Xipamide

How it works

It acts mainly at the distal convoluted tubule to inhibit sodium and chloride reabsorption, increasing urinary salt and water excretion and lowering blood pressure.

Prescribing in practice

• It can cause hypokalaemia and other electrolyte disturbances, so potassium and renal function should be checked and corrected, particularly in older or co-medicated patients.
• Use cautiously in gout, diabetes and significant renal or hepatic impairment, as it may worsen glucose control, raise urate and precipitate metabolic disturbance.
• Avoid in patients with a known sulfonamide hypersensitivity given its chemical class.

Monitoring

Monitor serum electrolytes, renal function and blood pressure, with attention to potassium and sodium.

Counselling the patient

• Take in the morning to avoid disturbed sleep from increased urination.
• Report muscle weakness, cramps or marked dizziness, which can signal electrolyte imbalance.
• Maintain adequate fluid intake unless told otherwise.

Evidence & guidelines

Thiazide-like diuretics are established antihypertensive and anti-oedema agents, and current prescribing references support electrolyte monitoring during therapy.