Indapamide

• Tablets 2.5mg (£0.85)
• Modified-release tablets 1.5mg (£3.40)

Indications

• Hypertension

Dose

• 2.5mg daily in the morning
• 1.5mg modified-release 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 (£0.60)

Indications

• Oedema

Dose

• Initially 5–10mg daily

Metolazone

This entry is under review: A new licensed metolazone product (Xaqua) is available which is not interchangeable with unlicensed metolazone (see note 2).

• Tablets 2.5mg (unlicensed preparation)

Indications

• Oedema

Dose

• 5–10mg daily in the morning, increased if necessary to 20mg daily in resistant oedema, maximum 80mg daily

Notes

1. MHRA Drug Safety Update (January 2023): Xaqua (metolazone) 5mg tablets: exercise caution when switching patients between metolazone preparations
2. Xaqua (metolazone) 5mg tablets are licensed by the MHRA for the treatment of oedema related to congestive heart failure and kidney diseases. Xaqua tablets are not interchangeable with other metolazone preparations; bioavailability is up to approximately two-fold higher than for other metolazone preparations. A dose adjustment may be necessary and individualised titration based on patient's response and tolerability is advised if switching from an alternative metolazone preparation to Xaqua or vice versa.
   1. The recommended dose of Xaqua for oedema is initially 2.5mg once daily, increased if necessary to 5mg once daily (see BNF or Xaqua SmPC for further information)
   2. The 5mg Xaqua dose can be divided into equal halves.
3. 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.
4. 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).

Chlorothiazide

• Suspension 250mg in 5ml (unlicensed preparation)

Notes

1. For use within Plymouth Hospitals NHS Trust