indapamide [Neurosurgery Wiki]

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**Indapamide** is a **thiazide-like diuretic** commonly used to treat **high blood pressure (hypertension)** and sometimes **fluid retention (edema)** associated with heart failure. Though chemically distinct from thiazide diuretics, it has similar effects and is often grouped with them.

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### 🔬 **Mechanism of Action**
Indapamide works on the **distal convoluted tubules** of the kidney by:
- Inhibiting sodium reabsorption,
- Leading to increased excretion of sodium and water,
- Reducing blood volume and peripheral resistance,
→ Resulting in **lower blood pressure**.

Over time, its **vasodilatory effect** becomes more prominent than its diuretic action.

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### 💊 **Clinical Uses**
- **Primary hypertension** (as monotherapy or in combination with other antihypertensives, like ACE inhibitors)
- **Heart failure** (off-label or supportive use)
- May be used in **stroke prevention**, as shown in the **PROGRESS trial** when combined with **perindopril**.

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### 📚 **Evidence: The PROGRESS Trial**
In the **PROGRESS trial**, the combination of **perindopril + indapamide** significantly **reduced the risk of recurrent stroke** compared to placebo or perindopril alone. This supports the idea that **blood pressure reduction** is key in stroke prevention, regardless of initial BP levels.

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### ⚠️ **Common Side Effects**
- **Hypokalemia** (low potassium)
- **Hyponatremia** (low sodium)
- Dizziness or fatigue
- **Elevated uric acid** or glucose levels
- Muscle cramps

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### 🩺 **Monitoring**
- Regular checks of **blood electrolytes** and **kidney function** are recommended.
- Usually taken **once daily**, preferably in the **morning** to avoid nocturia.