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Thiazide-like diuretic Pregnancy: SPC section 4.6: there is no experience with the use of xipamide during pregnancy; in animal studies, reproduction toxic effects occurred. Thiazide diuretics pass the placenta and may lead to electrolyte changes, hypoglycaemia, haemolytic anaemia and thrombocytopenia in the unborn or newborn child; diuretics like xipamide are contraindicated during pregnancy in principle, are not to be used under any circumstances for treatment of pregnancy-related or physiological oedemas, and thiazides and related diuretics should not be used to treat hypertension. Breast-feeding: since it is unknown whether xipamide passes into human breast milk, Diurexan is contraindicated during the lactation period.

Xipamide

Brand names: Diurexan

Xipamide is a thiazide-like (sulfonamide) diuretic used in the management of hypertension and oedema.

Adult dose

Dose: Treatment of hypertension (alone or as an adjunct to other antihypertensive drugs), adults: 1 tablet (20 mg; each Diurexan tablet contains xipamide 20 mg) daily as a single early morning dose; when used with other antihypertensive therapy the same 20 mg single early morning dose is maintained. Use as a diuretic, adults: initial phase usual dose 2 tablets (40 mg) daily in a single early morning dose; depending on response the dose may be lowered to 1 tablet (20 mg) daily once sufficient control of oedema is achieved; higher doses, up to 4 tablets daily (80 mg), may be employed in resistant cases.
Route: Oral
Frequency: Once daily, as a single early morning dose
Max: 80 mg daily (4 tablets) in resistant cases, when used as a diuretic
The pinned product is DIUREXAN TABLETS 20MG (PL463020127, Viatris Products Limited); section 4.1: 'For the treatment of hypertension, either alone or as an adjunct to treatment with anti-hypertensive drugs. For use as a diuretic.' The 80 mg ceiling is printed only for the diuretic use ('Higher doses, up to 4 tablets daily (80 mg), may be employed in resistant cases'); the SPC prints no maximum for the hypertension indication, which stays at the single 20 mg daily dose. Children: 'No dose recommended' for both indications, so paedDose is null. Elderly: section 4.2 refers to 'Precautions' (section 4.4) with no separate dose figure. Section 4.4: sodium plasma level to be controlled before start of therapy and at regular intervals, serum electrolytes (in particular potassium, sodium, calcium), bicarbonate, creatinine, urea, uric acid and blood sugar to be controlled regularly; first potassium control during the first week in risk groups. TRUNCATION: sections 4.5 and 4.8 were cut off at the source-fetch limit (4.5 during the ACE inhibitor entry, 4.8 during the 'therapy should be discontinued in case of' list), and no 4.9 or later section was retrieved - the interaction and side-effect lists below may be incomplete. Contraindicated in pregnancy and lactation (section 4.3).

Dose adjustments

Renal

SPC section 4.3: contraindicated in severe renal insufficiency. Section 4.4: thiazide and related substances are only fully effective with normal or at most slightly impaired renal function (creatinine serum level <25 mg/l or <220 μmol/l in adults); hypovolaemia from diuresis may aggravate pre-existing renal insufficiency; discontinue in therapy-resistant decompensation of the electrolyte balance. No dose-reduction figure is printed.

Hepatic

SPC section 4.3: contraindicated in precomatose states associated with liver cirrhosis. Section 4.4: in patients with liver disease, thiazide diuretics and related substances may cause hepatic encephalopathy - treatment with Diurexan must then be discontinued immediately; elderly patients and patients with liver cirrhosis must be closely monitored for hyponatraemia. No dose-reduction figure is printed.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Severe electrolyte deficiency
  • Precomatose states associated with liver cirrhosis
  • Severe renal insufficiency
  • Hypersensitivity to xipamide or to any of the excipients
  • Untreated Addison's disease
  • Hypercalcaemia
  • Pre-existing hypovolaemia
  • Symptomatic hyperuricaemia
  • Pregnancy and lactation

Side effects

  • Hypokalaemia (very common) which may become apparent with nausea, vomiting, ECG changes, increased sensitivity to glycosides, arrhythmia or hypotonia of the skeletal muscles
  • Common: lethargy, anxiety, agitation; headache, dizziness, dry mouth, fatigue, sweating; palpitation; orthostatic hypotension; upper abdominal discomfort, cramping abdominal pain, diarrhoea, constipation; muscle spasms/cramps
  • Common: disturbances in the electrolytes and water balance such as dehydration, hyponatraemia, hypomagnesaemia, hypochloremic alkalosis; reversible increase in urea and creatinine, particularly at the beginning of treatment; increased serum uric acid and triggering of acute gouty arthritis in predisposed patients
  • Uncommon: photosensitivity reactions
  • Rare: hyperlipidaemia; minor visual disturbances and aggravation of existing myopia; haemorrhagic pancreatitis; acute cholecystitis in pre-existing cholelithiasis; allergic skin reactions (pruritus, erythema, urticaria); anaphylactoid reactions
  • Very rare: thrombocytopenia, leukopenia, agranulocytosis, aplastic anaemia; jaundice; acute interstitial nephritis
  • Excessive diuresis: haemoconcentration from hypovolaemia, and in rare cases convulsions, somnolence, confusional state and circulatory collapse; a latent diabetes mellitus may manifest
  • Choroidal effusion with visual field defect, transient myopia and acute angle-closure glaucoma (sulfonamide-derivative class effect)
  • This side-effect list may be incomplete — check the full SPC.

Interactions

  • Other diuretics, antihypertensive agents, beta-adrenergic blockers, nitrates, vasodilators, barbiturates, phenothiazines, tricyclic antidepressants or alcohol - may intensify the antihypertensive effect
  • Loop diuretics - increased risk of disturbances in electrolytes and fluid balance; adequate monitoring required
  • Antidiabetic agents, uricosuric substances, noradrenaline and adrenaline - effects may be reduced
  • Lithium - not recommended: cardiotoxic and neurotoxic effects of lithium intensified; if diuretic treatment is essential, monitor the lithium level closely and adjust the dose
  • Sultopride - not recommended: increased risk of ventricular arrhythmias, especially torsade de pointes (hypokalaemia a predisposing factor)
  • Torsade de pointes-inducing substances (class Ia and class III antiarrhythmics, certain antipsychotics, bepridil, cisapride, erythromycin i.v., moxifloxacin and others) - increased risk of ventricular arrhythmias; test for hypokalaemia before therapy, consider ECG and electrolyte monitoring
  • NSAIDs including COX 2 inhibitors, high dose salicylic acid (>3g/day) - possible reduction of the antihypertensive effect; risk of acute renal failure in dehydration; ensure sufficient fluid supply and control renal function at therapy start
  • ACE inhibitors - risk of a large drop in blood pressure and/or acute renal failure at therapy start in patients with pre-existing sodium deficiency (entry truncated at the source-fetch limit - further interactions may exist; review the full SPC)

Monitoring

  • Sodium plasma level before start of therapy and at regular intervals during treatment - hyponatraemia may be asymptomatic at first; elderly patients and patients with liver cirrhosis need close monitoring
  • Serum electrolytes (in particular potassium, sodium, calcium), bicarbonate, creatinine, urea, uric acid and blood sugar to be controlled regularly; potassium substitution may become necessary, particularly in elderly patients with insufficient potassium intake
  • Hypokalaemia (potassium plasma level < 3.4 mmol/l) must be avoided, particularly with larger fluid loss and in risk groups; frequent potassium control with the first control in the first week after beginning therapy in high-risk patients, including those with congenital or iatrogenic prolonged QT interval
  • Blood sugar closely in diabetic patients with concomitant hypokalaemia; patients with hyperuricaemia may show an increased tendency toward acute gouty arthritis
  • Stop xipamide before examination of parathyroid gland function (thiazide-like drugs can raise plasma calcium)
  • Acute onset of decreased visual acuity or ocular pain (acute angle-closure glaucoma): discontinue as rapidly as possible; photosensitivity reaction: discontinue xipamide
  • Caution in severe coronary or cerebral arteriosclerosis and in prostatic hypertrophy (increased risk of urinary retention)

Clinical monograph

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.

Reference: 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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