Metolazone Medication: Uses, Dosage, Side Effects & Interactions

Summary of Key Points

Metolazone is a prescription medication used to treat high blood pressure (hypertension) and fluid retention (edema) associated with conditions such as heart failure, kidney disease, and liver cirrhosis. It works by helping the kidneys remove excess fluid and salt from the body, which helps reduce swelling and lower blood pressure. Always consult a healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist you.

Names of Medication

US Brand Name: Zaroxolyn

Generic Name: Metolazone

The generic name refers to the chemical composition of the medication, while the brand name is assigned by the manufacturer. In this article, the generic name is shown in parentheses.

Pharmacologic Category

Metolazone belongs to a class of medications called thiazide-like diuretics, commonly referred to as “water pills.” Other medications in this category include:

1. Hydrochlorothiazide (Microzide)
2. Chlorthalidone (Thalitone)
3. Indapamide (Lozol)

Metolazone Dosage

Metolazone is prescribed for various conditions, and the dosage may vary depending on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. Our telemedicine providers are available to help manage your treatment plan.

Metolazone for Hypertension (High Blood Pressure)

Initial Dose: 2.5 mg once daily

Maintenance Dose: 2.5 to 5 mg once daily

Duration: Long-term treatment, as directed by your doctor

Metolazone for Edema (Fluid Retention)

Initial Dose: 5 to 20 mg once daily

Maintenance Dose: 5 to 20 mg once daily, depending on the severity of the edema

Duration: As directed by your healthcare provider

Metolazone for Congestive Heart Failure

Initial Dose: 5 to 20 mg once daily

Maintenance Dose: Adjusted based on response and kidney function

Duration: Long-term treatment, as guided by your doctor

Metolazone for Chronic Kidney Disease

Initial Dose: 5 to 20 mg once daily

Maintenance Dose: Adjusted based on kidney function and fluid retention

Duration: As directed by your healthcare provider

Metolazone for Nephrotic Syndrome

Initial Dose: 5 to 20 mg once daily

Maintenance Dose: Adjusted based on response

Duration: As directed by your healthcare provider

Metolazone for Liver Cirrhosis

Initial Dose: 5 to 20 mg once daily

Maintenance Dose: Adjusted based on response and fluid retention

Duration: As directed by your healthcare provider

Metolazone for Heart Failure

Initial Dose: 5 to 20 mg once daily

Maintenance Dose: Adjusted based on response and kidney function

Duration: Long-term treatment, as directed by your doctor

Metolazone for Pulmonary Edema

Initial Dose: 5 to 20 mg once daily

Maintenance Dose: Adjusted based on response

Duration: As directed by your healthcare provider

Metolazone for Diabetes Insipidus

Initial Dose: 2.5 to 5 mg once daily

Maintenance Dose: Adjusted based on response

Duration: As directed by your healthcare provider

Metolazone for Ascites

Initial Dose: 5 to 20 mg once daily

Maintenance Dose: Adjusted based on response and fluid retention

Duration: As directed by your healthcare provider

Dosage Forms and Strengths

Metolazone is available in the following forms and strengths:

1. Tablet: 2.5 mg, 5 mg, 10 mg

Administration Instructions for Metolazone

Metolazone should be taken orally, usually once daily, with or without food. It is best to take it in the morning to avoid frequent urination at night. Drink plenty of fluids unless your doctor advises otherwise. If you miss a dose, take it as soon as you remember. If it’s close to your next dose, skip the missed dose. Do not double up on doses.

Contraindications for Metolazone

A contraindication is a specific condition where a medication should not be used due to potential harm. For Metolazone, several situations make it unsafe to take the medication. These contraindications include:

1. Severe kidney disease: Metolazone is processed by the kidneys, and impaired kidney function can cause the medication to accumulate, leading to harmful effects.
2. Allergy to Metolazone or other thiazide-like diuretics: If you’ve had an allergic reaction to Metolazone or similar medications, taking it again could result in serious allergic reactions, such as rash, swelling, or difficulty breathing.
3. Severe liver disease (hepatic coma or pre-coma): In patients with severe liver disease, Metolazone can cause electrolyte imbalances, worsening the condition and leading to serious complications.
4. Electrolyte imbalances (low potassium or sodium levels): Metolazone can further lower potassium and sodium levels, which can be dangerous, especially if these levels are already low.

If you have any of these conditions, discuss them with your healthcare provider before starting Metolazone. You can also schedule a telemedicine appointment with one of our providers to review your medical history and determine if Metolazone is right for you.

Metolazone Drug Interactions

Metolazone can interact with other medications, increasing the risk of side effects or reducing treatment effectiveness. Common medications that may interact with Metolazone include:

1. Digoxin (Lanoxin): Taking Metolazone with Digoxin can increase the risk of low potassium levels, potentially leading to dangerous heart problems.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve): These medications can reduce Metolazone’s effectiveness and increase the risk of kidney problems.
3. ACE inhibitors or ARBs (e.g., lisinopril, losartan): These blood pressure medications, when combined with Metolazone, can increase the risk of low blood pressure and kidney issues.
4. Insulin or oral diabetes medications (e.g., metformin, glipizide): Metolazone can affect blood sugar levels, so adjustments to your diabetes medications may be necessary.
5. Other diuretics (e.g., furosemide [Lasix]): Combining Metolazone with other diuretics can increase the risk of dehydration and electrolyte imbalances.

Always inform your healthcare provider about all medications and supplements you are taking. If you are unsure about potential interactions, consult one of our telemedicine providers for guidance.

Metolazone in Pregnancy

Is it safe to take Metolazone when pregnant?

Metolazone is generally not recommended during pregnancy unless absolutely necessary. This diuretic can disrupt the electrolyte balance in both the mother and baby, potentially leading to complications. If you are pregnant or planning to become pregnant, it’s important to consult your healthcare provider about safer alternatives. Our telemedicine providers are also available to discuss options for managing your health during pregnancy.

Metolazone while Breastfeeding

Is it safe to take Metolazone while breastfeeding?

Metolazone may pass into breast milk and could affect a nursing infant. It’s essential to weigh the benefits of the medication against any potential risks to your baby. If you are breastfeeding, consult your healthcare provider to determine the best course of action. You can also schedule a telemedicine appointment with one of our providers to explore safe alternatives while breastfeeding.

Estimated Cost of Metolazone Medication

The cost of Metolazone can vary depending on the pharmacy and your location. Without insurance, a 30-day supply using a GoodRx coupon typically ranges from $15 to $30. Prices may differ, so it’s a good idea to check with your local pharmacy or use a discount service like GoodRx to find the best price for your Metolazone prescription.

Possible Alternatives to Metolazone

If Metolazone is not suitable for you, there are alternative treatments and lifestyle changes that may help manage your condition. Always discuss these options with your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine visit with one of our providers to explore these alternatives.

Alternatives for Hypertension (High Blood Pressure)

For high blood pressure, alternatives to Metolazone include ACE inhibitors (such as lisinopril), ARBs (like losartan), calcium channel blockers (such as amlodipine), and lifestyle changes like reducing salt intake, exercising regularly, and managing stress.

Alternatives for Edema (Fluid Retention)

Other diuretics, such as furosemide (Lasix) or spironolactone (Aldactone), may help manage edema. Additionally, lifestyle changes like reducing salt intake and elevating your legs can help alleviate fluid retention.

Alternatives for Congestive Heart Failure

For congestive heart failure, ACE inhibitors, beta-blockers (such as metoprolol), and lifestyle changes like reducing fluid intake and monitoring your weight can be effective alternatives to Metolazone.

Alternatives for Chronic Kidney Disease

In chronic kidney disease, medications like ACE inhibitors or ARBs may help protect kidney function. Dietary changes, such as reducing protein intake, may also be recommended to support kidney health.

Alternatives for Nephrotic Syndrome

Treatment for nephrotic syndrome may include corticosteroids, immunosuppressants, and other diuretics. Dietary changes, such as reducing salt and protein intake, may also help manage the condition.

Alternatives for Liver Cirrhosis

Spironolactone (Aldactone) is often used as an alternative diuretic for managing liver cirrhosis. Reducing salt intake and avoiding alcohol are important lifestyle changes to consider for better management of this condition.

Alternatives for Heart Failure

In addition to diuretics, medications like beta-blockers and ACE inhibitors can help manage heart failure. Lifestyle changes, such as reducing fluid intake and monitoring your weight, are also crucial for managing this condition.

Alternatives for Pulmonary Edema

Treatment for pulmonary edema may include oxygen therapy, other diuretics like furosemide, and addressing the underlying cause of fluid buildup to improve symptoms.

Alternatives for Diabetes Insipidus

Desmopressin (DDAVP) is commonly used to treat diabetes insipidus. Managing fluid intake is also essential in controlling this condition effectively.

Alternatives for Ascites (Fluid Buildup in the Abdomen)

Spironolactone (Aldactone) is frequently used to manage ascites. Reducing salt intake and avoiding alcohol are important lifestyle changes that can help control this condition.

Recent Updates on Metolazone Research

Recent studies have explored the use of Metolazone in combination with other diuretics for treating resistant edema, particularly in patients with heart failure and chronic kidney disease. Research suggests that Metolazone, when used alongside loop diuretics like furosemide, can be effective in patients who do not respond to single diuretic therapy. However, ongoing research aims to better understand the long-term safety of this combination, especially concerning electrolyte imbalances and kidney function.

As new studies emerge, staying informed about the latest findings is important. If you have concerns about your current treatment plan, our telemedicine providers are available to discuss the most up-to-date research and how it may impact your care.

James Kingsley

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