Vazamide SR Drug Interactions

Lithium: Concomitant use of diuretics with lithium is not recommended. Careful monitoring of plasma lithium and dose adjustment is required if use of diuretics is necessary.
Torsade de pointes-inducing drugs: Class Ia Antiarrhythmics (quinidine, hydroquinidine, and disopyramide), Class III Antiarrhythmics (amiodarone, sotalol, dofetilide, and ibutilide).
Antipsychotics: Phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, and trifluoperazine), benzamides (amisulpride, sulpiride, sultopride, and tiapride), and butyrophenones (droperidol and haloperidol). These agents increase the risk of ventricular arrhythmias, particularly torsades de pointes (hypokalemia is a risk factor). Plasma electrolytes and ECG monitoring is advised if this combination is used.
NSAIDs (systemic route) including COX-2 selective inhibitors, high dose salicylic acid (≥3 g/day): Concomitant use may decrease the antihypertensive effect of Indapamide. Risk of acute renal failure in dehydrated patients caused by decrease glomerular filtration may occur. Hydrate the patient and monitor renal function.
A.C.E. Inhibitors: Risk of sudden hypotension and/or acute renal failure when treatment with an A.C.E. is initiated in the presence of pre-existing sodium depletion (particularly in patients with renal artery stenosis). Stop diuretic 3 days before starting treatment with A.C.E. inhibitor, and restart a hypokalemic diuretic if necessary; or gradual increment in dosing of A.C.E. inhibitors. In CHF patients, dose adjustment is required if concomitant use with hypokalemic diuretic. Monitor renal function (plasma creatinine) during the first weeks of treatment.
Potassium-depleting Drugs: Use of agents such as Amphotericin B (IV), gluco- and mineralo-corticoids (systemic route), stimulant laxatives, and tetracosactide may increase risk of hypokalemia (additive effect). Monitor plasma potassium and correct, if required. Use non-stimulant laxatives.
Baclofen: Concomitant use may increase the antihypertensive effect of Indapamide. Hydrate the patient and monitor renal function.
Digitalis Preparations: Adjust treatment and/or monitor plasma potassium and ECG as hypokalemia may increase risk to exposure of the toxic effects of digitalis, if used with diuretics.
Allopurinol: Concomitant treatment with indapamide may increase the incidence of hypersensitivity reactions to allopurinol.
Potassium-sparing Diuretics (Amiloride, Spironolactone, and Triamterene): Occurrence of hypokalemia/hyperkalemia particularly in patients with renal failure or diabetes is increased. Plasma potassium and ECG should be monitored.
Metformin: Increased risk of metformin-induced lactic acidosis due to the possibility of functional renal failure associated with diuretics (loop diuretics). Concomitant use of Indapamide with metformin should be avoided if plasma creatinine exceeds 15 mg/L (135 μmol/L) in men and 12 mg/L (110 μmol/L) in women.
lmipramine-like Antidepressants (Neuroleptics): Concomitant use with these agents may cause an additive effect of the antihypertensive effects of Indapamide increasing risk of orthostatic hypotension.
Calcium (Salts): Decreased urinary elimination of calcium may increase risk of hypercalcemia.
Ciclosporin and Tacrolimus: Risk of increased plasma creatinine without any change in circulating cyclosporin levels, even in the absence of water/sodium depletion.
Corticosteroids and Tetracosactide (Systemic route): Concomitant use may lead to decreased antihypertensive effect of Indapamide due to water/sodium retention caused by corticosteroids.