The drug atlas
Cardiovascular/Thiazide / thiazide-like diuretic
Thiazide-like diuretics
also: indapamide · bendroflumethiazide
Overview
Step-2/3 antihypertensives. Thiazide-LIKE (indapamide) now preferred over true thiazides in NICE hypertension.
Mechanism
Inhibit the Na⁺/Cl⁻ cotransporter (NCC) in the distal convoluted tubule → natriuresis, mild diuresis; chronic effect is vasodilatory. Increased distal Na⁺ delivery drives K⁺ and H⁺ loss.
Indications
- Hypertension (step add-on)
- Mild oedema
The agents
Indapamidethiazide-like
OD
NICE-preferred; metabolic effects milder.
Bendroflumethiazidethiazide
OD
Older true thiazide.
Adverse effects
Hypokalaemiaclassic
Hyponatraemiaserious
Especially elderly.
Hyperuricaemia → goutclassic
Hyperglycaemiacommon
Hypercalcaemiacommon
↑distal Ca²⁺ reabsorption (contrast loop diuretics).
Erectile dysfunctioncommon
Cautions & contraindications
Goutgout
Reduce urate excretion → precipitate attacks.
Hypokalaemia / hyponatraemiaall
Addison diseaseall
Interactions
- Hypokalaemia potentiates digoxin toxicity
- NSAIDs blunt effect
- Lithium retention (↑toxicity)
Monitoring & kinetics
U&E (Na⁺, K⁺), glucose, urate,BP
Oral. Ineffective at low eGFR (use a loop diuretic instead).
Source: BNF — Thiazide diuretics