The short answer
Glycyrrhizin-containing Gan cao may add to potassium loss with indapamide. Severe licorice-associated cases have involved muscle injury, so review the exact preparation with your prescriber before use.
What this answer covers
Radix et Rhizoma Glycyrrhizae (Gan cao), with concern limited to glycyrrhizin-containing oral licorice preparations. Food licorice, root/stolon preparations and processed multi-herb products are not exact dose equivalents.
- Supplement or preparation
- Radix et Rhizoma Glycyrrhizae
- Medication ingredient
- indapamide
There is a plausible additive potassium risk
Indapamide can lower potassium, and glycyrrhizin-containing licorice can also promote potassium loss. The licorice assessment advises against combining it with diuretics or other medicines that aggravate electrolyte imbalance. This makes the exact ingredient list important.
What the muscle-injury reports show
One man taking indapamide and simvastatin developed very low potassium and muscle breakdown after a new habit of heavy licorice consumption. A pharmacovigilance analysis also found licorice in two indapamide reports. Other medicines and incomplete product details limit certainty; these reports do not establish the risk of every Gan cao preparation.
Review the preparation before use
Show the clinician the species, processing, daily amount and all other herbs. Evidence about glycyrrhizin-containing root or food licorice does not establish equivalence to every rhizome extract, combination formula or deglycyrrhizinated product. Do not rely on hours-apart dosing to prevent systemic potassium loss.
Do not ignore new muscle symptoms
Seek prompt medical assessment for substantial muscle pain or weakness, especially if it progresses or accompanies palpitations. Severe potassium loss can be serious and may require monitored treatment. Do not try to manage suspected muscle injury by taking potassium or magnesium at home.
Evidence and practical considerations
Side effects & toxicity
Glycyrrhizin-containing licorice may add to indapamide-related potassium loss, with severe cases associated with muscle injury.
- Exact scope
- Radix et Rhizoma Glycyrrhizae (Gan cao), with concern limited to glycyrrhizin-containing oral licorice preparations. Food licorice, root/stolon preparations and processed multi-herb products are not exact dose equivalents. with Exact indapamide RxCUI 5764 IN, confirmed by current NLM properties. Oral indapamide dose and release formulation are retained; evidence for hydrochlorothiazide, other diuretics or combination antihypertensive products is not automatically equivalent.
- Medication form and route
- Oral
What remains uncertain
- Case reports and spontaneous reports are confounded and may overlap. Some exposures were candy or mixed herbs, not exact Gan cao; no event rate, universal threshold or safe product-specific dose established.
Factors that may matter: Dose and duration; Exact supplement preparation; Kidney function; Other medicines; Baseline electrolyte status.
Read the supporting source summaries
Source 1: Current U.S. prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed oral indapamide 1.25 or 2.5 mg tablets; additional dose-ranging study data.
Recommends periodic electrolyte and renal-function assessment. Potassium reductions were dose-related; some low measurements normalized without intervention. Calcium increases in indapamide studies were only slight. Includes a thiazide-like magnesium-loss warning.
How this applies: Exact medication guidance with explicit dose and nutrient distinctions. Exact indapamide RxCUI 5764 IN, confirmed by current NLM properties. Oral indapamide dose and release formulation are retained; evidence for hydrochlorothiazide, other diuretics or combination antihypertensive products is not automatically equivalent.
A label class warning is not proof that every patient has magnesium depletion or that routine supplements are required. Higher-dose risks and other diuretics cannot be assigned to every low-dose regimen.
Source 2: Current prescribing information
medicines.org.uk · Source check Sep 10, 2026
Population: Patients prescribed oral indapamide 2.5 mg.
Calcium salts may increase hypercalcemia risk through reduced urinary calcium elimination. Stimulant laxatives add to hypokalemia risk; non-stimulant laxatives are advised. Low potassium increases arrhythmia risk, particularly with long QT or digitalis, and may cause muscle injury. Low magnesium can make low potassium refractory.
How this applies: Exact indapamide guidance supports conditional calcium/laxative and electrolyte-management conclusions.
Regulatory guidance, not direct clinical trials for every botanical. Does not establish universal supplement requirements, a fixed supplement dose or protective spacing.
Source 3: Final regulatory herbal assessment
ema.europa.eu · Source check Sep 10, 2026
Population: Users of specified glycyrrhizin-containing licorice root/stolon preparations.
Describes hypokalemia, fluid retention and hypertension; advises against combining with diuretics or other medicines aggravating electrolyte imbalance.
How this applies: Constituent and preparation bridge to Radix et Rhizoma Glycyrrhizae, with limits.
Not every processed Gan cao or rhizome product matches the defined root/stolon preparations; deglycyrrhizinated licorice is not equivalent.
Source 4: Original clinical research
ebi.ac.uk · Source check Sep 10, 2026
Population: One 65-year-old man taking indapamide and simvastatin.
Severe hypokalemia and rhabdomyolysis; improvement after drug withdrawal, fluids and potassium replacement.
How this applies: Direct indapamide plus licorice exposure, indirectly applicable to glycyrrhizin-containing Gan cao rather than exact product equivalence.
Single confounded case; simvastatin also withdrawn. Botanical species, preparation and glycyrrhizin dose not established in the original case.
Source 5: Original clinical research
ebi.ac.uk · Source check Sep 10, 2026
Population: 28 unique spontaneous reports of indapamide-associated rhabdomyolysis.
Hypokalemia or hyponatremia frequently accompanied muscle injury; two licorice reports support a possible additive electrolyte-related mechanism.
How this applies: Original pharmacovigilance analysis, supportive of a conditional glycyrrhizin concern, not proof for every Gan cao preparation.
No exposed denominator or incidence estimate. Incomplete preparation details, multiple suspected medicines and possible overlap with the separately cited case prevent counting these as independent replications.
Source 6: Authoritative medication terminology
rxnav.nlm.nih.gov · Source check Sep 10, 2026
Population: Medication terminology.
Identifies indapamide as IN.
How this applies: Exact medication identifier.
Does not establish formulation equivalence or a clinical interaction.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Sources checked and article drafted. | |
| Research summary published |
Article revision: 37fa1f77b5296d9e
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.