Abstract
Indapamide sustained release (SR) 1.5mg is a new galenic formulation that is characterised by a relatively constant plasma concentration at steady state, with only minor fluctuations during the 24-hour period.
A dose-titration study of 3 doses of indapamide SR (1.5, 2 and 2.5mg) given once daily has shown that the 3 dosages are equipotent in lowering blood pressure, and have an effect similar to that of indapamide immediate-release (IR) 2.5mg; all were statistically more effective than placebo. The percentage of hypertensive patients whose serum potassium was less than 3.4 mmol/L was significantly lower after indapamide SR 1.5mg than after indapamide IR 2.5mg. Neither indapamide formulation had any significant effects on lipid profile, glucose, urea and serum creatinine; only uric acid was slightly raised during the 2-month study.
In an equivalence study, indapamide SR 1.5mg and IR 2.5mg produced similar blood pressure reductions (within the equivalence limit of ±5mm Hg), whereas the percentage of patients whose serum potassium fell to less than 3.4 mmol/L was lower in the IR 1.5mg group than in the SR 2.5mg group.
Antihypertensive treatment with indapamide SR 1.5mg once daily produced reductions in blood pressure in elderly patients with systolic/diastolic or isolated systolic hypertension that were similar to reductions with amlodipine 5 mg/day.
The incidence of adverse effects was very low in all studies with indapamide SR 1.5mg and very similar to that in the placebo group, confirming thereby the improvement in the efficacy : tolerance ratio with the new indapamide compound.
Similar content being viewed by others
References
Hollander W, Wilkins RW. Chlorothiazide: a new type of drug for the treatment of hypertension. BMQ 1957; 8: 68–75
Weil JV, Chidsey CA. Plasma volume expansion resulting from interference with adrenergic function in normal man. Circulation 1968; 37: 54–61
Finnerty Jr FA, Davidov M, Mroczek WJ, et al. Influence of extracellular fluid volume on response to antihypertensive drugs. Circ Res 1970; 26 Suppl. 1: 71–80
Veterans Administration Cooperative Study Group on Anti-hypertensive Agents. Effects of treatment on morbidity in hypertension. Results in patients with diastolic averaging 115 through 129 mmHg. JAMA 1967; 202: 1028–34
MacMahon S, Rodgers A. The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives. Clin Exp Hypertens 1993; 15: 967–78
The fifth report of the Joint National Committee on detection, evaluation and treatment of high blood pressure (JNC V). Arch Intern Med 1993; 153(2): 154–83
The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC VI). Arch Intern Med 1997; 157(21): 2413–46
MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for regression dilution bias. Lancet 1990; 335: 765–74
Kaplan NM. Treatment of hypertension: rationale and goals. In: Kaplan NM, editor. Clinical hypertension. 6th ed. Baltimore: Williams & Wilkins, 1994: 145–70
McVeigh G, Galloway D, Johnston D. The case for low dose diuretics in hypertension: comparison of low and conventional doses of cyclopenthiazide. BMJ 1988; 297: 95–8
Carlsen JE, Kober L, Torp-Pederson C, et al. Relation between dose of bendrofluazide, antihypertensive effect, and adverse biochemical effects. BMJ 1990; 300: 975–8
Johnston GD, Wilson R, McDermott BJ, et al. Low-dose cyclopenthiazide in the treatment of hypertension: a one-year community-based study. Q JMed 1991; 78: 135–43
Harper R, Ennis CN, Sheridan B, et al. Effects of low dose versus conventional dose thiazide diuretic on insulin action in essential hypertension. BMJ 1994; 309: 226–30
Hall WD, Weber MA, Ferdinand K, et al. Lower dose diuretic therapy in the treatment of patients with mild to moderate hypertension. J Hum Hypertens 1994; 8: 571–5
Andren L, Weiner L, Svensson A, et al. Enalapril with either a ‘very low’ or ‘low’ dose of hydrochlorothiazide is equally effective in essential hypertension. A double-blind trial in 100 hypertensive patients. J Hypertens 1983; 1 Suppl. 2: 384–6
Frishman WH, Bryzinski BS, Coulson LR, et al. A multifactorial trial design to assess combination therapy in hypertension. Arch Intern Med 1994; 154: 1461–8
Yakovlevitch M, Black HR. Resistant hypertension in tertiary care clinic. Arch Intern Med 1991; 151: 1786–92
1993 guidelines for the management of mild hypertension. Memorandum from a World Health Organization/International Society of Hypertension Meeting. Guidelines Subcommittee of the WHO/ISH Mild Hypertension Liaison Committee. Hypertension 1993; 22(3): 392–403
Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet 1990; 335: 827–38
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug-treatment in older persons with isolated systolic hypertension. JAMA 1991; 265: 3255–64
Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1992; 304: 405–12
Leonetti G, Rappelli A, Salvetti A, et al. Long-term effects of indapamide: final results of a 2-year Italian multicenter study in systemic hypertension. Am J Cardiol 1990; 65: 67H-71
Chaffman M, Heel RC, Brodgen RN, et al. Indapamide: a review of its pharmacodynamic properties and therapeutic efficacy in hypertension. Drugs 1988; 28: 121–249
Senior R, Imbs JL, Bory M, et al. Indapamide reduces hypertensive left ventricular hypertrophy: an international multicenter study. J Cardiovasc Pharmacol 1993; 22 Suppl. 6: S106–10
Carey PA, Sheridan DJ, de Cordoue A, et al. Effect of indapamide on left ventricular hypertrophy in hypertension: a meta-analysis. Am J Cardiol 1996; 17B–9
Ames RP. A comparison of blood lipid and blood pressure responses during treatment of systemic hypertension with indapamide and with thiazides. Am J Cardiol 1996; 77: 12B-6
Leonetti G, Rappelli A, Salvetti A, et al. Tolerability and well-being with indapamide in the treatment of mild-moderate hypertension. Am J Med 1988; 84 Suppl 1B: 59–64
Asmar R, Guez D, Malbezin M, et al. Therapeutic benefit of a low dose of indapamide: results of a double-blind against placebo European controlled study [in French]. Arch Mal Coeur Vaiss 1995; 88: 1083–7
Ambrosioni E, Safar M, Degaute JP, et al. Low-dose antihypertensive therapy with 1.5 mg sustained-release indapamide: results of randomized double-blind controlled studies. J Hypertens 1998; 16: 1677–84
Staessen JA, Fagard R, Thiys L, et al. A consensus view on the technique of ambulatory blood pressure monitoring. Hypertension 1995; 261: 912–8
Parati G, Pomidossi G, Albini F, et al. Relationship of 24-hour blood pressure mean and variability to severity of target organ damage in hypertension. J Hypertens 1987; 5: 93–8
Mallion JM, Asmar R, Ambrosioni E, et al. Evaluation of trough-to-peak ratio of indapamide 1.5 mg sustained-release form assessed by ambulatory blood pressure monitoring. Arch Mal Coeur Vaiss 1996; 89 Spec 4: 27–38
Mallion JM, Asmar R, Boutelant S, et al. Twenty-four hour antihypertensive efficacy of indapamide 1.5 mg sustained-release: results of two randomized double-blind controlled studies. J Cardiovasc Pharmacol 1998; 32: 673–8
Meredith PA, Elliott HF. FDA guidelines on trough peak ratios in the evaluation of antihypertensive agents. J Cardiovasc Pharmacol 1994; 23: 526–30
Emeriau JP, Bulpitt CJ, Abate G, et al. Equivalence de l’effet antihypertenseur d’indapamide 1.5 mg comprimé enrobé a libération prolongée (LP) versus hydroclorothiazide 25 mg et versus amlodipine 5 mg dans l’hypertension artérielle du sujet âgé [abstract P36]. Arch Mal Coeur Vaiss 1997; 90: 36
Emeriau JP, Bulpitt CJ, Abate G, et al. Hypertension artérielle systolique isolée du sujet âgé: comparison de l’effet antihypertenseur d’indapamide 1.5 mg comprimé enrobé a libération prolongée (LP) versus hydroclorothiazide 25 mg et versus amlodipine 5 mg [abstract P38]. Arch Mal Coeur Vaiss 1997; 90: 37
Guez D, Mallion JM, Malini PL, et al. Treatment of hypertension with indapamide 1.5mg sustained-release form: synthesis of results [in French]. Arch Mal Coeur Vaiss 1996; 89 (Spec. Issue): 17–25
Schiavi P. Pharmacokinetics of slow and immediate release formulations of indapamide after repeated administration in healthy volunteers. Eur J Drug Metab Pharmacokinet 1996; Special Issue: 41
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Leonetti, G. Clinical Positioning of Indapamide Sustained Release 1.5mg in Management Protocols for Hypertension. Drugs 59 (Suppl 2), 27–38 (2000). https://doi.org/10.2165/00003495-200059002-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-200059002-00004