2.2.1 Thiazides and related diuretics

Indapamide
  • Tablets 2.5mg (£1.30)

Indications

Dose

  • 2.5mg daily in the morning

Notes

  1. In hypertension the dose response to thiazides is flat and increasing the dose brings little benefit.
  2. Indapamide is the formulary choice thiazide diuretic, patients whose blood pressure is well controlled with bendroflumethiazide may remain on treatment.
Bendroflumethiazide
  • Tablets 2.5mg (£0.67)

Indications

Dose

  • Initially 5–10mg daily
Metolazone
  • Tablets 2.5mg (unlicensed special)

Indications

Notes

  1. Metolazone may be useful in combination with furosemide for refractory oedema. It may cause profound diuresis and potassium loss; close monitoring is essential, with initiation preferably in hospital.
  2. Due to the high cost of an unlicensed preparation metolazone should be reserved for patients with eGFR less than 30mL/min/1.73m2 with fluid overload (adjunct to loop diuretic therapy).
  3. The British Society for Heart Failure recommends bendroflumethiazide as an alternative to metolazone (advice not applicable to renal patients).

 

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