Lozol (Indapamide): Lozol is the first approved drug in a new class of diuretics called indolines. It is used for the management of hypertension and congestive heart failure. Lozol is an acceptable form of therapy. Nevertheless, like thiazide diuretics, care needs to be taken when administering Lozol with other antihypertensive drugs like hydralazine, propanolol, guanethidine, and methyldopa since some studies have shown Lozol to have an additive effect which can be dangerous. Other precautions include an increase in uric acid which could lead to gout, and a change in glucose tolerance which may require a change in insulin dosing for people with diabetes.

For the management of hypertension it is recommended that dosing begin at 1.25 mg and not exceed 5 mg daily. For the treatment of congestive heart failure, daily dosing is recommended to be 2.5-5.0 mg. If Lozol therapy is combined with other antihypertensives, blood pressure should be monitored carefully. Side effects may include; headache, diarrhea, dyspepsia, dizziness, rhinitis, sinusitis, peripheral edema, among others.

Lozol should not be used with Lithium.

Diuretics frequently induce hypokalemia (low levels of potassium in the blood) and are commonly used in conjunction with Lanoxin (Digoxin). In addition, the risk of hypokalemia is increased with compromised liver function or concomitant use of corticosteroids or ACTH (adreno- corticotropic hormone). Hypokalemia may increase the risk of Lanoxin toxicity. Therefore, potassium supplements are often taken along with diuretics.

Recent Developments in the Treatment of Congestive Heart Failure:

ACE inhibitors are currently the drug of choice for the treatment of congestive heart failure. Their use is sometimes accompanied by a loop diuretic, Lanoxin (Digoxin), or potassium supplements. Until recently, the use of an ACE inhibitor in conjunction with an Aldosterone-receptor antagonist like Aldactone (Spirinolactone) was not recommended because of the risk of developing hyperkalemia. Nevertheless, a recent study showed that adding Aldactone to the drug regimen of people with severe heart failure reduced the relative risk of death by as much as 30%.¹

Hyperkalemia, which is commonly encountered with concomitant use of an ACE inhibitor and a potassium sparing diuretic like Aldactone, can be avoided by limiting the use of a loop diuretic and/or potassium supplements, as long as renal function is adequate. It is important to note that the new therapy described here applies primarily to people with heart failure who are at significant risk of death. Concomitant use of an Aldosterone-receptor antagonist needs to be further studied in people taking other cardiovascular medications like Beta-Blockers (i.e. Propanolol, Metoprolol).

¹ Pitt, Bertram; Zannad, Faiez; Remme, Willem J.; Cody, Robert; Castaigne, Alain; Perez, Alfonso; Palensky, Jolie; Wittes, Janet. The New England Journal of Medecine. "The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure." Sept. 2, 1999.

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