Thiazide-like diuretic Pregnancy: Preferably avoid in pregnancy (limited data; prolonged thiazide exposure in the third trimester can reduce uteroplacental blood flow and cause growth retardation). Should not be used during breast-feeding.

Indapamide

Brand names: Natrilix

Used in: Hypertension

Indapamide is a thiazide-like diuretic used for hypertension.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One tablet containing 2.5 mg indapamide once daily

Route: Oral

Frequency: Once daily in the morning

Max: 2.5 mg daily (doses above 2.5 mg give no appreciable additional antihypertensive effect and are not recommended)

For hypertension. The antihypertensive action is progressive and may not reach maximum until several months after starting. If a single daily tablet does not sufficiently reduce blood pressure, another antihypertensive agent may be added (e.g. beta-blocker, ACE inhibitor, methyldopa, clonidine); co-administration with diuretics that can cause hypokalaemia is not recommended. Contraindicated in severe renal failure and severe hepatic impairment. In the elderly, treat only when renal function is normal or minimally impaired. Not recommended in children and adolescents due to lack of safety/efficacy data.

Dose adjustments

Renal

Contraindicated in severe renal failure (creatinine clearance below 30 mL/min); thiazide-related diuretics are fully effective only when renal function is normal or minimally impaired.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE & ADMINISTRATION Hypertension : The adult starting indapamide dose for hypertension is 1.25 mg as a single daily dose taken in the morning. If the response to 1.25 mg is not satisfactory after 4 weeks, the daily dose may be increased to 2.5 mg taken once daily. If the response to 2.5 mg is not satisfactory after 4 weeks, the daily dose may be increased to 5.0 mg taken once daily, but adding another antihypertensive should be considered. Edema of Congestive Heart Failure : The adult starting indapamide dose for edema of congestive heart failure is 2.5 mg as a single daily dose taken in the morning. If the response to 2.5 mg is not satisfactory after one week, the daily dose may be …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-06-26. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to indapamide, other sulfonamides, or any excipient
Severe renal failure
Hepatic encephalopathy or severe impairment of liver function
Hypokalaemia (including refractory hypokalaemia)
Porphyria
Addison's disease
Hyponatraemia; hypercalcaemia

Side effects

Hypokalaemia (common; dose-dependent)
Hypersensitivity reactions, mainly maculopapular rashes (common)
Hyponatraemia; hypochloraemia; hypomagnesaemia
Vertigo, fatigue, headache, paraesthesia (rare)
Rare/very rare: blood dyscrasias, arrhythmia and torsade de pointes, pancreatitis, abnormal hepatic function, photosensitivity

Interactions

Lithium - reduced renal clearance may raise plasma lithium and cause toxicity
Other antihypertensive drugs - additive/potentiated blood-pressure lowering
Other diuretics that can cause hypokalaemia - concomitant use not recommended
Drugs that prolong the QT interval / can cause torsades de pointes (risk increased by hypokalaemia)

Clinical monograph

How it works

It acts on the distal tubule to reduce sodium reabsorption, with additional vasodilatory effects, lowering blood pressure.

Prescribing in practice

It can cause hyponatraemia and hypokalaemia — check electrolytes after starting and periodically.
It is the preferred type of thiazide-like diuretic in current UK hypertension guidance.
Use caution in gout (it can raise urate) and review glucose and lipids over time.

Monitoring

Check U&E (sodium, potassium, renal function) after initiation and periodically; monitor blood pressure.

Counselling the patient

Report marked tiredness, cramps, dizziness or confusion (possible low salt or potassium).
Take it in the morning to avoid night-time urination.

Evidence & guidelines

A thiazide-like diuretic recommended for hypertension in NICE NG136, preferred over conventional thiazides.

Reference: NICE NG136; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways