Pharmacology · Thiazide and thiazide-like diuretics

Indapamide !

A thiazide-like diuretic used mainly for high blood pressure. It lowers vascular resistance with little effect on heart output.

Updated 2026-11-01

Class: Thiazide and thiazide-like diuretics
Transporter: Na⁺-Cl⁻ cotransporter (NCC) of the distal convoluted tubule
ATC code: C03BA11

Na⁺-Cl⁻ cotransporter (NCC) of the distal convoluted tubuleIndapamide

The figure shows one of indapamide's two mirror-image forms (the S form) bound to the human NCC; the medicine is a mixture of both.

Target in 3D: Na⁺-Cl⁻ cotransporter (NCC) of the distal convoluted tubule. PDB structure 8VPN (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Indapamide, an indoline sulfonamide, blocks the Na⁺-Cl⁻ cotransporter (NCC) in the distal convoluted tubule, so more sodium and chloride are lost in the urine and potassium is lost downstream. It lowers peripheral vascular resistance with little change in cardiac output, rate or rhythm.

Indapamide blocks NCC in the distal tubule
More Na⁺ and Cl⁻ lost; K⁺ lost downstream
Peripheral vascular resistance falls
Blood pressure falls with little change in cardiac output

Pharmacokinetics

Metabolism: Extensively metabolised; little is excreted unchanged
Elimination: Urine and probably the bile
Half-life: About 14 hours in whole blood

Indications

High blood pressure, alone or combined Arterial hypertension →
Salt and fluid retention in heart failure Heart failure →

Adverse effects

Common

Hypokalaemia
Hyponatraemia
Headache and dizziness
Muscle cramps
High uric acid

Contraindications

Anuria
Hypersensitivity to indapamide or other sulfonamide-derived drugs

Key interactions

Lithium: Less lithium clearance and risk of toxicity
Digoxin: Hypokalaemia increases digoxin toxicity
Other antihypertensives: Additive lowering of blood pressure

What is monitored

Sodium and potassium
Blood pressure
Uric acid and glucose

Nursing care

Before giving: blood pressure, sodium and potassium.
Watch for confusion, weakness or cramps (low sodium or potassium), especially in older adults.
Teach: take in the morning, rise slowly, report muscle weakness or confusion.

Pregnancy and breastfeeding

Used only for oedema from pathological causes, not for ordinary oedema of pregnancy.

Test yourself

Think of the answer, then tap the question to see it.

Which transporter does indapamide block?

The Na⁺-Cl⁻ cotransporter (NCC) of the distal convoluted tubule, like thiazides.

Which electrolyte problems are linked to indapamide?

Hypokalaemia and hyponatraemia; the risk rises with higher exposure.

Why is indapamide avoided in sulfonamide allergy?

It is a sulfonamide derivative, and hypersensitivity to other sulfonamide-derived drugs is a contraindication.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - INDAPAMIDE tablet, film coated (DailyMed (U.S. National Library of Medicine), 2026); Indapamide: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); RCSB PDB - 8VPN: Phosphorylated human NCC in complex with indapamide (RCSB Protein Data Bank, 2026).

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Representative model, for educational purposes only.