Supplements and Indapamide.
Indapamide, sold under the brand names Natrilix, Natrilix SR, is a thiazide diuretic: it inhibits sodium reabsorption in the distal tubule, a milder diuresis than loop agents.
Indapamide is a thiazide diuretic, or the thiazide-like agents that share the same prescribing space. The class inhibits sodium reabsorption in the distal convoluted tubule. It produces a milder diuresis than loop agents, but with a longer plasma half life suitable for dosing once a day in hypertension. The metabolic profile carries hypokalaemia, hyponatraemia (especially in older patients on combined antihypertensives), hyperuricaemia, and a small impact on glucose control. Supplement-relevant points sit on the electrolyte side. Potassium and magnesium supplementation is often given alongside in patients with low baseline electrolytes. Liquorice opposes thiazide effect through sodium retention mediated by aldosterone. The combination with NSAIDs is the same as for loop diuretics. Blunted antihypertensive effect and added renal stress. Indapamide sits in the same prescribing space as bendroflumethiazide in current UK practice and shares the profile.
Below are the 10 documented pairs we have explicitly assessed against Indapamide in the Distil database: 10 amber. The pairs cluster around 4 mechanisms: Additive blood-pressure lowering, Hypercalcaemia risk, Reduced renal lithium clearance, and Renal zinc wasting (drug-induced). Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.
Documented interactions
Additive blood-pressure lowering
Garlic supplements have a mild blood-pressure-lowering effect, and indapamide lowers blood pressure as well. The combined effect tends to be slightly larger. Watch for dizziness on standing in the first couple of weeks and tell your GP if symptoms appear.
Hibiscus tends to lower blood pressure on its own, and indapamide is a water tablet used to lower it. Taken together the blood-pressure effects may stack, so watch for dizziness on standing, especially in the first couple of weeks. If symptoms appear, tell your GP.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Taken at night, melatonin can modestly lower blood pressure during sleep. Combined with a blood-pressure medicine like indapamide this may add up to a slightly larger drop than the medicine alone. This is usually mild and often welcome, but if you notice dizziness or lightheadedness, check your blood pressure and mention it to your prescriber.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Pine bark extract (pycnogenol) has a mild blood-pressure-lowering effect, and indapamide lowers blood pressure as well. The combined effect tends to be slightly larger. Watch for dizziness on standing in the first couple of weeks and tell your GP if symptoms appear.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Taurine tends to lower blood pressure on its own, and indapamide is a water tablet used to lower it. Taken together the blood-pressure effects may stack, so watch for dizziness on standing, especially in the first couple of weeks. The added effect tends to be modest. If symptoms appear, tell your GP.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Hypercalcaemia risk
Indapamide is a thiazide-like diuretic that makes the kidneys keep more calcium, and a calcium supplement adds more calcium directly. Together they may raise blood calcium too high, particularly at higher calcium doses or alongside vitamin D. Modest doses with an occasional calcium check are usually fine, but let your prescriber know you take both.
Indapamide is a thiazide-like diuretic that makes the kidneys keep more calcium, and vitamin D increases how much calcium you absorb. Together, particularly at higher vitamin D doses or with calcium supplements, blood calcium may rise too high. Normal replacement doses with an occasional calcium check are usually fine, but let your prescriber know you take both.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Reduced renal lithium clearance
Thiazide-like water tablets such as indapamide make the kidneys hold on to lithium and have the strongest lithium-raising effect of these medicines. With prescription lithium this is a recognised cause of toxicity. At the small amount of lithium in a typical lithium orotate supplement (around 5 mg) the effect is expected to be very small; it matters more for higher-strength products (around 20 mg) and for anyone whose kidney function is reduced. If you take a thiazide-like diuretic, check with your pharmacist or GP before using a lithium supplement.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Renal zinc wasting (drug-induced)
Indapamide is a thiazide-like water tablet. The classic thiazides are known to make the kidneys pass more zinc into the urine, which can lower body zinc over months. Indapamide is closely related but works a bit more gently on the kidney's salt handling, and it has not been measured directly for zinc, so the effect is likely present but probably smaller. Taking a zinc supplement is supportive here rather than harmful. If you have been on indapamide long term, your GP can check your zinc if you have symptoms like a poor sense of taste or slow-healing skin.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Indapamide is a thiazide-like water tablet. The classic thiazides are known to make the kidneys pass more zinc into the urine, which can lower body zinc over months. Indapamide is closely related but works a bit more gently on the kidney's salt handling, and it has not been measured directly for zinc, so the effect is likely present but probably smaller. Taking a zinc supplement is supportive here rather than harmful. If you have been on indapamide long term, your GP can check your zinc if you have symptoms like a poor sense of taste or slow-healing skin.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.
How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
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- the same graded, cited interaction check across your whole stack, not just the pairs you thought to type in
- where your current routine may be leaving you short of your goals
- the evidence-backed compounds worth adding, and the ones worth dropping
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