Thiazide-like diuretics indapamide

Renal function impairment Use with caution in severe renal disease because these agents may precipitate azotemia. Cumulative effects of the drug may develop in patients with impaired renal function. Monitor renal function periodically. Metolazone is the only thiazide-like diuretic that may produce diuresis in patients with GFR less than 20 mL/min. Indapamide may also be useful in patients with impaired renal function. 

Indapamide is a thiazide-like diuretic. Although it was introduced as a specific antihypertensive drug without appreciable diuretic action, the effects of indapamide are no different from those of bendroflume-thiazide. 

Thiazides reduce the blood pressure (Chapter 11). Initially, the reduction reflects the reduction of blood volume, but with continued use these agents appear to reduce vascular resistance as well. The antihj rtensive effect is modest but significant and is maximal at doses lower than the maximal diuretic dosage. Compared with older thiazides and thiazide-like agents, indapamide may have a greater ratio of vasodilating effect relative to its sodium diuretic effect. 

Further investigations in this area led to the preparation of a range of compounds classified as thiazide-like diuretics, e.g. indapamide, metolazone and chlortalidone, and other compounds such as furosemide (Fig. 12.24). 

Uses of indapamide inciude the treatment of essentiai hypertension and edema resulting from congestive heart failure. Like metolazone. indapamide is an effective diuretic drug when GFR faiis beiow 40 mL/min. The duration of action is approximately 24 hours, with the normal oral adult dosage starting at 2.5 mg given each morning. The dose may be increased to 5.0 mg/day, but doses beyond this ievei do not appear to provide additional results. Effects on urine content and side effects are similar to effects induced by thiazide diuretics. 

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