Indapamide
Pronunciation: in-DAP-uh-mide.
- Generic name
- indapamide
- Drug class
- Thiazide-like (indoline) diuretic and antihypertensive
- Form
- Tablet (immediate-release 1.25 mg/2.5 mg; prolonged/sustained-release 1.5 mg in the UK, EU, and Australia)
- Route
- Oral
- Legal status
- Prescription-only in all markets reviewed
Availability and supply rules vary by country
Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand
Australia: Natrilix / Natrilix SR (5), Indapamide Hemihydrate Tablets (5) · Full directory
What indapamide is and how it works
Indapamide is an oral thiazide-like diuretic ("water pill") and antihypertensive. It helps the kidneys remove excess salt and water from the body, which lowers blood pressure and, in the United States specifically, is also used to reduce fluid retention (edema) linked to congestive heart failure. (1) (2)
Indapamide does not carry a boxed warning in any of the markets reviewed for this page, but it does have real, dose-related safety signals worth knowing about: it can lower your blood sodium and potassium levels (more so at higher doses), and in the UK/EU label it can also cause a skin reaction to sunlight (photosensitivity) and, rarely, changes to the heart's electrical rhythm. Regular blood tests to check your electrolytes and kidney function are a normal, expected part of taking this medicine long-term.
Mechanism of action: how indapamide works
Indapamide is an indoline-derivative thiazide-like diuretic that acts at the cortical diluting segment of the distal renal tubule, increasing urinary excretion of sodium and chloride and, to a lesser extent, potassium and magnesium, thereby increasing urine output; its antihypertensive effect is thought to involve both this diuretic action and a direct vasodilatory effect on arterial smooth muscle, at doses below those producing a maximal diuretic effect. (1) (2)
What indapamide is used for
Hypertension (high blood pressure)
Used alone or together with other blood-pressure medicines to treat hypertension, in all six markets reviewed. (1) (2)
Salt and fluid retention (edema) in congestive heart failure
In the United States specifically, also indicated for the treatment of salt and fluid retention associated with congestive heart failure, typically at a higher starting dose than for hypertension. This edema indication was not identified in the UK/EU sources reviewed, which describe indapamide for hypertension only. (1)
Before taking indapamide
Do not take / not appropriate for
- Do not take if you have a known hypersensitivity (allergic reaction) to indapamide, or to sulfonamide (sulfa) medicines. (all countries) (1) (2)
- Do not take if you have anuria (produce no urine). (United States) (1)
- Do not take if you have severe kidney failure, hepatic encephalopathy or severe liver impairment, or already have low blood potassium. (United Kingdom, European Union) (2)
Tell your clinician about
- If you have kidney or liver disease.
- If you have gout or a history of high uric acid levels.
- If you have ever had a skin reaction to sunlight (photosensitivity).
- If you have a heart rhythm condition, or take other medicines that can affect heart rhythm (QT interval).
- If you take lithium, digoxin, corticosteroids, or NSAIDs (anti-inflammatory painkillers).
- If you are pregnant, trying to become pregnant, or breastfeeding.
- If you are having blood tests, since indapamide can affect sodium, potassium, calcium, and uric acid results.
How to take indapamide
- Taken by mouth, once daily, generally in the morning.
- Prolonged/sustained-release tablets (1.5 mg, available in the UK, EU, and Australia) should be swallowed whole with water and not chewed or crushed.
- Higher doses do not give extra blood-pressure benefit but do increase the risk of low potassium -- do not take more than your prescribed dose.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)
Missed dose
The evidence dossier for indapamide does not include specific patient-facing missed-dose instructions from any of the six regulator sources reviewed. As general practice for a once-daily oral medicine, take a missed dose as soon as you remember that day, or skip it and continue your normal schedule if it is almost time for your next dose -- do not take a double dose to make up for a missed one. Ask your pharmacist or clinician if unsure.
Overdose
An indapamide overdose can cause excessive fluid and electrolyte loss (low sodium, low potassium, low blood pressure), nausea, vomiting, muscle cramps, dizziness, drowsiness, or confusion. Seek urgent medical attention or contact a poison control service; treatment is supportive, focused on correcting fluid and electrolyte imbalance. (1)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms.
Headache.
What to notice: Headache.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Constipation.
What to notice: Constipation.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Dizziness or lightheadedness.
What to notice: Dizziness or lightheadedness.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Nausea.
What to notice: Nausea.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Fatigue or drowsiness.
What to notice: Fatigue or drowsiness.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Orthostatic hypotension (dizziness on standing).
What to notice: Orthostatic hypotension (dizziness on standing).
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Increased urination and nighttime urination (nocturia).
What to notice: Increased urination and nighttime urination (nocturia).
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Low blood potassium (hypokalaemia).
What to notice: Low blood potassium (hypokalaemia).
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)
Serious warnings
Hyponatremia (low blood sodium), sometimes with hypokalemia — high caution
Symptoms: Dry mouth, thirst, weakness, fatigue, lethargy, drowsiness, muscle cramps, low blood pressure, fast heart rate; in severe cases, confusion.
Action: Severe hyponatremia, sometimes accompanied by low potassium, has been reported at recommended doses, mainly in elderly women, and appears dose-related. Your clinician will check blood electrolytes periodically, especially at higher doses; report the symptoms above promptly. (1)
Hypokalemia (low blood potassium) — high caution
Symptoms: Muscle cramps or weakness, fatigue, irregular heartbeat.
Action: Dose-related and well quantified in the US label: about 20% of patients had potassium below 3.4 mEq/L at the 1.25 mg dose, versus 47% below 3.5 mEq/L at 2.5 mg and 72% below 3.5 mEq/L at 5 mg (note the 1.25 mg cohort was assessed against a slightly different, lower 3.4 mEq/L threshold in the source label). Regular blood potassium monitoring is required, particularly at higher doses, in the elderly, and alongside other medicines that lower potassium (e.g. corticosteroids) or digoxin. (1) (2)
Photosensitivity (sun-sensitivity skin reaction) — moderate caution
Symptoms: Exaggerated sunburn-like skin reaction on sun-exposed skin.
Action: A real, UK/EU-labelled adverse reaction. Use sun protection, and contact your clinician if a photosensitivity reaction occurs during treatment -- your clinician will decide whether indapamide should be stopped. (2)
QT-interval prolongation / abnormal heart rhythm (including torsades de pointes) — moderate caution
Symptoms: Palpitations, dizziness, or fainting.
Action: A caution in the UK/EU label, especially when combined with other medicines that also prolong the QT interval (certain antiarrhythmics, antipsychotics, methadone); torsades de pointes has been reported at an unknown frequency. Tell your clinician about all other medicines you take. (2)
Gout (precipitated by raised uric acid) — moderate caution
Symptoms: Sudden, severe joint pain and swelling, classically in the big toe.
Action: Indapamide raises blood uric acid levels and may precipitate gout attacks in susceptible patients; periodic uric acid monitoring is recommended. (1) (2)
Interactions
- Lithium: not recommended in combination -- indapamide reduces the kidney's clearance of lithium, raising blood lithium levels and the risk of lithium toxicity. (1) (2)
- Other antihypertensive medicines: effects may add together, increasing blood-pressure-lowering effect. (1)
- QT-prolonging medicines (certain antiarrhythmics, antipsychotics, methadone): combined use requires special care because of the risk of abnormal heart rhythm. (2)
- Medicines that lower potassium (corticosteroids, some laxatives, amphotericin B) or digoxin: increased risk of low potassium and related heart-rhythm effects when combined with indapamide. (2)
- NSAIDs (anti-inflammatory painkillers): may reduce indapamide's antihypertensive effect and increase kidney-related risk, particularly in dehydration. (2)
- ACE inhibitors: combined use requires precaution because of the risk of sudden low blood pressure and/or reduced kidney function, particularly if starting with existing low sodium. (2)
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
Use in pregnancy is generally avoided; the US label advises use only if clearly needed, given hazards including fetal/neonatal jaundice and thrombocytopenia, while the UK/EU label advises avoidance altogether. (1) (2) (3) (4) (5) (6)
Breastfeeding
Not recommended during breastfeeding. It is not known whether indapamide passes into human breast milk in the US source reviewed; the UK/EU source advises against breastfeeding during treatment given insufficient safety data. (1) (2) (3) (4) (5) (6)
Children
Safety and effectiveness in children have not been established in the sources reviewed for this dossier. (1) (2) (3) (4) (5) (6)
Elderly
Elderly patients, particularly women, appear to be at higher risk of severe hyponatremia; more frequent electrolyte monitoring is prudent. (1) (2) (3) (4) (5) (6)
Hepatic_impairment
Use with caution in impaired hepatic function, since electrolyte imbalance can precipitate hepatic coma (US label); contraindicated in hepatic encephalopathy or severe hepatic impairment (UK/EU label). (1) (2) (3) (4) (5) (6)
Renal_impairment
Use with caution in severe renal disease, which may worsen azotemia (US label); contraindicated in severe renal failure (UK/EU label). Your clinician will discontinue indapamide if progressive renal impairment develops. (1) (2) (3) (4) (5) (6)
Source_ids
US-DAILYMED-INDAPAMIDE-2026,UK-EMC-INDAPAMIDE-NATRILIX-SR-2026 (1) (2) (3) (4) (5) (6)
Monitoring
Before starting
- Baseline blood sodium, potassium, magnesium, and calcium
- Baseline kidney function
- Baseline uric acid, especially with a history of gout
During treatment
- Periodic serum electrolyte monitoring (sodium, potassium, magnesium, calcium), more frequently in the elderly, in cirrhotic patients, and at higher doses.
- Periodic kidney function monitoring.
- Periodic uric acid monitoring, especially with a history of gout.
- Watch for symptoms of low sodium/potassium: dry mouth, thirst, weakness, fatigue, lethargy, drowsiness, muscle cramps, low blood pressure, fast heart rate.
- Watch for photosensitivity reactions on sun-exposed skin.
Storage
The evidence dossier for indapamide does not include specific storage details from any of the six regulator sources reviewed. As standard practice for oral tablets, store at room temperature, away from moisture and heat, in the original container, out of the sight and reach of children; check the pack for any product-specific storage instructions.
Study the drug class: Thiazide and thiazide-like diuretics
Professional information
Clinician-facing context only, sourced from the current US FDA prescribing information and the UK emc SmPC reviewed for this dossier; verify against the current full label before prescribing.
United States
Indication: Hypertension; salt/fluid retention in congestive heart failure
Dose summary: Hypertension: 1.25 mg once daily, titrate to 2.5 mg then 5 mg at 4-week intervals if needed. CHF-edema: 2.5 mg once daily, titrate to 5 mg after 1 week if needed. No added benefit above 5 mg.
Renal context: Use with caution in severe renal disease; discontinue if progressive renal impairment develops. (1)
United Kingdom / European Union
Indication: Essential hypertension
Dose summary: One 1.5 mg prolonged-release tablet once daily, preferably in the morning; higher doses increase diuresis without added antihypertensive benefit.
Renal context: Contraindicated in severe renal failure. (2)
Hepatic guidance
Contraindicated in hepatic encephalopathy or severe hepatic impairment (UK/EU); use with caution in impaired hepatic function due to risk of electrolyte-imbalance-precipitated hepatic coma (US).
Overdose note
Manage supportively: correct fluid and electrolyte imbalance; no specific antidote. (1) (2)
Frequently asked questions
Is indapamide available in the US, UK, Europe, Canada, Australia, and New Zealand?
Yes. This review confirmed indapamide is authorised and marketed in all six markets reviewed: the United States (generic indapamide tablets), the United Kingdom (Natrilix/Natrilix SR and generics), the European Union (confirmed directly via Ireland's HPRA and France's Fludex), Canada (Lozide and generics including APO-Indapamide and Mylan-Indapamide), Australia (Natrilix, Natrilix SR, and Indapamide Hemihydrate Tablets), and New Zealand (DAPA-TABS). (1) (2) (3) (4) (5) (6)
Does indapamide have a boxed warning?
No. Indapamide does not carry a boxed warning (the FDA's strongest safety warning) in any of the markets reviewed. It does have real, well-documented dose-related risks -- low blood sodium and potassium, and in the UK/EU label, photosensitivity and a QT-prolongation caution -- which is why regular blood tests are part of routine care. (1) (2)
Why do I need blood tests while taking indapamide?
Indapamide can lower blood sodium and potassium levels, and the risk increases at higher doses. In US clinical trials, about 72% of patients on the 5 mg dose had potassium levels below 3.5 mEq/L, compared with about 20% at the lowest 1.25 mg dose (assessed against a slightly lower 3.4 mEq/L threshold for that dose group). Regular blood tests let your clinician catch and correct any imbalance before it causes symptoms. (1)
Can indapamide make me sunburn more easily?
Yes, in a minority of patients. Photosensitivity (an exaggerated skin reaction to sunlight) is a documented adverse reaction in the UK/EU label. Use sun protection, and tell your clinician if you notice unusual skin reactions to sun exposure -- treatment is usually stopped if this occurs. (2)
What is the mechanism of action of indapamide?
Indapamide is an indoline-derivative thiazide-like diuretic that acts at the cortical diluting segment of the distal renal tubule, increasing urinary excretion of sodium and chloride and, to a lesser extent, potassium and magnesium, thereby increasing urine output; its antihypertensive effect is thought to involve both this diuretic action and a direct vasodilatory effect on arterial smooth muscle, at doses below those producing a maximal diuretic effect. (1) (2)
References
- INDAPAMIDE tablet -- full prescribing informationDailyMed (U.S. National Library of Medicine) -- FDA-approved drug labeling · United States · accessed 2026-07-31 · source 1
- Natrilix SR 1.5 mg Tablets -- Summary of Product Characteristics (SmPC)electronic medicines compendium (emc), United Kingdom -- Servier Laboratories Limited · United Kingdom · accessed 2026-07-31 · source 2
- Indapamide product information (Ireland, HPRA) and Fludex (indapamide hemihydrate), France -- ANSM RCP / HASHealth Products Regulatory Authority (HPRA), Ireland, and Haute Autorite de Sante / ANSM, France -- national marketing authorisations · European Union (Ireland and France, as two directly confirmed EU member states) · accessed 2026-07-31 · source 3
- Lozide (indapamide) and generic Indapamide Tablets USP (APO-Indapamide, Mylan-Indapamide, pms-Indapamide, NTP-Indapamide) -- Health Canada Product MonographsHealth Canada -- Product Monograph / Drug Product Database · Canada · accessed 2026-07-31 · source 4
- NATRILIX indapamide hemihydrate 2.5mg tablet (ARTG 45361); NATRILIX SR indapamide hemihydrate 1.5mg tablet (ARTG 66849); Indapamide Hemihydrate Tablets USP 1.25 mg (ARTG 172734, Alphapharm)Therapeutic Goods Administration (TGA), Australia -- Australian Register of Therapeutic Goods (ARTG) · Australia · accessed 2026-07-31 · source 5
- DAPA-TABS (indapamide hemihydrate 2.5 mg) -- New Zealand Data SheetMedsafe (New Zealand regulator) -- New Zealand Data Sheet · New Zealand · accessed 2026-07-31 · source 6
Brand names by country
Single-ingredient indapamide names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Indapamide (generic) (1)FDA approved dailymed confirmed · 1.25 mg, 2.5 mg · multiple manufacturers
United Kingdom
Canada
- LOZIDE
Australia
New Zealand
- DAPA-TABS (6)Medsafe registered confirmed · 2.5 mg · per Medsafe data sheet