Thiazide-like diuretics
ATC code: C03BA11 (Indapamide)
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.
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.
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.
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.
Limited data on excretion in breast milk. Diuretics may reduce lactation. Not prescribed to breastfeeding mothers unless essential.
indapamide is evaluated for the following indications with varying evidence strength: Isolated systolic hypertension in the elderly (evidence tier A), Hypertension (evidence tier A). See the full indication matrix with dosing and citations above on this page.
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.
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.
Limited data on excretion in breast milk. Diuretics may reduce lactation. Not prescribed to breastfeeding mothers unless essential.
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.