(177) Indapamide-Induced Rhabdomyolysis: A Retrospective Analysis of Electronic Health Records

Background: Post-marketing reports have been generated suggesting a potential association between indapamide use and rhabdomyolysis; especially those with abnormal potassium blood levels. However, establishing causal relationship based on these reports might be biased by confounding factors.

Objectives: To evaluate the association between indapamide use and occurrence of rhabdomyolysis in adult patients.

Methods: This was a case-control study conducted from 2016 till end of 2022. The study data were extracted from the Real-world Research Network (RERN) at the Saudi Food and Drug Authority. RERN collects and standardizes electronic health record data from several hospitals in Saudi Arabia. Patients who had a record of rhabdomyolysis (cases) were matched to four controls based on age, gender and date. Rhabdomyolysis was ascertained based on the recording of a creatinine kinase level > 1,000 U/L. We examined the odds for indapamide exposure through three risk periods: current use (within three months before case date), recent use (3 to 6 months before case date), and former use (6 to 12 months before case date). The analyses were conducted using a multivariable conditional logistic regression models adjusting for the potential confounding variables. Sensitivity analyses were conducted to restrict the analysis on patients with only hypertension. All analyses were conducted using RStudio 1.2.5033.

Results: A total of 2,965 cases and 11,860 controls were included in the study. The odds of exposure to indapamide among cases were lower than control group in the current use definition (adjusted odds ratio [OR]: 0.6; 95% confidence interval [CI]0.39 - 1.05). While exposure to indapamide in the recent use risk period resulted in an adjusted OR of 0.2 (95% CI: 0.14 - 0.47). Additionally, the adjusted OR for indapamide exposure in the former risk period was 0.1 (95% CI: 0.07 - 0.23). The various sensitivity analyses yielded similar results.

Conclusions: In this study, we did not find association between indapamide use and rhabdomyolysis regardless timing of exposure.