A Successful Desensitization Protocol for Indapamide

RATIONALE: Recurrent kidney stones represent a major health care problem in terms of costly therapeutic procedures and hospitalizations. Pharmacological prevention is cost effective. The preferred agent for lowering urinary calcium for the prevention of stone formation is indapamide. METHODS: A 19-year-old female with recurrent kidney stones and an urticarial rash associated with indapamide treatment was admitted to an intensive care unit for oral desensitization to indapamide. Following pretreatment with diphenhydramine, incrementally increasing doses of serial 10-fold dilutions (5 mg x 10-7 to 5 mg x 10-2) were administered at 15-minute intervals. At the 5 mg x 10-2 dose, the interval was extended to 30 minutes and later increased to 2-hours to the recommended therapeutic dose of indapamide 5 mg BID. RESULTS: The desensitization schedule was well tolerated, with no evidence of systemic or cutaneous reactions. The patient was discharged on indapamide at the recommended therapeutic dose. CONCLUSION: This case presents an indapamide desensitization protocol that was successfully utilized in a patient who previously had an urticarial reaction to indapamide.