Dapa-tabs

Dapa-tabs - Precautions | Side Effects

This article was medically reviewed by M.Pharm, Marko Tanaskovic on Mon, 13 Apr 2020. To read more about an author, click here.

Dapa-tabs is a drug that contains indapamide as the active substance. It belongs to a group of medicines called diuretics, which have antihypertensive effects (lowers high blood pressure).

Dapa-tabs is indicated in the treatment of hypertension as well as in the treatment of fluid and sodium retention in patients with congestive heart failure. Dapa-tabs can be administered alone or in combination with other medicines.

The mechanism of action is based on the blocking of certain proteins involved in the regulation of potassium transport. Potassium plays a very important role in the regulation of heart rate. This drug is also thought to stimulate the synthesis of prostaglandins that have vasodilatory effects (wider blood vessels) which also lower blood pressure.

Pharmacokinetics

Dapa-tabs is largely metabolized via the liver. According to the FDA, only 7% of the drug is excreted unchanged in the urine. It is estimated that about 75% of the drug binds to plasma proteins while the half-life of approximately 14 hours in the blood.

Contraindications and Precautions

Dapa-tabs should not be used in patients who are allergic to indapamide or other substances having indoline, as well as patients who have anuria (anuria is defined as passage of less than 100 ml of urine per day).

A study comparing the effects of indapamide and thiazide diuretics (thiazides are considered to be the most widely used diuretics) showed that both types of diuretics have the same antihypertensive effect, with indapamide increasing creatinine clearance, which makes it more beneficial than thiazide diuretics, in patients with mild kidney impairment.

Dapa-tabs should be used with caution in patients with impaired renal or hepatic function, since the elimination of the drug in these patients is slowed, thereby increasing the risk of toxic effects.

Dapa-tabs increase potassium excretion and can lead to hypokalemia. Hypokalemia is defined as decreased levels of potassium in the blood (potassium deficiency) and is a potentially dangerous condition because it can cause severe arrhythmias (irregular heartbeat). Therefore, Dapa-tabs should not be used in patients who already have low levels of potassium in their blood, or in patients who use other medicines that lower the potassium levels. The most common symptoms of hypokalemia include weakness, fatigue, muscle cramps, muscle pain and stiffness, heart palpitations, and mood swings. If you notice these symptoms, contact your doctor immediately.

Dapa-tabs should be used with caution in patients with diabetes. A study published in the American Journal of Hypertension, which involved 64 patients, showed that Dapa-tabs did not significantly affect blood glucose levels. The FDA states that indapamide can increase glucose levels by 6.47 g/dL, which is not considered clinically significant. However, if you notice any symptoms of hyperglycaemia or hypoglycaemia, please contact your doctor immediately.

Dapa-tabs can increase uric acid levels in the blood and therefore should not be used in patients with gout.

Indapamide-induced hyperparathyroidism has been reported and therefore Dapa-tabs should be used with caution in patients who have thyroid problems.

The FDA notes that it should be borne in mind that systemic lupus symptoms may be exacerbated in patients using indapamide, since thiazides exacerbate the symptoms of this disease.

Use of Dapa-tabs During Pregnancy and Breastfeeding

Dapa-tabs belongs to FDA category B - a group of medicines for which animal studies have shown that this medicine is safe and does not cause fetotoxicity. However, you should never take medication on your own during pregnancy. Tell your doctor if you are pregnant or planning a pregnancy.

Breastfeeding should be discontinued while you are on therapy with this medicine because there is no information on whether this drug is excreted in breast milk.

Interactions

The concomitant use of Dapa-tabs with the following medicines is contraindicated or should be avoided, since co-administration with these medicines can cause severe cardiac arrhythmias, which can endanger the patient's life:

  • Antiarrhythmics, such as: amiodarone, dofetilide, and dronedarone
  • Cisapride - a gastroprokinetic drug
  • Dolasetron - a medicine used to prevent nausea and vomiting in patients receiving chemotherapy
  • Ziprasidone - a drug used to treat agitation in schizophrenics

In addition to the medicines listed above, Dapa-tabs should not be used concomitantly with the following medicines:

  • Bepridil - a medicine used to treat angina
  • Fluoroquinolones (antibiotics), such as moxifloxacin and sparfloxacin
  • Non-steroidal anti-inflammatory drugs, such as diclofenac, ibuprofen and ketoprofen
  • Tricyclic antidepressants

It is very important that you inform your physician about all medicines you are using.

Dapa-tabs can be taken independently of the meal.

Side Effects

Dapa-tabs can cause the following side effects:

  • Hepatic encephalopathy
  • Allergic reaction
  • Vomiting
  • Hepatitis
  • Feeling tired
  • Fatigue
  • Dry mouth
  • Constipation
  • Blurred or impaired vision
  • Irregular heartbeat
  • Increased uric acid levels in the blood
  • Decreased potassium and sodium levels in the blood
  • Increase in liver enzyme levels in the blood

Tell your doctor if you are experiencing any side effects.

References

  1. FDA
  2. Madkour H, Gadallah M, Riveline B, et all. Indapamide is superior to thiazide in the preservation of renal function in patients with renal insufficiency and systemic hypertension. Am J Cardiol. 1996. 77(6): 23B-25B.
  3. Kuo SW, Pei-Dee, Hung YJ, et all. Effect of indapamide SR in the treatment of hypertensive patients with type 2 diabetes. Am J Hypertension. 2003. 16(8): 623-8.

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