Vazamide SR Special Precautions

Patients with Hepatic Impairment: Use of thiazide diuretics may cause hepatic encephalopathy, particularly in case of electrolyte imbalance. Administration of the diuretic must be stopped immediately.
Photosensitivity: Cases have been reported with the use of thiazide and thiazide-related diuretics. Immediately stop the treatment and if use of diuretic is deemed necessary, it is recommended to protect exposed areas to the sun or artificial UVA.
Patients with Rare Hereditary Problems: This formulation contains ingredients that is not recommended for patients with rare hereditary problem such as galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption.
Water to Electrolyte Balance - Plasma Sodium: Plasma Sodium must be monitored regularly especially in the elderly and cirrhotic patients (asymptomatic fall in plasma sodium). All diuretics may cause hyponatremia. Dehydration and orthostatic hypolension may be caused by hyponatremia with hypovolemia. Slight incidence of Secondary Compensatory metabolic alkalosis due to concomitant loss of chloride ions were observed.
Water to Electrolyte Balance - Plasma Potassium: Potassium depletion with hypokalemia is the major risk of thiazide and related diuretics. Regular monitoring is advised especially in the elderly, malnourished, poly-medicated patients, cirrhotic patients with edema and ascites, and coronary artery disease and cardiac failure patients as Indapamide may increase cardiac toxicity of digitalis and risks of arrhythmias (Patients with long QT Interval is at risk whether the origin is congenital or latrogenic). Bradycardia caused by hypokalemia, may onset severe arrhythmia, particularly potentially fatal torsades de pointes. Frequent monitoring of plasma potassium is advised in all the situations mentioned previously.
Water to Electrolyte Balance - Plasma Calcium: Thiazide diuretics may decrease urinary calcium elimination and may cause a slight transitory rise in plasma calcium. Sudden hypercalcemia may be due to previously unrecognized hyperparathyroidism. Withdrawal from treatment is advised before Investigating parathyroid functions.
Blood Glucose: Frequent monitoring of blood glucose is advised in diabetic patients for presence of hypokalemia.
Uric Acid: Use of indapamide in hyperuricemic patients may increase tendency of gout attacks.
Renal Functions and Diuretics: Thiazide and related diuretics are fully effective only when renal function is normal or only minimally impaired (plasma creatinine levels <25 mg/L). Dosage adjustment may be required in the elderly. Hypovolemia due lo loss of water and sodium induced by a diuretic may cause a reduction in the glomerular filtration leading to an increase in blood urea and plasma creatinine. The transitory functional renal insufficiency may worsen in patients with preexisting renal insufficiency.
Athletes: Use of Indapamide may render a positive reaction in doping test.
Effects on the Ability to Drive or Operate Machinery: Indapamide does not affect vigilance but different reactions in relation with the decrease in blood pressure may occur in individual cases, especially at the start of the treatment or when another antihypertensive agent is added. As a result, the ability to drive vehicles or to operate machinery may be impaired.