oral tablet

Along with its needed effects, indapamide may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur while taking indapamide:

Signs and symptoms of an imbalance of water or potassium in the body

• Dryness of mouth
• increased thirst
• irregular heartbeat
• mood or mental changes
• muscle cramps or pain
• nausea or vomiting
• unusual tiredness or weakness
• weak pulse

Rare

• Skin rash, itching, or hives

Some side effects of indapamide may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common or rare

• Diarrhea
• dizziness or lightheadedness, especially when getting up from a lying or sitting position
• headache
• loss of appetite
• trouble in sleeping
• stomach upset

Applies to indapamide: compounding powder, oral tablet

Most adverse side effects are mild and transient.

Dermatologic reactions, such as rashes, occur in less than 5% of patients, and comprise up to 36% of all adverse drug reactions associated with indapamide.

Metabolic abnormalities are common, but are rarely clinically significant. Hypokalemia occurs in 15% of patients, although clinically relevant hypokalemia is reported in only 1% and 3% of patients receiving 2.5 and 5.0 mg/day, respectively. Hyponatremia, hyperglycemia, and hyperuricemia are reported in 1% to 5% of patients but are rarely clinically relevant. Unlike the thiazides, indapamide has little or no adverse effect on the lipid profile. Severe cases of hyponatremia, accompanied by hypokalemia have been reported with recommended doses of indapamide in elderly females.

Renal side effects are unusual, consisting primarily of azotemia.

A case of interstitial nephritis and an urticarial rash associated with indapamide has been reported.

Gastrointestinal side effects include dyspepsia, constipation, diarrhea, flatulence, and dry mouth in less than 5% of patients.

Nervous system side effects include dizziness, lightheadedness, headache, and fatigue in 5% of patients.

Cardiovascular side effects are usually limited to postural hypotension. Indapamide does not affect the heart rate.

Musculoskeletal cramps are reported in about 5% of patients. A single case of skeletal muscle damage has been associated with indapamide.

A 71-year-old woman with a history of psychiatric problems and reflux esophagitis developed chest pain, finger numbness, sweating, and nausea while gardening. Her medications included indapamide, trifluoperazine, oxazepam, and ranitidine. Myocardial infarction was definitively ruled out by ECG and CPK isoenzyme analysis. Interesting laboratory values included a reduced serum sodium (117 mmol/L), elevated LDH and AST enzymes, and elevated CPK-MM isoenzymes. There was no history of muscular trauma, and thyroid function tests were normal. The hyponatremia and elevated CPK-MM fractions fell precipitously upon hydration with normal saline. A definite causal link between indapamide and rhabdomyolysis could not be made, but thiazide diuretics have been previously implicated in some cases of hypokalemia with subsequent muscle damage.

Genitourinary side effects generally reflect the activity of the drug, with less than 5% of patients reporting polyuria and nocturia.

Decreased sexual libido is rare, with up to 88% of patients reporting no change and most of the remaining 12% reporting improvement of sexual libido during indapamide therapy.

A case of reversible hepatitis associated with indapamide has been reported.

Hepatic side effects are rare, at least one case of hepatitis has been reported.

Hypersensitivity reactions occur in less than 5% of patients. Cases of severe reactions including toxic epidermal necrolysis, erythema multiforme, and Stevens-Johnson syndrome have been reported. Patients with a sulfa allergy may react to indapamide.

Endocrine side effects include at least one case of indapamide-induced hyperparathyroidism. In one study, indapamide significantly reduced parathyroid hormone levels in all patients.

Hematologic side effects are rare, but have included at least one case of mild thrombocytopenia and mucosal bleeding from the tongue. Bleeding stopped promptly and platelet counts returned to normal following discontinuation of indapamide.