Lozol
indapamide
Pharmacologic class: Thiazide-like diuretic
Therapeutic class: Diuretic, antihypertensive
Pregnancy risk category B
Action
Increases sodium and water excretion by inhibiting sodium reabsorption in distal tubule; enhances excretion of sodium, chloride, potassium, and water. May cause arteriolar vasodilation.
Availability
Tablets: 1.25 mg, 2.5 mg
Indications and dosages
➣ Edema caused by heart failure
Adults: 2.5 mg P.O. daily in morning. After 1 week, may increase to 5 mg/day.
➣ Mild to moderate hypertension
Adults: 1.25 mg P.O. daily in morning. May increase q 4 weeks, up to 5 mg/day.
Contraindications
• Hypersensitivity to drug, other thiazide-like drugs, or tartrazine
• Anuria
Precautions
Use cautiously in:
• renal or severe hepatic impairment, ascites, fluid or electrolyte imbalances, gout, systemic lupus erythematosus, impaired glucose tolerance, hyperparathyroidism, bipolar disorder
• pregnant or breastfeeding patients.
Administration
• Administer with food or milk to reduce GI upset.
• Give early in day to avoid nocturia.
Adverse reactions
CNS: dizziness, light-headedness, headache, restlessness, insomnia, lethargy, fatigue, drowsiness, asthenia, depression, anxiety, nervousness, paresthesia, irritability, agitation
CV: orthostatic hypotension, palpitations, premature ventricular contractions, arrhythmias
EENT: blurred vision, rhinorrhea
GI: nausea, vomiting, diarrhea, constipation, bloating, epigastric distress, gastric irritation, abdominal pain or cramps, dry mouth, anorexia
GU: nocturia, polyuria, glycosuria, erectile dysfunction
Metabolic: dehydration, gout, hyperglycemia, hypokalemia, hypocalcemia, hypomagnesemia, hyponatremia, hypovolemia, hypophosphatemia, hyperuricemia, hypochloremic alkalosis
Musculoskeletal: muscle cramps and spasms
Skin: flushing, rash, urticaria, pruritus, photosensitivity, cutaneous vasculitis, necrotizing vasculitis
Other: weight loss
Interactions
Drug-drug. Amphotericin B, corticosteroids: additive hypokalemia
Antihypertensives, nitrates: additive hypotension
Cholestyramine, colestipol: decreased indapamide absorption
Lithium: decreased lithium excretion, increased risk of lithium toxicity
Sulfonylureas: decreased hypoglycemic efficacy
Drug-diagnostic tests. Bilirubin, blood and urine glucose (in diabetic patients), blood urea nitrogen (BUN), calcium, creatinine, uric acid: increased values Cholesterol, low-density lipoproteins, magnesium, potassium, protein-bound iodine, sodium, triglycerides, urinary calcium: decreased values
Drug-herbs. Ginkgo: decreased antihypertensive effect
Licorice, stimulant laxative herbs (aloe, cascara sagrada, senna): increased risk of hypokalemia
Drug-behaviors. Acute alcohol ingestion: additive hypotension
Sun exposure: increased risk of photosensitivity
Patient monitoring
See Assess for signs and symptoms of hypokalemia, including ventricular arrhythmias, muscle weakness, and cramping.
• Monitor BUN, creatinine, and electrolyte levels.
• Assess daily weight and fluid intake and output.
• Monitor blood pressure response to drug.
• Watch for signs and symptoms of orthostatic hypotension.
Patient teaching
• Advise patient to consume potassium-rich foods, such as oranges, bananas, potatoes, and spinach.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.
• Tell patient to weigh himself daily on same scale at same time of day while wearing similar clothing. Instruct him to report gain of more than 2 lb (0.9 kg) in 1 day or 5 lb (2.2 kg) in 1 week.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
indapamide
(in-dap-a-mide) indapamide,Lozol
(trade name),Lozide
(trade name)Classification
Therapeutic: antihypertensivesPharmacologic: thiazide like diuretics
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (antihypertensive effect)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO (single dose) | unknown | 24 hr | unknown |
| PO (multiple dose) | 1–2 wk | 8–12 wk | up to 8 wk |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness
- drowsiness
- lethargy
Cardiovascular
- arrhythmias
- hypotension
Gastrointestinal
- anorexia
- cramping
- nausea
- vomiting
Dermatologic
- photosensitivity
- rashes
Endocrinologic
- hyperglycemia
Fluid and Electrolyte
- hypokalemia (most frequent)
- dehydration
- hypochloremic alkalosis
- hyponatremia
- hypovolemia
Metabolic
- hyperuricemia (most frequent)
Musculoskeletal
- muscle cramps
Interactions
Drug-Drug interaction
Additive hypotension with other antihypertensives, nitrates, or acute ingestion of alcohol.Additive hypokalemia with corticosteroids, amphotericin B, piperacillin, or ticarcillin.↓ excretion of lithium ; may cause toxicity.Hypokalemia may ↑ risk of digoxin toxicity.Licorice and stimulant laxative herbs (aloe, senna) may ↑ risk of potassium depletion.Route/Dosage
Availability (generic available)
Nursing implications
Nursing assessment
- Monitor BP, intake and output, and daily weight and assess feet, legs, and sacral area for edema daily.
- Assess patient, especially if taking digoxin, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion; report signs of electrolyte imbalance. Patients taking digoxin have an increased risk of digitalis toxicity due to the potassium-depleting effect of the diuretic.
- Assess patient for allergy to sulfonamides.
- Lab Test Considerations: Monitor electrolytes (especially potassium), blood glucose, BUN, serum creatinine, and uric acid levels periodically during therapy. May cause ↓ potassium, sodium, and chloride concentrations. May ↑ serum glucose; diabetic patients may require ↑ oral hypoglycemic or insulin dose. ↑ uric acid level an average of 1.0 mg/100 mL; may precipitate an episode of gout.
Potential Nursing Diagnoses
Excess fluid volume (Indications)Risk for deficient fluid volume (Side Effects)
Implementation
- Administer in the morning to prevent disruption of sleep cycle.
- Oral: May be given with food or milk to minimize GI irritation.
Patient/Family Teaching
- Instruct patient to take this medication at the same time each day. Take missed doses as soon as remembered but not just before next dose is due. Do not double doses. Advise patients using indapamide for hypertension to continue taking the medication even if feeling well. Indapamide controls but does not cure hypertension.
- Caution patient to change positions slowly to minimize orthostatic hypotension. This may be potentiated by alcohol.
- Advise patient to use sunscreen (avoid those containing PABA) and protective clothing when in the sun to prevent photosensitivity reactions.
- Instruct patient to follow a diet high in potassium (see ).
- Advise patient to report muscle weakness, cramps, nausea, or dizziness to health care professional.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products,.
- Emphasize the importance of routine follow-up exams.
- Hypertension: Instruct patient and family on proper technique of BP monitoring. Advise them to check BP at least weekly and to report significant changes.
- Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, regular exercise, smoking cessation, moderation of alcohol consumption, and stress management).
Evaluation/Desired Outcomes
- Control of hypertension.
- Decrease in edema secondary to HF.