Thiazide diuretics · Cardiovascular
Indapamide
Lozide® · Natrilix®(brand names vary by market)
A thiazide-like diuretic that keeps working when the kidney is tired.
Also: modified release
Mechanism
Thiazide-like agent inhibiting the sodium-chloride cotransporter in the distal tubule, with additional direct vasodilator effect at antihypertensive doses.
Indications
- Hypertension
- Oedema
Formulations
Dosing concepts
Renal impairment
Thiazide-like agents retain more antihypertensive effect at lower eGFR than hydrochlorothiazide does, which is why they persist further into chronic kidney disease.
Low dose
The blood-pressure effect plateaus early while the metabolic effects keep climbing, so higher doses buy side effects rather than control.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~90%
- Half-life
- 14 to 18 h
- Elimination
- hepatic: Largely metabolised, unlike the renally cleared thiazides
- Protein binding
- ~75%
Adverse effects
- Hyponatremiacommon & seriousMore frequent than with hydrochlorothiazide, and the classic cause of confusion in an older woman weeks after starting.
- Hypokalemiacommon
- Hyperuricemia and goutcommon
- QT prolongation through electrolyte lossserious
- Photosensitivitycommon
Contraindications & precautions
Contraindications
- Severe renal or hepatic impairment
- Refractory hypokalemia or hyponatremia
- Sulfonamide hypersensitivity, relative
Precautions
- Older adults
- Concurrent QT-prolonging drugs
- Gout
- Lithium
Interactions
Monitoring
Sodium and potassium
The two electrolytes it moves · Baseline, 2 to 4 weeks after starting, then periodically
Urate in anyone with gout
It raises it and can precipitate a flare
Blood pressure
Effect
Counselling points
- Take it in the morning so you are not up in the night.
- Bloods a few weeks after starting.
- Tell us about confusion, unsteadiness or unusual drowsiness: these can be a low sodium.
- Use sun protection.
Clinical pearls
- Thiazide hyponatremia typically appears within the first weeks, and older women are at the highest risk. A confused older patient a fortnight after a new antihypertensive needs a sodium before anything else.
- Thiazide-like agents (indapamide, chlorthalidone) have better outcome evidence than hydrochlorothiazide and outlast it as the eGFR falls.
References & review
- Indapamide product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.