Xipamide

Xipamide
Clinical data
AHFS/Drugs.com	International Drug Names
Pregnancy; category	contraindication;
Routes of; administration	By mouth
ATC code	C03BA10 (WHO) ;
Legal status
Legal status	In general: ℞ (Prescription only);
Pharmacokinetic data
Bioavailability	95%
Protein binding	98%
Metabolism	glucuronide (30%)
Elimination half-life	5.8 to 8.2 hours
Excretion	kidney (1/3) and bile duct (2/3)
Identifiers
	IUPAC name 4-chloro-N-(2,6-dimethylphenyl)-2-hydroxy-5-sulfamoylbenzamide;
JSmol)	Interactive image;
	SMILES CC1=C(C(=CC=C1)C)NC(=O)C2=CC(=C(C=C2O)Cl)S(=O)(=O)N;
	InChI InChI=1S/C15H15ClN2O4S/c1-8-4-3-5-9(2)14(8)18-15(20)10-6-13(23(17,21)22)11(16)7-12(10)19/h3-7,19H,1-2H3,(H,18,20)(H2,17,21,22) ; Key:MTZBBNMLMNBNJL-UHFFFAOYSA-N ;
	(what is this?) (verify)

Xipamide is a sulfonamide

oedema and hypertension

.

Mechanism of action

Like the structurally related

osmolarity in the lumen, causing less water to be reabsorbed by the collecting ducts. This leads to increased urinary output. Unlike the thiazides, xipamide reaches its target from the peritubular side (blood side).^[1]

Additionally, it increases the secretion of potassium in the distal tubule and collecting ducts. In high doses it also inhibits the enzyme carbonic anhydrase which leads to increased secretion of bicarbonate and alkalizes the urine.

Unlike with thiazides, only terminal kidney failure renders xipamide ineffective.^[2]

Uses

Xipamide is used for^[1]^[2]

cardiac oedema caused by decompensation of heart failure

chronic renal disease (but not with anuria
)

hepatic oedema caused by cirrhosis

ascites
lymphoedema
hypertension in combination with chronic renal disease

Pharmacokinetics

After oral administration, 20 mg of xipamide are resorbed quickly and reach the peak plasma concentration of 3 mg/L within an hour. The diuretic effect starts about an hour after administration, reaches its peak between the third and sixth hour, and lasts for nearly 24 hours.

One third of the dose is

haemodialysis but not by peritoneal dialysis.^[2]

Dosage

Initially 40 mg, it can be reduced to 10–20 mg to prevent a relapse.[2]

The lowest effective dose is 5 mg. More than 60 mg have no additional effects.^[1]

Adverse effects

more than 1/10 of all patients^[1]
- ECG
  abnormities
1/100 to 1/10
- hyponatraemia
  , which can lead to headache, nausea, drowsiness or confusion
- orthostatic hypotension
- initially increase of urea, uric acid and creatinine, which can lead to a gout attack in predisposed patients
1/1000 to 1/10,000
- allergic reactions of the skin
- hyperlipidaemia
less than 1/10,000
- haemorrhagic pancreatitis
- acute interstitial nephritis
- leucopenia

Contraindications

anuria
praecoma and
coma hepaticum
hypovolemia, hyponatremia, hypokalemia
hypercalcemia
gout
sulfonamide hypersensitivity
pregnancy, lactation period^[1]^[2]

Interactions

Not recommended combinations

Xipamide lowers the renal clearance of
lithium which can lead to lithium intoxication.^[1] (This interaction is classified as medium.^[3]
)

Combinations requiring special precautions

The product information requests special precautions for these combinations:[1]

The antihypertensive effect can be increased by ACE inhibitors, barbiturates, phenothiazines, tricyclic antidepressants, alcohol, etc. (Classified as minor.^[3])
NSAIDs can reduce the antihypertensive and diuretic effects. Xipamide increases the neurotoxicity of high doses of salicylates. (Classified as minor.^[3]
)