Indapamide - EM Doctors

1. About indapamide

Indapamide is a type of medicine called a diuretic.

Diuretics are sometimes called "water pills/tablets" because they make you pee more.

Indapamide is used to treat high blood pressure (hypertension). It's also sometimes used to treat heart failure.

Indapamide is only available on prescription.

It comes as tablets and slow-release ("modified-release") tablets.

Indapamide sometimes comes mixed with perindopril to also treat high blood pressure.

2. Key facts

It's usual to take indapamide once a day, in the morning.
You can take indapamide with or without food.
The most common side effect of indapamide is a skin rash.
Indapamide is not usually recommended during pregnancy.
Indapamide is also called by the brand names Natrilix, Indipam XL, Rawel XL, Tensaid XL and Alkapamid XL.

3. Who can and can't take indapamide

Indapamide can be taken by adults aged 18 and over.

Indapamide isn't suitable for some people. Tell your doctor if you:

have had an allergic reaction to indapamide or any other medicine in the past
are pregnant or breastfeeding
have liver disease
have kidney disease
have low levels of calcium, potassium or sodium in your blood
have gout
have diabetes
have an inflammatory condition called systemic lupus erythematosus
have heart rhythm problems
have underactive adrenal glands (Addison's disease)
have a rare blood disease called porphyria

4. How and when to take it

It's usual to take it once a day, in the morning.

Do not take indapamide too late in the day (after 4pm) or at night, otherwise you may have to wake up to go to the toilet.

How much will I take?

The usual dose to treat:

heart failure is 2.5mg to 5mg once a day
high blood pressure is 2.5mg once a day - but if you're taking slow-release indapamide, you'll take a lower dose of 1.5mg

If you have trouble swallowing pills, ask your pharmacist or doctor for advice. Do not crush or chew slow-release tablets, as this stops them from working properly.

How to take it

Swallow the tablets whole with a drink of water. You can take indapamide with or without food.

What if I forget to take it?

If you usually take your dose in the morning, take your forgotten dose as soon as you remember, unless it's after 4pm. In this case, skip the missed dose and take your next dose as usual.

Do not take a double dose to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicines.

What if I take too much?

Accidentally taking an extra dose of indapamide is unlikely to harm you.

If you have accidentally taken too much, you may:

feel sick (nausea) or be sick (vomit)
feel very thirsty
have diarrhoea
feel faint, dizzy or weak
feel sleepy
have muscle cramps

If you take too much indapamide by accident, contact your doctor and have the packet with you.

In serious cases you can have fits (seizures) and may need emergency treatment in hospital.

Urgent advice: Go to A&E straight away if you take too much indapamide and feel unwell

Find your nearest A&E department

Do not drive yourself - get someone else to drive you or call for an ambulance.

Take the indapamide box, or the leaflet inside the packet, plus any remaining medicine with you.

5. Side effects

Like all medicines, indapamide can cause side effects, although not everyone gets them. Side effects often get better as your body gets used to the medicine.

Common side effects

These common side effects of indapamide happen in more than 1 in 100 people. They include:

peeing more than normal - most people need to pee a couple of times within a few hours of taking indapamide, and you may also lose a bit of weight as your body loses water
mild skin rash
feeling or being sick
feeling dizzy or faint

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Tell your doctor straight away if you get:

a severe skin reaction including swelling, itching blistering and flu-like symptoms with a high temperature (38C and above)
a severe stomach pain that develops suddenly, feeling or being sick, diarrhoea, indigestion, a high temperature, yellowing of your skin or the whites of your eyes and tenderness or swelling of your stomach - these could be signs of pancreatitis
feeling or being sick, confusion, yellow skin or eyes, dark pee, pale poo, tiredness and loss of appetite - these could be signs of liver disease

Serious allergic reaction

In rare cases, indapamide may cause a serious allergic reaction (anaphylaxis).

Immediate action required: Call 999 or go to A&E if:

you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
you're wheezing
you get tightness in the chest or throat
you have trouble breathing or talking
your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of indapamide. For a full list, see the leaflet inside your medicine packet.

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

peeing more than normal - it's nothing to worry about but, if it's inconvenient for you, change the time you take indapamide to one that better suits you, provided it's no later than 4pm. If peeing a lot is still a problem for you, talk to your pharmacist or doctor.
mild skin rash - it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you. If your skin rash does not go away, speak to your doctor. They may suggest a change of treatment.
feeling or being sick - try taking indapamide after a meal. Try to stick to simple foods and avoid rich or spicy meals. Drink water or squash in small, frequent sips so you don't get dehydrated (ask your doctor how much fluid you can drink). Speak to your doctor if your symptoms continue for more than a week.
feeling confused or dizzy - try sitting or lying down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better. Do not drive or use tools or machinery while you're feeling dizzy or shaky.

7. Pregnancy and breastfeeding

Indapamide isn't normally recommended in pregnancy. However, your doctor may prescribe it if they think the benefits of the medicine outweigh the risks.

If you're trying to get pregnant or already are pregnant, talk to your doctor about the benefits and possible harms of taking indapamide.

It will depend on how many weeks pregnant you are and why you're taking the medicine. There may be other treatments that are safer for you.

Indapamide and breastfeeding

Indapamide isn't normally recommended when breastfeeding. It can reduce the amount of breast milk you produce.

Talk to your doctor, as other medicines might be better while you're breastfeeding.

Non-urgent advice: Tell your doctor if you're:

trying to get pregnant
pregnant
breastfeeding

8. Cautions with other medicines

Some medicines can interfere with the way indapamide works.

If you're taking these medicines, tell your doctor before starting indapamide:

medicines that treat, or might give you, an irregular heartbeat - including amiodarone, digoxin and sotalol
other medicines that treat high blood pressure - like ACE inhibitors such as ramipril, angiotensin receptor blockers such as candesartan, or calcium channel blockers such as amlodipine
medicines that decrease blood pressure, including baclofen, levodopa or clonidine
medicines used to treat mental health problems, including amisulpride, lithium, pimozide and risperidone
medicines that can change the level of potassium in your blood, such as potassium supplements, steroids or other diuretics
painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), including diclofenac, ibuprofen and naproxen

Mixing indapamide with herbal remedies and supplements

Some supplements, such as calcium, can cause side effects if taken with indapamide.

There's very little other information about taking herbal remedies and supplements with indapamide.

Important

For safety, tell your pharmacist or doctor if you're taking any other medicines, including herbal remedies, vitamins or supplements.

9. Common questions

How does indapamide work?

How long does it take to work?

How long does it work for?

How long will I take it for?

Is it safe to take for a long time?

Indapamide is safe to take for a long time.

You will have to see your doctor or nurse every so often to get your blood pressure checked and have blood and urine tests. This is to make sure the chemicals in your blood are balanced properly and your kidneys are working well.

How often you'll need these tests will depend on the reason you're taking indapamide, whether your dose has changed recently or if you have any other health problems.

What will happen if I stop taking it?

What if it doesn't work?

How much fluid should I drink while I'm taking indapamide?

It's usually best to drink normally while you're taking indapamide. A good rule is to drink enough so that you're not thirsty for long periods. Steadily increase the amount you drink when you're exercising and during hot weather.

If your pee's pale or clear, you're probably drinking enough.

However, if you have heart failure or kidney problems, you might need to limit how much fluid you drink. In this case, your doctor or nurse will tell you how much you need to drink each day.

Are there other treatments that could help?

There are lots of other medicines that can help treat high blood pressure, including angiotensin converting enzyme (ACE) inhibitors such as lisinopril, or calcium channel blockers such as amlodipine.

If you have high blood pressure, you'll usually need to take more than one medicine to get the best effect.

Speak to your doctor or pharmacist if you think you would like to try a different treatment.

Is it safe to take indapamide when I'm ill?

If you're ill with a fever (a high temperature above 38C), sweats and shaking, being sick (vomiting) or have severe diarrhoea, contact your doctor as you may need to stop taking indapamide for 1 to 2 days until you are better.

You can start to take it again when you're eating and drinking normally. If you take indapamide when you have an illness that makes you dehydrated, it can make the dehydration worse.

Can I take indapamide to lose weight?

Can I take indapamide before surgery?

Are there similar medicines to indapamide?

Can I drink alcohol with it?

Drinking alcohol can alter your blood pressure and make you feel dizzy or lightheaded.

During the first few days of taking indapamide or after increasing the dose, see how the medicine affects you before you drink any alcohol.

If you feel ok, you can drink alcohol in moderation by following national guidelines of no more than 14 units a week for men and women. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.

If you have high blood pressure, it's best not to drink alcohol in large amounts while you're taking indapamide. It may raise your blood pressure, make you feel dizzy and cause dehydration.

Is there any food or drink I need to avoid?

Will it affect my fertility?

Will it affect my contraception?

Can lifestyle changes help?

You can boost your general health - and the health of your heart - by making some key lifestyle changes. These will also help if you have high blood pressure or heart failure.

Stop smoking - smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid secondhand smoke too.
Drink alcohol sensibly - drinking too much alcohol raises blood pressure over time and also makes heart failure worse. Men and women shouldn't drink more than 14 units of alcohol a week.
Be more active - regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It doesn't need to be too energetic - walking every day can help.
Eat healthily - aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products, and lean proteins. It's a good idea to cut down on salt too, however, it's important not to go on a low-salt (or low-sodium) diet while taking this medicine, as that could make your sodium levels too low. People need salt in their diet, but eating too much salt is the biggest cause of high blood pressure - the more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
Manage stress - when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
Vaccinations - if you have heart failure, it's recommended you have a flu jab every year and a pneumonia vaccination every 5 years. Ask your doctor about these vaccinations. You can have them free on the NHS if you have heart failure.