xipamide xipamide xipamide is a sulfonamide diuretic drug marketed by eli lilly under the trade names aquaphor (in germany) and aquaphoril (in austria). it is used for the treatment of oedema and hypertension. xipamideclinical dataahfs/drugs.cominternational drug namespregnancycategory contraindication routes ofadministrationby mouthatc codec03ba10 (who) legal statuslegal status in general: ℞ (prescription only) pharmacokinetic databioavailability95%protein binding98%metabolismglucuronide (30%)elimination half-life5.8 to 8.2 hoursexcretionkidney (1/3) and bile duct (2/3)identifiers iupac name 4-chloro-n-(2,6-dimethylphenyl)-2-hydroxy-5-sulfamoylbenzamide cas number14293-44-8 ypubchem cid26618iuphar/bps7900chemspider24795 nunii4s9ey0nueckeggd06341 ychemblchembl517199 ncomptox dashboard (epa)dtxsid5023744 echa infocard100.034.727 chemical and physical dataformulac15h15cln2o4smolar mass354.81 g·mol−13d model (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) nkey:mtzbbnmlmnbnjl-uhfffaoysa-n n ny (what is this?) (verify) mechanism of action like the structurally related thiazide diuretics, xipamide acts on the kidneys to reduce sodium reabsorption in the distal convoluted tubule. this increases the 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). 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. uses xipamide is used for cardiac oedema caused by decompensation of heart failure renal oedema, 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 glucuronidized, the rest is excreted directly through the kidney (1/3) and the faeces (2/3). the total plasma clearance is 30-40 ml/min. xipamide can be filtrated by haemodialysis but not by peritoneal dialysis. dosage initially 40 mg, it can be reduced to 10–20 mg to prevent a relapse. the lowest effective dose is 5 mg. more than 60 mg have no additional effects. adverse effects more than 1/10 of all patients hypokalaemia, which can lead to nausea, muscular weakness or cramps, and 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 thrombocytopenia, leucopenia contraindications anuria praecoma and coma hepaticum hypovolemia, hyponatremia, hypokalemia hypercalcemia gout sulfonamide hypersensitivity pregnancy, lactation period interactions not recommended combinations xipamide lowers the renal clearance of lithium which can lead to lithium intoxication. (this interaction is classified as medium.) combinations requiring special precautions the product information requests special precautions for these combinations: the antihypertensive effect can be increased by ace inhibitors, barbiturates, phenothiazines, tricyclic antidepressants, alcohol, etc. (classified as minor.) nsaids can reduce the antihypertensive and diuretic effects. xipamide increases the neurotoxicity of high doses of salicylates. (classified as minor.) toxicity of cardiac glycosides is increased due to hypokalemia and hypomagnesemia.(classified as minor.) antiarrhythmic agents (classes ia and iii), phenothiazines and other antipsychotics increase the risk of torsades de pointes due to hypokalemia. interactions not included in the product information xipamide can reduce the effect of antidiabetics. (classified as minor.) banned use in sport on 17 july 2012, cyclist fränk schleck was removed from the tour de france by his team radioshack-nissan after his a-sample returned traces of xipamide.