Health & Fitness Indapamide and other medicines: which combinations are safe?

21:50  17 october  2020
21:50  17 october  2020 Source:   netdoctor.co.uk

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Find out if it's OK to take OTC medicines with indapamide and how it may affect other medicines you're already taking, for example indapamide and ramipril © Yulia Reznikov - Getty Images Find out if it's OK to take OTC medicines with indapamide and how it may affect other medicines you're already taking, for example indapamide and ramipril

It's important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with indapamide.

Similarly, check with your doctor or pharmacist before taking any new medicines while you're taking indapamide, to make sure that the combination is safe.

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Indapamide is likely to have an additive effect with other medicines that decrease blood pressure, particularly medicines used to treat high blood pressure (antihypertensives). This may cause dizziness, which can usually be relieved by lying down until the symptoms pass.

If you frequently feel dizzy while taking indapamide with other medicines that lower blood pressure you should let your doctor know, as your doses may need adjusting. Other medicines that decrease blood pressure include the following:

  • ACE inhibitors, eg ramipril
  • aldesleukin
  • alpha-blockers such as prazosin
  • alprostadil
  • angiotensin II receptor antagonists such as losartan
  • antipsychotics such as chlorpromazine
  • benzodiazepines, eg temazepam, diazepam
  • baclofen
  • beta-blockers such as propranolol
  • calcium-channel blockers such as amlodipine, verapamil, nifedipine
  • clonidine
  • diazoxide
  • other diuretics, eg furosemide
  • dopamine agonists for Parkinson's, eg bromocriptine, apomorphine
  • hydralazine
  • levodopa
  • MAOI antidepressants, eg phenelzine
  • methyldopa
  • minoxidil
  • moxisylyte
  • moxonidine
  • nicorandil
  • nitrates, eg glyceryl trinitrate
  • tizanidine
  • tricyclic antidepressants, eg amitriptyline.

Indapamide can increase the amount of calcium in your blood. If you're taking calcium or vitamin D supplements, or regularly take large amounts of calcium-containing antacids, your doctor may want to monitor the level of calcium in your blood to make sure it doesn't rise too high. Taking occasional antacids with indapamide shouldn't cause any problems, but check with your doctor or pharmacist before taking calcium or vitamin D supplements on a regular basis.

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Indapamide can lower the amount of potassium in your blood. This is more likely to be a problem if you take indapamide with other medicines that can lower potassium, such as the following:

  • acetazolamide
  • aminophylline
  • amphotericin
  • beta 2 agonists, eg salbutamol, terbutaline
  • corticosteroids, such as hydrocortisone and prednisolone
  • stimulant laxatives such as senna or bisacodyl (if used excessively)
  • other diuretics, eg furosemide
  • reboxetine
  • theophylline.

If the level of potassium in your blood falls too low, this can increase the risk of side effects on the heart caused by certain other medicines, such as the following:

  • digoxin
  • medicines for abnormal heart rhythms (antiarrhythmics), eg amiodarone, flecainide, sotalol, disopyramide
  • certain antipsychotic medicines, eg amisulpride, sertindole, pimozide.

The following medicines may oppose the blood pressure lowering effect of indapamide:

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  • corticosteroids, such as dexamethasone or prednisolone
  • oestrogens, such as those in the contraceptive pill
  • regular use of non-steroidal anti-inflammatory painkillers (NSAIDs) such as aspirin,ibuprofen, diclofenac or indometacin. Occasional painkilling doses of these medicines are unlikely to have a significant effect on your blood pressure. However, taking this type of painkiller with indapamide can increase the risk of getting side effects on your kidneys, so you should always check with your doctor or pharmacist before taking one of these. It's fine to take paracetamol with indapamide.

Diuretics can sometimes increase blood glucose levels and people with diabetes may therefore need increases in their dose of insulin or antidiabetic tablets while taking indapamide. If you have diabetes you should talk to your doctor about this. You may need to monitor your blood sugar levels more frequently.

Indapamide reduces the ability of the body to remove the medicine lithium. As this can increase the blood level of lithium and the risk of its side effects, indapamide should not usually be taken by people taking lithium. If your doctor thinks it is essential, your lithium level should be closely monitored.

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There may be an increased risk of side effects on the kidneys if indapamide is taken with ciclosporin.

There may be an increased risk of allergic reactions to allopurinol in people taking thiazide diuretics such as indapamide, particularly if they also have any kidney problems.

Last updated: 17.10.2020

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