Diurexan Tablets

Xipamide 20 mg

The tablets are white, round and biplanar with bisecting score on one side and debossed A on the other. They have a diameter of approximately 6 mm.

For oral use.

For treatment of hypertension, either alone or as an adjunct to treatment with anti-hypertensive drugs.

For use as a diuretic.

1. Treatment of hypertension

Dosage:

Adults: 1 tablet (20 mg) daily, as a single early morning dose. When using Diurexan in combination with other antihypertensive therapy, the same dose of 20 mg as a single early morning dose should be maintained.

Children: No dose recommended.

Elderly: See 'Precautions'.

2. Use as a diuretic

Dosage:

Adults: In the initial phase of treatment the usual dose is 2 tablets (40 mg) daily in a single early morning dose. Depending on the patient's response, the dose may be lowered to 1 tablet daily when sufficient control of oedema has been achieved. Higher doses, up to 4 tablets daily (80 mg), may be employed in resistant cases.

Children: No dose recommended.

Elderly: See 'Precautions'.

Diurexan is contra-indicated in severe electrolyte deficiency, precomatose states associated with liver cirrhosis, severe renal insufficiency, hypersensitivity to xipamide and untreated Addisons disease.

Like other diuretics, Diurexan may induce hypokalaemia in long-term therapy. Potassium supplements may be necessary, particularly in the elderly where dietary potassium intake may be inadequate, in digitalised patients and in conditions where additional potassium loss occurs such as vomiting, diarrhoea, malnutrition, nephrosis, hepatic cirrhosis and hyperaldosteronism.

Diurexan may exacerbate gout or induce hyperuricaemia or impaired glucose metabolism in patients predisposed to these conditions. In such patients serum urate or glucose levels should be monitored. Hyperuricaemia may require concomitant use of a uricosuric agent while diabetic patients will probably require an adjustment of insulin dosage, or other hypoglycaemic agent therapy.

As with all antihypertensive agents, care should be taken in patients with severe coronary or cerebral arteriosclerosis.

An increased risk of developing urinary retention may arise in patients with prostatic hypertrophy.

The dosage of other hypotensive drugs and cardiac glycosides may require adjustment when used in conjunction with Diurexan. Diabetic patients may require an increase in their dose of insulin or oral hypoglycaemic drug. Corticosteroids, ACTH, carbenoxolone, amphotericin and laxatives may provoke hypokalaemia.

Increased serum lithium levels may occur due to diminished urinary excretion.

Use in pregnancy: Animal experiments have indicated that Diurexan is devoid of teratogenic properties or effects on fertility and reproduction. However, care should be taken when treating hypertension or oedema in pregnancy as excessive use may result in hypovolaemia and reduced placental perfusion. As with all drugs, treatment should be avoided in the first trimester of pregnancy.

No information is available on the excretion of xipamide in breast milk. Treatment should be avoided in breast feeding mothers.

None known.

Diurexan is generally well-tolerated. Slight gastro-intestinal disturbances have been reported in a few cases as have episodes of mild dizziness. Hypokalaemia and, more rarely, other electrolyte disturbances such as hyponatraemia have been reported.

Little information is available on the effects of acute overdosage with xipamide, however hypotension with metabolic disturbances and electrolyte imbalances are likely. Chronic overdose may lead to a temporary increase in blood viscosity due to haemoconcentration although thromboembolic complications have not been reported.

There is no specific antidote to xipamide. Gastric lavage or induced emesis may prevent further absorption. General measures should be aimed at the maintenance of blood pressure, restoration of blood volume and correction of electrolyte imbalance with appropriate intravenous infusion as required.

Xipamide is an anti-hypertensive diuretic which can be characterised pharmacologically neither as a thiazide nor as a specific loop diuretic. Although structurally similar to chlorthalidone, it has a markedly different pharmacological profile with its main diuretic effect exerted at the distal section of the nephron.

As a diuretic, xipamide has been shown to be as effective as frusemide in terms of daily urine output, but has a more gradual and prolonged action.

Following single oral administration of 20 mg xipamide, peak plasma concentrations of up to 3 g/ml occur within 1 hour. Absolute bioavailability after oral administration is about 73%.

Xipamide is highly bound to plasma protein and has a volume of distributions of about 10 litres. After oral or i.v. administration, the apparent elimination t_½ is of the order of 5-8 h. About 90% of an oral or i.v. dose is excreted in the urine with 50% of the dose eliminated in urine unchanged and a further 30% as the 0-0 glucuronide.

Not relevant.

Maize starch EP, Mannitol BP, Cellulose powder EP, Colloidol silicon dioxide EP, Magnesium stearate EP, Purified Water EP.

None known.

5 years.

None.

Aluminium - PVC Blister strip holds 14 tablets

Ten blister strips in folded cardboard box.

Not relevant.

Meda Pharmaceuticals Ltd

249 West George Street

Glasgow

G2 4RB

Trading as:

Meda Pharmaceuticals Ltd

Skyway House

Parsonage Road

Takeley

Bishop's Stortford

CM22 6PU

PL 15142/0132

30 June 02

December 2009