Volume 176 - Issue 12
Hyponatraemia and hypokalaemia caused by indapamide
Authors: Laurence G Howes, John McEwen and John E Marley
Med J Aust 2002; 176 (12): 53-54. || doi: 10.5694/j.1326-5377.2002.tb04579.x
Published online: 17 June 2002
Published online: 17 June 2002
To the Editor: The recent article by Chapman et al1 and a case report published some years previously in the Journal2 indicated that hyponatraemia may occur during indapamide therapy. However, it should be noted that the data came from spontaneous adverse drug reaction reporting, and therefore can give no indication of the incidence or relative risk of hyponatraemia compared with other diuretics. Nor can it give the incidence of hyponatraemia as a proportion of side effects occurring during indapamide therapy.
The presentation of these data appears to cause some confusion, including an interpretation that hyponatraemia was more common with indapamide therapy than other diuretics.3 However, adverse events may be more likely to be reported for drugs which are usually well tolerated. Hyponatraemia led to discontinuation of therapy in only eight out of 3000 patients in the PROGRESS study.3,4 Previous controlled studies of indapamide (2.5 mg or sustained-release 1.5 mg daily) have found no significant overall changes in serum sodium levels.3
Hyponatraemia associated with indapamide therapy may occur with a recommended dose of 2.5 mg, which does not have a significant diuretic effect. Indapamide appears to be useful for treating central diabetes insipidus, raising the possibility that hyponatraemia occurs because of an inappropriate antidiuretic hormone secretion syndrome.6 Indapamide-related hyponatraemia may be more common in elderly women,1 as is the case for hyponatraemia associated with selective serotonin reuptake inhibitors. Hyponatraemia associated with indapamide therapy appears to be sporadic and uncommon and may be avoided by appropriate monitoring of serum electrolyte levels.
References
- Chapman D, Hanrahan R, McEwen J, Marley JE. Hyponatraemia and hypokalaemia due to indapamide. Med J Aust 2002; 176: 19-21.
- Read SJ, Trenerry HM, Whiting GF. Hyponatraemia and raised creatine kinase level associated with indapamide. Med J Aust 1994; 161: 607-608. CEGGAJGJ
- Woodhead M. TGA issues advice on indapamide. Aust Doctor 2002; 8 Mar: 7. i1149923
- PROGRESS Collaborative Group. Randomised trial of perindopril-based blood-pressure-lowering regimen among 6105 individuals with stroke or transient ischaemic attack. Lancet 2001; 358: 1033-1041. i1149925
- Plante GE, Dessuranult DL. Hypertension in elderly patients. A comparative study between indapamide and hydrocholorothiazide. Am J Med 1988; 84: 98-103.
- PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with stroke or transient ischaemic attack. Lancet 2001; 358: 1033-1041.