Lozol (indapamide) is a thiazide-like diuretic prescription medication specifically formulated for the management of hypertension (high blood pressure) and edema (fluid retention) associated with congestive heart failure. By promoting the excretion of excess salt and water from the body, it effectively reduces blood volume, thereby lowering blood pressure and alleviating the symptomatic swelling caused by fluid overload. Its targeted mechanism offers a cornerstone therapeutic option within comprehensive cardiovascular treatment plans, aiding in the reduction of long-term cardiovascular risk. Treatment should always be initiated and monitored by a qualified healthcare professional.

Features

• Active Pharmaceutical Ingredient (API): Indapamide 1.25 mg or 2.5 mg
• Pharmacotherapeutic Class: Thiazide-like diuretic / sulfonamide
• Standard Presentation: Film-coated, scored tablets for oral administration
• Mechanism of Action: Primarily acts on the distal convoluted tubule of the nephron to inhibit sodium reabsorption, accompanied by chloride and water excretion
• Onset of Diuretic Action: Typically observed within 1-2 hours post-administration
• Peak Pharmacological Effect: Occurs approximately 2-3 hours following a dose
• Duration of Action: Up to 24 hours, supporting convenient once-daily dosing
• Bioavailability: High, exceeding 90% following oral ingestion
• Protein Binding: Extensively bound (71-79%) to plasma proteins
• Metabolism: Undergoes extensive hepatic metabolism
• Elimination Half-life: Ranges from 14 to 18 hours
• Excretion: Primarily renal (approximately 60-70%) and fecal (approximately 20-25%)

Benefits

• Effective Blood Pressure Control: Provides consistent 24-hour antihypertensive efficacy, helping to achieve and maintain target blood pressure goals as outlined in clinical guidelines.
• Reduction of Edema: Effectively mobilizes and eliminates excess interstitial fluid, relieving swelling in the extremities and pulmonary congestion associated with heart failure.
• Convenient Dosing Regimen: A single daily dose supports patient adherence to the prescribed treatment plan, simplifying long-term therapy management.
• Cardiovascular Risk Reduction: By controlling hypertension, a major modifiable risk factor, it contributes to the long-term reduction in the risk of stroke, myocardial infarction, and heart failure.
• Potential for Combination Therapy: Its complementary mechanism allows it to be effectively combined with other antihypertensive agents (e.g., ACE inhibitors, beta-blockers) for synergistic blood pressure lowering effects in treatment-resistant cases.
• Well-Established Safety Profile: As a medication with decades of clinical use, its efficacy and adverse effect profile are thoroughly documented and understood by medical professionals.

Common use

Lozol is indicated for the first-line treatment of essential hypertension, either as monotherapy or as a component of combination drug therapy. It is also approved for the treatment of salt and fluid retention-associated edema (congestive heart failure - NYHA Class I-III). Its use is determined following a comprehensive clinical assessment, including measurement of blood pressure, evaluation of renal function (e.g., serum creatinine, eGFR), and assessment of electrolyte levels, particularly potassium and sodium. It is not intended for the immediate relief of hypertensive emergencies.

Dosage and direction

The dosage must be individualized based on patient response, therapeutic goals, and electrolyte balance. The typical recommended dosage for hypertension is 1.25 mg taken orally once daily in the morning. If the response is insufficient after 4 to 8 weeks, the dose may be increased to 2.5 mg once daily, and subsequently to 5 mg once daily, though higher doses provide little additional blood pressure effect and significantly increase the risk of hypokalemia. For edema in congestive heart failure, the usual initial dose is 2.5 mg once daily. The tablet may be taken with or without food, but consistency in administration relative to meals is advised. Regular monitoring of blood pressure, potassium, sodium, creatinine, and uric acid is imperative, especially following dosage adjustments.

Precautions

• Electrolyte Imbalance: Regular monitoring of serum electrolytes (potassium, sodium, magnesium, chloride, calcium) is crucial. Watch for signs of hypokalemia (e.g., muscle weakness, cramps, arrhythmias), hyponatremia (e.g., confusion, seizures), and hypomagnesemia.
• Renal Impairment: Use with caution in patients with severe renal impairment (e.g., eGFR <30 mL/min) as the drug may be ineffective and the risk of azotemia increases. It is contraindicated in anuria.
• Hepatic Impairment: Use with caution in patients with impaired liver function or progressive liver disease, as minor alterations of fluid and electrolyte balance may precipitate hepatic coma.
• Diabetes: May decrease glucose tolerance and elevate serum glucose levels, potentially necessitating adjustment of antidiabetic drug doses.
• Gout: Indapamide may elevate serum uric acid levels and precipitate gout attacks in susceptible patients.
• Systemic Lupus Erythematosus (SLE): Thiazide diuretics have been reported to exacerbate or activate SLE.
• Photosensitivity: Cases of photosensitivity reactions have been reported; patients should be advised to use sun protection.
• Sulfonamide Allergy: Although cross-reactivity is rare, indapamide is a sulfonamide derivative; use with caution in patients with a history of sulfa allergy.

Contraindications

Lozol is contraindicated in patients with:

• Known hypersensitivity to indapamide, other sulfonamide-derived drugs, or any component of the formulation.
• Severe renal impairment (anuria, eGFR <15-30 mL/min/1.73m², depending on regional labeling).
• Refractory hypokalemia, hyponatremia, or hypercalcemia.
• Severe hepatic impairment or hepatic encephalopathy.
• Concomitant use with drugs that prolong the QT interval (e.g., certain antiarrhythmics, antipsychotics) may increase the risk of torsades de pointes, particularly in the setting of diuretic-induced hypokalemia.

Possible side effect

Adverse reactions are generally dose-dependent. Common side effects include:

• Very Common (≥1/10): Hypokalemia (low potassium).
• Common (≥1/100 to <1/10): Headache, dizziness, asthenia (weakness), fatigue, muscle cramps or spasm, paresthesia (tingling), nausea, constipation, orthostatic hypotension.
• Uncommon (≥1/1,000 to <1/100): Hypovolemia, hyponatremia (low sodium), hyperuricemia, hyperglycemia, elevated blood urea nitrogen (BUN) and creatinine, rash, pruritus (itching), urticaria (hives).
• Rare (≥1/10,000 to <1/1,000): Photosensitivity reaction, vasculitis (e.g., necrotizing angiitis), blood dyscrasias (e.g., thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia), pancreatitis, hepatic encephalopathy.
• Very Rare (<1/10,000): Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), cardiac arrhythmias (secondary to electrolyte disturbances).

Drug interaction

• Other Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers, calcium channel blockers): Concomitant use may lead to an additive hypotensive effect.
• Drugs inducing Torsades de Pointes (e.g., Class Ia & III antiarrhythmics, some antipsychotics/antidepressants): Hypokalemia caused by indapamide potentiates the arrhythmogenic effects of these drugs.
• Lithium: Diuretics reduce renal clearance of lithium and significantly increase the risk of lithium toxicity. Concomitant use is generally avoided; if necessary, monitor lithium levels closely.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): May reduce the diuretic, natriuretic, and antihypertensive effects of indapamide and increase the risk of renal impairment.
• Corticosteroids, ACTH: Intensify electrolyte depletion, particularly hypokalemia.
• Digitalis Glycosides (e.g., Digoxin): Hypokalemia or hypomagnesemia predisposes the patient to digitalis-induced cardiac arrhythmias.
• Metformin: Functional renal failure associated with diuretics may increase the risk of metformin-induced lactic acidosis.
• Pressor Amines (e.g., norepinephrine): Response to pressor amines may be decreased.
• Cholestyramine and Colestipol: May reduce the absorption of indapamide.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If it is not remembered until the next day, the patient should skip the missed dose and resume the usual dosing schedule. Do not take a double dose to make up for a missed one.

Overdose

The most likely signs and symptoms of overdose are those related to excessive pharmacologic effects: profound diuresis leading to dehydration and severe electrolyte deficiencies (hypokalemia, hyponatremia, hypochloremia). This can manifest as nausea, vomiting, weakness, gastrointestinal disturbances, dizziness, syncope, hypotension, tachycardia, and arrhythmias. Supportive and symptomatic treatment is essential. There is no specific antidote. Treatment involves gastric lavage or emesis soon after ingestion, followed by correction of fluid and electrolyte imbalances through careful IV replacement under ECG and frequent electrolyte monitoring. Monitoring of renal function and vital signs is crucial.

Storage

Store at room temperature between 15°C and 30°C (59°F and 86°F). Protect from light and moisture. Keep the bottle tightly closed. Keep out of the reach and sight of children. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The author and publisher are not responsible for any specific health or allergy needs that may require medical supervision and are not liable for any damages or negative consequences from any treatment, action, application, or preparation, to any person reading or following the information in this document.

Reviews

“Lozol has been a foundational agent in my practice for managing mild to moderate hypertension, particularly in patients who also benefit from a mild diuretic effect. Its once-daily dosing promotes excellent adherence. Vigilant monitoring of potassium levels is non-negotiable, but for most patients, it is a well-tolerated and effective option.” – Cardiologist, 15 years of experience.

“I find indapamide to be a valuable tool for managing edema in my heart failure patients. It’s effective at reducing peripheral swelling and pulmonary congestion with a relatively lower risk of significant hypokalemia compared to some loop diuretics, especially at the 1.25 mg dose. It fits well into a combination diuretic strategy.” – Nephrologist, 10 years of experience.

“As a primary care physician, I appreciate the efficacy and simplicity of Lozol. It often provides sufficient control as a first-line agent, avoiding the need for polypharmacy initially. The key is setting up a monitoring schedule for electrolytes at the outset and educating patients on signs of electrolyte imbalance.” – General Practitioner, 20 years of experience.