Metolazone 2.5 mg tab. Metolazone 2.5 mg: Comprehensive Guide to Uses, Side Effects, and Interactions

01.08.202304.07.2023 by alexxlab

What are the primary uses of Metolazone 2.5 mg. How does Metolazone work in treating hypertension and edema. What are the most common side effects of Metolazone. How does Metolazone interact with other medications.

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Understanding Metolazone: A Powerful Diuretic for Hypertension and Edema

Metolazone is a prescription medication that belongs to the class of drugs known as diuretics. It’s available as an oral tablet in various strengths, including 2.5 mg. This medication is marketed under the brand name Zaroxolyn but is also available as a generic drug, which often comes at a lower cost.

The primary function of Metolazone is to increase urine production, effectively removing excess fluid and salt from the body. This mechanism of action makes it particularly useful in treating two main conditions: high blood pressure (hypertension) and edema (fluid retention).

How Does Metolazone Work?

Metolazone works by inhibiting the reabsorption of sodium and chloride in the distal tubules of the kidneys. This leads to increased excretion of these electrolytes along with water, resulting in a decrease in blood volume. The reduced blood volume, in turn, helps lower blood pressure and alleviate fluid retention in various parts of the body.

Key Uses of Metolazone 2.5 mg: Tackling Hypertension and Edema

Metolazone 2.5 mg is primarily prescribed for two main conditions:

Hypertension (High Blood Pressure): Metolazone helps reduce blood pressure by decreasing blood volume through increased urine production.
Edema: The medication aids in removing excess fluid from the body, which can accumulate due to various conditions such as heart failure, liver disease, or kidney problems.

In some cases, healthcare providers may prescribe Metolazone as part of a combination therapy with other medications to enhance its effectiveness in managing these conditions.

Can Metolazone Be Used for Other Conditions?

While hypertension and edema are the primary indications for Metolazone, healthcare providers may sometimes prescribe it for off-label uses. These could include managing certain kidney disorders or as an adjunct therapy in some cases of heart failure. However, such uses should always be under the strict guidance of a medical professional.

Common Side Effects of Metolazone: What to Expect

Like all medications, Metolazone can cause side effects. While not everyone experiences these, it’s important to be aware of the potential adverse reactions. The most common side effects of Metolazone include:

Constipation
Dry mouth
Diarrhea
Headache
Abdominal pain
Blurred vision

These side effects are generally mild and often subside as your body adjusts to the medication. However, if they persist or worsen, it’s crucial to consult your healthcare provider.

Are There Any Serious Side Effects to Be Concerned About?

While less common, Metolazone can potentially cause more serious side effects. These require immediate medical attention and include:

Allergic reactions (rash, hives, difficulty breathing)
Heart problems (irregular heartbeat, chest pain)
Liver issues (yellowing of skin or eyes, abdominal pain)
Nerve problems (muscle pain, numbness in extremities)

If you experience any of these symptoms, seek medical help immediately.

Important Warnings: Potential Risks Associated with Metolazone Use

Healthcare providers and patients should be aware of several important warnings associated with Metolazone use:

1. Electrolyte Imbalance Risk

Metolazone can cause sudden drops in sodium (hyponatremia) and potassium (hypokalemia) levels. This risk is rare but potentially serious. Your doctor will likely monitor your electrolyte levels regularly while you’re on this medication.

2. Azotemia in Kidney Disease Patients

For individuals with kidney disease, Metolazone can lead to high levels of nitrogen in the body (azotemia). If you have kidney issues, your doctor will closely monitor your nitrogen levels and may adjust or discontinue the medication if necessary.

3. Orthostatic Hypotension

Some patients may experience a sudden drop in blood pressure when standing up (orthostatic hypotension) while taking Metolazone. This can lead to dizziness or fainting, particularly when first starting the medication or after dosage increases.

Metolazone Interactions: Medications to Watch Out For

Metolazone can interact with various other medications, potentially altering their effectiveness or increasing the risk of side effects. Some key drug interactions to be aware of include:

Antibiotics

Certain antibiotics, such as methenamine, may reduce the effectiveness of Metolazone. Your healthcare provider may need to adjust your dosage or consider alternative treatments if you need to take these medications concurrently.

Other Blood Pressure Medications

Combining Metolazone with other antihypertensive drugs can potentially lead to excessive blood pressure reduction. These medications include:

ACE inhibitors (e.g., benazepril, captopril, enalapril)
Angiotensin II receptor blockers (ARBs) (e.g., irbesartan, losartan, valsartan)
Beta-blockers (e.g., atenolol, metoprolol, propranolol)
Calcium channel blockers (e.g., amlodipine, nifedipine)
Other diuretics (e.g., furosemide, spironolactone)

Your doctor will carefully monitor your blood pressure and may adjust the dosages of these medications as needed.

Blood Thinners

If you’re taking anticoagulants (blood thinners), your dosage may need to be increased when used in combination with Metolazone. This is because Metolazone can potentially reduce the effectiveness of these medications.

Dosage and Administration: Getting the Most from Metolazone 2.5 mg

The appropriate dosage of Metolazone can vary depending on several factors, including the condition being treated, the patient’s age, and overall health status. However, some general guidelines for Metolazone 2.5 mg tablets include:

For Hypertension:

Initial dose: Usually 2.5 mg to 5 mg once daily
Maintenance dose: May be adjusted to 5 mg to 10 mg once daily

For Edema:

Initial dose: Typically 5 mg once daily
Maintenance dose: May be adjusted to 5 mg to 20 mg once daily

It’s crucial to take Metolazone exactly as prescribed by your healthcare provider. Do not adjust your dosage without consulting your doctor first.

What Should I Do If I Miss a Dose?

If you miss a dose of Metolazone, take it as soon as you remember. However, if it’s close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Never take a double dose to make up for a missed one.

Special Considerations: Metolazone Use in Specific Populations

Certain groups of people may require special consideration when using Metolazone:

Elderly Patients

Older adults may be more sensitive to the effects of Metolazone, particularly its impact on blood pressure and electrolyte balance. Dosage adjustments may be necessary, and closer monitoring is often required.

Patients with Liver or Kidney Disease

Individuals with impaired liver or kidney function may process Metolazone differently. Your healthcare provider will likely start with a lower dose and monitor you more closely for side effects and efficacy.

Pregnant and Breastfeeding Women

The safety of Metolazone during pregnancy and breastfeeding hasn’t been fully established. If you’re pregnant, planning to become pregnant, or breastfeeding, discuss the potential risks and benefits with your healthcare provider before using this medication.

Monitoring and Follow-up: Ensuring Safe and Effective Metolazone Use

Regular monitoring is crucial when taking Metolazone to ensure its effectiveness and minimize potential side effects. Your healthcare provider may recommend:

Regular blood pressure checks
Periodic blood tests to monitor electrolyte levels and kidney function
Adjustments to your dosage based on your response to the medication

It’s important to attend all scheduled follow-up appointments and promptly report any unusual symptoms or side effects to your healthcare provider.

How Often Should I Have My Blood Work Checked?

The frequency of blood tests can vary depending on your individual situation. Generally, your doctor may recommend more frequent testing when you first start Metolazone or after any dosage changes. Once your condition is stable, less frequent monitoring may be sufficient. Always follow your healthcare provider’s recommendations for monitoring and follow-up.

Lifestyle Considerations: Maximizing the Benefits of Metolazone Treatment

While Metolazone can be an effective medication for managing hypertension and edema, combining it with healthy lifestyle choices can enhance its benefits and potentially reduce the need for higher doses. Consider the following lifestyle modifications:

Dietary Changes

Reduce sodium intake: Since Metolazone works by eliminating excess salt from your body, reducing your dietary sodium can support its effectiveness.
Increase potassium-rich foods: Metolazone can lead to potassium loss, so incorporating potassium-rich foods (under your doctor’s guidance) may help maintain balance.
Stay hydrated: While Metolazone increases urine output, it’s important to maintain adequate hydration. Discuss appropriate fluid intake with your healthcare provider.

Physical Activity

Regular exercise can complement the blood pressure-lowering effects of Metolazone. Aim for at least 150 minutes of moderate-intensity aerobic activity per week, as recommended by health authorities. Always consult your doctor before starting a new exercise regimen.

Alcohol and Caffeine

Both alcohol and caffeine can interact with Metolazone and affect your blood pressure. It’s best to limit or avoid alcohol consumption and discuss caffeine intake with your healthcare provider.

Alternative Treatments: Exploring Options Beyond Metolazone

While Metolazone is effective for many patients, it may not be suitable for everyone. If you’re unable to take Metolazone or if it’s not providing adequate results, your healthcare provider might consider alternative treatments:

Other Diuretics

Loop diuretics (e.g., furosemide, bumetanide)
Thiazide diuretics (e.g., hydrochlorothiazide)
Potassium-sparing diuretics (e.g., spironolactone)

Non-Diuretic Blood Pressure Medications

ACE inhibitors
Angiotensin II receptor blockers (ARBs)
Calcium channel blockers
Beta-blockers

Non-Pharmacological Approaches

In some cases, lifestyle modifications alone may be sufficient to manage mild hypertension or edema. These could include dietary changes, increased physical activity, stress reduction techniques, and weight management.

Remember, any changes to your treatment plan should only be made under the guidance of your healthcare provider.

Long-Term Outlook: Living with Metolazone Treatment

For many patients, Metolazone becomes a long-term part of their healthcare regimen. Understanding what to expect can help you navigate this ongoing treatment:

Efficacy Over Time

Metolazone’s effectiveness in managing hypertension and edema can be sustained over long periods for many patients. However, your body’s response to the medication may change over time, necessitating dosage adjustments.

Regular Check-ups

Ongoing monitoring is crucial for long-term Metolazone use. Your healthcare provider will schedule regular check-ups to assess the medication’s continued effectiveness and monitor for any potential long-term side effects.

Potential for Dosage Reduction

In some cases, particularly if lifestyle modifications are successfully implemented, it may be possible to reduce your Metolazone dosage over time. This decision should always be made in consultation with your healthcare provider.

What If Metolazone Stops Working?

If Metolazone becomes less effective over time, your healthcare provider may consider adjusting your dosage, adding another medication, or switching to a different treatment approach. Open communication with your healthcare team is key to ensuring your treatment remains optimal.

Living with a chronic condition that requires long-term medication can be challenging, but with proper management and regular follow-ups, many patients successfully maintain their health and quality of life while on Metolazone treatment.

Side Effects, Dosage, Uses & More

Highlights for metolazone

Metolazone oral tablet is available as both a generic and brand-name drug. Brand name: Zaroxolyn.
The most common side effects of metolazone are constipation, dry mouth, diarrhea, headache, stomach pain, and blurred vision.
Metolazone is used to treat high blood pressure (hypertension) and the buildup of excess fluid and salt in your body (edema).

Low sodium and potassium levels warning: In rare cases, taking metolazone has suddenly led to low sodium levels (hyponatremia) or low potassium levels (hypokalemia) or both. If this occurs, your doctor may have you stop using metolazone.
High nitrogen levels warning: Metolazone can cause high levels of nitrogen in your body (azotemia). If you have kidney disease, and experience high levels of nitrogen in your body or you’re having trouble urinating (or are not urinating as often), then your doctor will stop treatment with metolazone.
Low blood pressure when standing warning: Metolazone can cause low blood pressure when you stand up (orthostatic hypotension).

Metolazone oral tablet is a prescription drug that’s available as the brand-name drug Zaroxolyn. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand.

Why it’s used

Metolazone is used to treat high blood pressure. It’s also used to treat the buildup of excess fluid and salt in your body. Metolazone may be taken as part of a combination therapy with other medications.

How it works

Metolazone belongs to a class of drugs called diuretics. A class of drugs is a group of medications that work in a similar way. They’re often used to treat similar conditions. Diuretics work by causing you to urinate more. This helps remove excess fluid and salt from your body. Removing this excess fluid and salt also helps to lower your blood pressure.

Metolazone oral tablet doesn’t cause drowsiness. However, it can cause other side effects. Mild side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

More common side effects

The most common side effects that occur with metolazone include:

abdominal pain
blurred vision
constipation
diarrhea
dry mouth
headache

Serious side effects

Call your doctor right away if you have any of these serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Allergic reactions. Symptoms can include:
- rash
- hives
- itching
- raised welts
- facial swelling
- fever
- difficulty breathing
- peeling or blistering skin
Heart problems. Symptoms can include:
- irregular heartbeat
- chest pain
Liver problems. Symptoms can include:
- yellowing of the whites of your eyes or your skin
- weakness or tiredness
- abdominal pain
- nausea
- vomiting
Nerve problems. Symptoms can include:
- muscle pain or cramps
- numbness in your hands or feet

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Metolazone oral tablet can interact with other medications, herbs, or vitamins you might be taking. An interaction is when a substance changes the way a drug works. This can be harmful or cause the drugs that you take to not work as well. To help prevent interactions, your doctor should manage all of your medications carefully. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with metolazone are listed below.

Antibiotics

Taking certain antibiotics with metolazone can make metolazone not work as well. These include:

methenamine

Other blood pressure drugs

These drugs can lower your blood pressure too much if taken with metolazone. They include:

angiotensin-converting enzyme (ACE) inhibitors, such as:
- benazepril
- captopril
- enalapril
- enalaprilat
- fosinopril
- moexipril
- perindopril
- quinapril
- ramipril
- trandolapril
angiotensin II receptor blockers (ARBs), such as:
- irbesartan
- losartan
- olmesartan
- telmisartan
- valsartan
beta-blockers, such as:
- acebutolol
- atenolol
- betaxolol
- bisoprolol
- esmolol
- metoprolol
- nadolol
- nebivolol
- penbutolol
- pindolol
- propranolol
- timolol (systemic)
calcium channel blockers, such as:
- amlodipine
- felodipine
- nicardipine
- nifedipine
direct renin inhibitors, such as:
- aliskiren
loop diuretics, such as:
- bumetanide
- furosemide
- indapamide
- torsemide
potassium-sparing diuretics, such as:
- eplerenone
- spironolactone
- triamterene

Blood thinners (anticoagulants)

Your dose of these drugs may need to be increased if you’re taking them with metolazone. When you take them with metolazone, they may not work as well. These drugs include:

warfarin

Corticosteroids

Taking these medications with metolazone may increase your risk for hypokalemia (low sodium). These include:

prednisone
prednisolone
methylprednisolone

Diabetes drugs

Your dose of these drugs may need to be increased if you’re taking them with metolazone. When you take them with metolazone, they may not work as well. These drugs include:

insulin

Diuretics

Taking these drugs with metolazone may increase your risk for low sodium levels (hypokalemia). These include:

furosemide

Heart drugs

Metolazone may increase the effects of these drugs. These drugs include:

digoxin

Mood stabilizers

Metolazone may increase the effects of these drugs. These drugs include:

lithium

Pain drugs

Taking the following pain drugs with metolazone can make metolazone not work as well:

aspirin
nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
- diclofenac
- ibuprofen
- indomethacin
- ketoprofen
- ketorolac
- meloxicam
- nabumetone
- naproxen
- piroxicam
COX-2 Inhibitors
- celecoxib

Taking the following pain drugs with metolazone can lower your blood pressure too much:

barbiturates, such as:
- butabarbital
- butalbital
- methohextal
- pentobarbital
- phenobarbital
- secobarbital
- thiopental
narcotics, such as:
- codeine
- dihydrocodeine
- fentanyl
- hydrocodone
- hydromorphone
- levorphanol
- mepiridine
- methadone
- morphine
- opium
- oxycodone
- oxymorphone
- tramadol

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Metolazone oral tablet comes with several warnings.

Allergy warning

Metolazone can cause a severe allergic reaction. Symptoms can include:

trouble breathing
swelling of your throat or tongue
hives

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction

Drinking alcohol while you take this drug can increase your risk for low blood pressure when you stand up (orthostatic hypotension).

Warnings for people with certain health conditions

For people with anuria: If your body isn’t able to make urine (anuria), you shouldn’t take metolazone. Metolazone is removed from your body by your kidneys. If your kidneys aren’t working well, this will make it harder for your body to get rid of the drug.

For people with liver failure: You shouldn’t take metolazone if you have advanced stages of liver failure. Metolazone can cause changes to your electrolyte levels, which may bring on a hepatic coma in people with liver disease.

For people with diabetes: Metolazone can increase your blood sugar level. Talk to your doctor before using this drug if you have diabetes.

For people with gout: Metolazone can increase the amount of acid in your body. This can cause gouty attacks.

For people with kidney disease: Metolazone is eliminated from your body through your kidneys and can build up in your body if your kidneys aren’t working as well as they should. This can lead to toxicity. Tell your doctor if you have kidney disease or kidney damage.

For people with systemic lupus erythematosus: Taking metolazone may make your systemic lupus erythematosus worse.

Warnings for other groups

For pregnant women: Metolazone is a category B pregnancy drug. That means two things:

Studies of the drug in pregnant animals haven’t shown risk to the fetus.
There aren’t enough studies done in pregnant women to show the drug poses a risk to the fetus.

Speak with your doctor if you’re pregnant or planning to become pregnant. Metolazone should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.

Women who are breastfeeding: Metolazone may pass into breast milk and can cause serious adverse effects. Talk to your doctor before taking metolazone if you’re breast-feeding or plan to breastfeed.

For children: This medicine shouldn’t be used in people younger than 18 years.

This dosage information is for metolazone oral tablet. All possible dosages and forms may not be included here. Your doctor will tell you what dosage is right for you. Your dose, form, and how often you take it will depend on:

your age
the condition being treated
how severe your condition is
other medical conditions you have
how you react to the first dose

Forms and strengths

Generic: metolazone

Form: Oral tablet
Strengths: 2.5 mg, 5 mg, 10 mg

Brand: Zaroxolyn

Form: Oral tablet
Strengths: 2.5 mg, 5 mg, 10 mg

Dosage for hypertension

Adult dosage (ages 18 years and older)

The usual dose for mild to moderate hypertension is 2.5–5 mg by mouth, once per day.

Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used in people younger than 18 years.

Dosage for edema

Adult dosage (ages 18 years and older)

The usual dose for edema is 5–20 mg by mouth, once per day.

Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used in people younger than 18 years.

Special considerations

People with kidney disease: If you have kidney disease, you may need a lower dose or you may need a different dosing schedule. Metolazone is removed from your body by your kidneys. It can build up in your body if your kidneys aren’t working as well as they should. This can lead to toxicity.

People with heart disease: If you have heart disease or decreased heart function you may need a lower dose or you may need a different dosing schedule.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Metolazone oral tablet is used for short-term or long-term therapy. For swelling and water retention in your legs and arms, metolazone is used as short-term therapy. For high blood pressure, it’s used as long-term therapy. It comes with serious risks if you don’t take it as prescribed.

If you don’t take it at all: If you don’t take metolazone at all, your blood pressure or edema, or both, might not be controlled. This may lead to a heart attack, stroke, pain, or infection.

If you stop taking it suddenly: If you’re taking metolazone for high blood pressure and suddenly stop taking it, you may experience rebound high blood pressure. This is a sudden increase in your blood pressure after you stop taking your blood pressure medication. Symptoms of rebound hypertension include headache, confusion, chest pain, sweating, nausea, and vomiting.

If you don’t take it on schedule: If you don’t take metolazone according to the schedule for your doses, it may not work as well. In order for this drug to work, you need a consistent amount of it in your body at all times.

If you take too much: Taking too much metolazone can cause dizziness, drowsiness, fainting spells, low blood pressure when you stand up, changes in your electrolytes, and trouble breathing. If you think you have taken too much metolazone, you should go to the nearest emergency room or contact poison control right away.

What to do if you miss a dose: If you forget to take your dose, take it as soon as you remember, unless you remember just a few hours before the time for your next dose. Then only take one dose. Never try to catch up by taking two doses at once. This could result in toxic side effects.

How to tell if the drug is working: You may or may not be able to tell if metolazone is working; however, your doctor will check your blood pressure and fluid volume regularly to see if they’re at normal levels and controlled. You also may purchase a blood pressure monitor from your local pharmacy so that you can check your blood pressure yourself.

Keep these considerations in mind if your doctor prescribes metolazone oral tablet for you.

General

Metolazone can be taken with or without food.
Metolazone should be taken early in the day. This helps to avoid frequent urination throughout the night.
Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead.

Storage

Keep it between 68°F (20ºC) and 77°F (25°C).
Don’t freeze metolazone.
Keep it away from light and high temperature.
Keep your drugs away from areas where they could get wet, such as bathrooms. Store these drugs away from moisture and damp locations.

Refills

A prescription for this medication is refillable.You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

Always carry your medication with you, such as in your carry-on bag.
Don’t worry about airport X-ray machines. They can’t hurt your medication.
You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

You may need to buy a blood pressure monitor. These can be purchased at most pharmacies.

Clinical monitoring

While you’re taking metolazone, your doctor will regularly monitor your electrolyte levels, blood sugar level, blood acid levels, calcium levels, heart function, liver function, and kidney function.

Sun sensitivity

Metolazone can make your skin more sensitive to the sun. This increases your risk of sunburn. Avoid the sun if you can. If you can’t, be sure to wear protective clothing and apply sunscreen.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available. Some may be better for you than others. Talk to your doctor about other options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Side Effects, Dosage, Uses & More

Highlights for metolazone

Metolazone oral tablet is available as both a generic and brand-name drug. Brand name: Zaroxolyn.
The most common side effects of metolazone are constipation, dry mouth, diarrhea, headache, stomach pain, and blurred vision.
Metolazone is used to treat high blood pressure (hypertension) and the buildup of excess fluid and salt in your body (edema).

Low sodium and potassium levels warning: In rare cases, taking metolazone has suddenly led to low sodium levels (hyponatremia) or low potassium levels (hypokalemia) or both. If this occurs, your doctor may have you stop using metolazone.
High nitrogen levels warning: Metolazone can cause high levels of nitrogen in your body (azotemia). If you have kidney disease, and experience high levels of nitrogen in your body or you’re having trouble urinating (or are not urinating as often), then your doctor will stop treatment with metolazone.
Low blood pressure when standing warning: Metolazone can cause low blood pressure when you stand up (orthostatic hypotension).

Why it’s used

How it works

More common side effects

The most common side effects that occur with metolazone include:

abdominal pain
blurred vision
constipation
diarrhea
dry mouth
headache

Serious side effects

Call your doctor right away if you have any of these serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Allergic reactions. Symptoms can include:
rash
hives
itching
raised welts
facial swelling
fever
difficulty breathing
peeling or blistering skin
Heart problems. Symptoms can include:
irregular heartbeat
chest pain
Liver problems. Symptoms can include:
yellowing of the whites of your eyes or your skin
weakness or tiredness
abdominal pain
nausea
vomiting
Nerve problems. Symptoms can include:
muscle pain or cramps
numbness in your hands or feet

Examples of drugs that can cause interactions with metolazone are listed below.

Antibiotics

Taking certain antibiotics with metolazone can make metolazone not work as well. These include:

methenamine

Other blood pressure drugs

These drugs can lower your blood pressure too much if taken with metolazone. They include:

angiotensin-converting enzyme (ACE) inhibitors, such as:
benazepril
captopril
enalapril
enalaprilat
fosinopril
moexipril
perindopril
quinapril
ramipril
trandolapril
angiotensin II receptor blockers (ARBs), such as:
irbesartan
losartan
olmesartan
telmisartan
valsartan
beta-blockers, such as:
acebutolol
atenolol
betaxolol
bisoprolol
esmolol
metoprolol
nadolol
nebivolol
penbutolol
pindolol
propranolol
timolol (systemic)
calcium channel blockers, such as:
amlodipine
felodipine
nicardipine
nifedipine
direct renin inhibitors, such as:
aliskiren
loop diuretics, such as:
bumetanide
furosemide
indapamide
torsemide
potassium-sparing diuretics, such as:
eplerenone
spironolactone
triamterene

Blood thinners (anticoagulants)

Your dose of these drugs may need to be increased if you’re taking them with metolazone. When you take them with metolazone, they may not work as well. These drugs include:

warfarin

Corticosteroids

Taking these medications with metolazone may increase your risk for hypokalemia (low sodium). These include:

prednisone
prednisolone
methylprednisolone

Diabetes drugs

Your dose of these drugs may need to be increased if you’re taking them with metolazone. When you take them with metolazone, they may not work as well. These drugs include:

insulin

Diuretics

Taking these drugs with metolazone may increase your risk for low sodium levels (hypokalemia). These include:

furosemide

Heart drugs

Metolazone may increase the effects of these drugs. These drugs include:

digoxin

Mood stabilizers

Metolazone may increase the effects of these drugs. These drugs include:

lithium

Pain drugs

Taking the following pain drugs with metolazone can make metolazone not work as well:

aspirin
nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
diclofenac
ibuprofen
indomethacin
ketoprofen
ketorolac
meloxicam
nabumetone
naproxen
piroxicam
COX-2 Inhibitors
celecoxib

Taking the following pain drugs with metolazone can lower your blood pressure too much:

barbiturates, such as:
butabarbital
butalbital
methohextal
pentobarbital
phenobarbital
secobarbital
thiopental
narcotics, such as:
codeine
dihydrocodeine
fentanyl
hydrocodone
hydromorphone
levorphanol
mepiridine
methadone
morphine
opium
oxycodone
oxymorphone
tramadol

Metolazone oral tablet comes with several warnings.

Allergy warning

Metolazone can cause a severe allergic reaction. Symptoms can include:

trouble breathing
swelling of your throat or tongue
hives

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction

Drinking alcohol while you take this drug can increase your risk for low blood pressure when you stand up (orthostatic hypotension).

Warnings for people with certain health conditions

For people with diabetes: Metolazone can increase your blood sugar level. Talk to your doctor before using this drug if you have diabetes.

For people with gout: Metolazone can increase the amount of acid in your body. This can cause gouty attacks.

For people with systemic lupus erythematosus: Taking metolazone may make your systemic lupus erythematosus worse.

Warnings for other groups

For pregnant women: Metolazone is a category B pregnancy drug. That means two things:

Studies of the drug in pregnant animals haven’t shown risk to the fetus.
There aren’t enough studies done in pregnant women to show the drug poses a risk to the fetus.

Speak with your doctor if you’re pregnant or planning to become pregnant. Metolazone should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.

For children: This medicine shouldn’t be used in people younger than 18 years.

your age
the condition being treated
how severe your condition is
other medical conditions you have
how you react to the first dose

Forms and strengths

Generic: metolazone

Form: Oral tablet
Strengths: 2.5 mg, 5 mg, 10 mg

Brand: Zaroxolyn

Form: Oral tablet
Strengths: 2.5 mg, 5 mg, 10 mg

Dosage for hypertension

Adult dosage (ages 18 years and older)

The usual dose for mild to moderate hypertension is 2.5–5 mg by mouth, once per day.

Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used in people younger than 18 years.

Dosage for edema

Adult dosage (ages 18 years and older)

The usual dose for edema is 5–20 mg by mouth, once per day.

Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used in people younger than 18 years.

Special considerations

People with heart disease: If you have heart disease or decreased heart function you may need a lower dose or you may need a different dosing schedule.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

If you don’t take it at all: If you don’t take metolazone at all, your blood pressure or edema, or both, might not be controlled. This may lead to a heart attack, stroke, pain, or infection.

Keep these considerations in mind if your doctor prescribes metolazone oral tablet for you.

General

Metolazone can be taken with or without food.
Metolazone should be taken early in the day. This helps to avoid frequent urination throughout the night.
Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead.

Storage

Keep it between 68°F (20ºC) and 77°F (25°C).
Don’t freeze metolazone.
Keep it away from light and high temperature.
Keep your drugs away from areas where they could get wet, such as bathrooms. Store these drugs away from moisture and damp locations.

Refills

Travel

When traveling with your medication:

Always carry your medication with you, such as in your carry-on bag.
Don’t worry about airport X-ray machines. They can’t hurt your medication.
You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

You may need to buy a blood pressure monitor. These can be purchased at most pharmacies.

Clinical monitoring

Sun sensitivity

Metolazone can make your skin more sensitive to the sun. This increases your risk of sunburn. Avoid the sun if you can. If you can’t, be sure to wear protective clothing and apply sunscreen.

Insurance

There are other drugs available. Some may be better for you than others. Talk to your doctor about other options that may work for you.

Metolazone – instructions for use

metolazone

Instruction:

Pharmacological action
Pharmacokinetics
Readings
Contraindications
With care
Pregnancy and breastfeeding
Dosage and Administration
Side effects
Overdose
Interaction
Transport management
Sports medicine
Classification

Pharmacological action

Metolazone is a thiazide diuretic. Suppresses sodium reabsorption in the distal tubules, causing increased excretion of water and sodium, potassium and hydrogen ions.

Pharmacokinetics

Absorption and distribution

Bioavailability is about 40-65%. Onset of action: diuresis, ~60 minutes. Duration of action: ≥24 hours.

Time to reach maximum plasma concentration (TC _max) – 8 hours.

Communication with plasma proteins – 95%.

Biotransformation and excretion

Metolazone is slightly metabolized. 70-95% is excreted unchanged in the urine due to glomerular filtration and active tubular secretion.

Half-life (T _½) – 20 hours.

Elimination – with urine (80%), with bile (10%).

Indications

Mild to moderate hypertension, edema in heart failure, nephrotic syndrome and conditions of reduced kidney function.

Contraindications

Hypersensitivity to metolazone;
anuria;
hepatic coma or precoma.

With caution

Diabetes,
hypercholesterolemia,
hyperuricemia,
gout,
hypotension,
systemic lupus erythematosus,
sympathectomy,
liver diseases.

Pregnancy and breastfeeding

Use in pregnancy

FDA fetal category B.

Adequate and strictly controlled studies on the safety of metolazone during pregnancy in humans have not been conducted. Metolazone crosses the placental barrier.

Animal studies have not shown evidence of teratogenicity.

In the event of pregnancy, absence of menstruation or suspected possible pregnancy, the patient should inform her physician.

The use of metolazone in pregnant women is contraindicated unless the potential benefit to the mother outweighs the possible risk to the fetus.

Use during breastfeeding

Special studies on the safety of the use of metolazone during breastfeeding have not been conducted.

Metolazone is excreted in breast milk. A risk to the infant cannot be ruled out.

Should stop breastfeeding if necessary to use the drug.

Dosage and administration

Orally (by mouth).

Children

200-400 mcg/kg/day in 1-2 divided doses.

Adults

Edema: 5-20 mg once daily.

Arterial hypertension: 2.5-5 mg once a day.

Side effects

Generally well tolerated, most adverse reactions reported were mild and transient.

Frequency not determined: chest pain, depression, dizziness, drowsiness, electrolyte disturbances, glucosuria, gout attacks, headache, hemoconcentration, hepatotoxicity, hyperuricemia, hypochloremic alkalosis, hypokalemia, hypomagnesemia, hyponatremia, hypophosphatemia, hyperglycemia, hypercalcemia, decreased libido, increased blood urea nitrogen, joint pain, leukopenia, necrotizing angiitis, neuropathy, nocturia, orthostatic hypotension, palpitations, pancreatitis, anxiety, Stevens-Johnson syndrome, syncope, toxic epidermal necrolysis, urticaria, venous thrombosis.

Overdose

Symptoms: labored breathing, dizziness, drowsiness, fainting, gastrointestinal irritation, lethargy leading to coma.

Interaction

The combined use of metolazone with aymaline increases the risk of cholestasis.

Alfuzosin may increase the hypotensive effect of drugs that lower blood pressure.

When used concomitantly, thiazide diuretics may increase the likelihood of allergic or hypersensitivity reactions to allopurinol and may increase the serum concentration of oxypurinol, the active metabolite of allopurinol.

Blood pressure lowering drugs may increase the hypotensive effect of amifostine.

Co-administration of metolazone with aminolevulinic acid may enhance the photosensitizing effect of aminolevulinic acid.

When used in combination with amphetamines, the antihypertensive effect of metolazone may be reduced.

Thiazide diuretics may increase the hypotensive and nephrotoxic effects of angiotensin-converting enzyme inhibitors.

Anticholinergics may increase the serum concentration of thiazide diuretics.

When used concomitantly, thiazide diuretics may reduce the therapeutic effect of antidiabetic agents.

Barbiturates may enhance the hypotensive effect of drugs that lower blood pressure.

With the simultaneous use of benperidol with antihypertensive drugs, the effect of antihypertensive drugs is enhanced.

Beta ₂ -agonists may enhance the hypokalemic effect of thiazide diuretics.

Brigatinib may reduce the antihypertensive effect and increase the bradycardia effect of antihypertensive agents.

Metolazone may increase the bradycardial effect of drugs that cause bradycardia.

Brimonidine may enhance the hypotensive effect of antihypertensive drugs.

Blood pressure lowering drugs may enhance the hypotensive effect of bromperidol. Bromperidol may reduce the antihypertensive effect of blood pressure lowering agents.

Photosensitizing agents may enhance the photosensitizing effect of verteporfin.

Thiazide diuretics may increase the hypercalcemic effect of vitamin D analogues.

Thiazide diuretics may reduce the excretion of calcium salts. Simultaneous intake with calcium salts can lead to metabolic alkalosis.

Co-administration of carbamazepine with diuretics may lead to symptomatic hyponatremia.

Due to the hypokalemic and hypomagnesemic action, thiazide diuretics can enhance the adverse / toxic effects of cardiac glycosides.

Corticosteroids may enhance the hypokalemic effect of thiazide diuretics.

Thiazide diuretics may increase the adverse/toxic effects of cyclophosphamide (potentiation of granulocytopenia is possible).

Dexketoprofen may increase the toxic effects of sulfonamides.

Co-administration of dexmethylphenidate may reduce the therapeutic effect of antihypertensive agents.

Co-administration of diacerein may enhance the therapeutic effect of diuretics and may increase the risk of dehydration or hypokalemia.

Diazoxide may enhance the antihypertensive effect of blood pressure lowering agents.

Thiazide diuretics may increase the adverse/toxic effects of diazoxide.

Thiazide diuretics may enhance the hypokalemic effect of dichlorphenamide.

Thiazide diuretics may increase the plasma concentration of dofetilide and increase its QT prolongation effect.

Antihypertensive agents may increase the hypotensive effect of duloxetine.

Thiazide diuretics may increase the arrhythmogenic effect of fexinidazole.

Herbal medicines with hypertensive properties may reduce the antihypertensive effect of antihypertensive drugs.

Herbal medicines with antihypertensive properties may enhance the hypotensive effect of blood pressure lowering agents.

Ipragliflozin may enhance the effects of diuretics and also increase the risks associated with their use, such as the risk of dehydration and hypotension.

Yohimbine may reduce the antihypertensive effect of antihypertensive drugs.

Bile acid sequestrants may reduce the absorption of thiazide diuretics and reduce the diuretic response.

Thiazide diuretics may increase the arrhythmogenic effect of ivabradine.

Antihypertensive agents may enhance the hypotensive effect of levodopa.

Thiazide diuretics may increase the adverse/toxic effects of levosulpiride.

The simultaneous use of thiazide diuretics with licorice is not recommended due to the risk of hypokalemia.

Thiazide diuretics may reduce lithium excretion.

Co-administration of lormetazepam may enhance the hypotensive effect of antihypertensive agents.

Thiazide diuretics may increase the severity of adverse reactions of mecamylamine.

Thiazide diuretics reduce the effectiveness of methenamine.

Methylphenidate may reduce the hypotensive effect of antihypertensive drugs.

With the simultaneous appointment of molsidomine with antihypertensive drugs, the hypotensive effect is enhanced.

Thiazide diuretics may enhance the hypotensive effect and QTc effect of arsenic trioxide.

Naftopidil may enhance the hypotensive effect of antihypertensive drugs.

Nicergoline enhances the effect of antihypertensive drugs.

Co-administration of nicorandil may potentiate the effects of antihypertensive agents.

Antihypertensive drugs may enhance the hypotensive effect of nitroprusside.

Thiazide diuretics may increase the nephrotoxic effect of NSAIDs. NSAIDs may reduce the therapeutic effect of thiazide diuretics.

Co-administration of obinutuzumab may enhance the effects of antihypertensive agents.

Opioid agonists may increase the severity of adverse reactions and reduce the therapeutic effect of diuretics.

Thiazide diuretics may increase the risk of hyponatremia when used concomitantly with oxcarbazepine.

Prostacyclin analogues may increase the effect of antihypertensive drugs.

Photosensitizing agents may increase the photosensitizing effect of the porfimer.

Co-administration with pentoxifylline may enhance the effect of antihypertensive drugs.

Thiazide diuretics may increase plasma concentrations and enhance the hypokalemic effect of topiramate.

Thiazide diuretics may increase the hypercalcemic effect of toremifene.

Phosphodiesterase 5 inhibitors may potentiate the effects of antihypertensives.

The combination of promazine with antihypertensive drugs can lead to severe orthostatic hypotension.

Reboxetine may enhance the hypokalemic effect of thiazide diuretics.

Antihypertensive drugs may enhance the hypotensive effect of folcodine.

Quinagolide may enhance the effect of antihypertensive drugs.

Selective serotonin reuptake inhibitors may enhance the hyponatremic effect of thiazide diuretics.

Diuretics may increase the nephrotoxic effect of sodium phosphates and increase the risk of acute phosphate nephropathy.

Ethanol may enhance the orthostatic hypotensive effect of thiazide diuretics.

Influence on the ability to drive vehicles and control mechanisms

It is necessary to refrain from driving vehicles and engaging in activities that require increased concentration of attention and speed of psychomotor reactions.

Sports medicine

Metolazone may cause anti-doping rule violations and positive results in doping controls.

Metolazone belongs to class S5 “Diuretics and masking agents” of the WADA Prohibited List.

⚠ Prohibited substances should not be used to enhance athletic performance as they pose a serious health risk.

NOTE: Detection in an athlete’s sample at any time or in-competition, as the case may be, of any number of substances that are authorized for use while meeting the threshold concentration level, for example: formoterol, salbutamol, cathine, ephedrine, methylephedrine and pseudoephedrine, in combination with a diuretic or masking agent will be considered an Adverse Analytical Finding (AAF) unless the Athlete has an approved Therapeutic Use Exemption (TUE) for that substance in addition to a Therapeutic Use Exemption for the diuretic.

Glossary

9030 5

Classification

ATX
C03BA08
Pharmacological group
Diuretics
ICD codes 10
I10 Essential (primary) hypertension
I15 Secondary hypertension
I50.0 Congestive heart failure
N04 Nephrotic syndrome
FDA pregnancy category
B
(no risk in non-human studies)

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