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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.02.01  Expand sub section  Thiazides and related diuretics
 note  See section 2.2
  • The action of indapamide is progressive and the reduction in blood pressure may continue and not reach a maximum until several months after the start of therapy.
  • Indapamide is claimed to lower blood pressure with less metabolic disturbance than other diuretics particularly less aggravation of diabetes mellitus.
  • Metolazone and loop diuretics appear to have a synergistic effect when combined. Profound diuresis can occur so monitor patient carefully. Use intermittently based on achievement of a target weight. Reduce dose or stop treatment until target weight exceeded again.
  • Indapamide 2.5mg
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    First Choice
    Green
    If a diuretic is to be initiated or changed. Existing patients should remain on bendroflumethiazide.
    NB Indapamide MR is not recommended as limited evidence of additional benefits and higher cost.

     
    Metolazone
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    Restricted Drug Restricted
    Amber Simple
    Oedema resistant to large doses of loop diuretics alone.
    This product has been discontinued by the manufacturers but imported sources are now available. Local specialist opinion is to use bendroflumethiazide as an alternative in line with the recommendations of the British Society for Heart Failure. 
    Link  British Society for Heart Failure statement: Metolazone withdrawal
       
     ....
     Non Formulary Items
    Indapamide SR  (Natrilix-SR)

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    Non Formulary
     
      
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    Traffic Light Status Information

    Status Description

    Black

    Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety. All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry   

    Red

    Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).  

    Amber SCA

    Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.   

    Amber Simple

    Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.  

    Green Conditional

    Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence see comments under individual entries.   

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    Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.   

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