Metolazone

Indications & Dose:

Hypertension

ORALLY

2.5-5 mg PO once daily. may be increased to 20 mg once daily PRN

Edema

ORALLY

2.5-10 mg PO once daily initially. may be gradually increased to 20 mg once daily

Renal impairment.

Not necessary to supplement dose in hemodialysis or peritoneal dialysis

Pregnancy

Metolazone crosses the placental barrier and appears in cord blood.

Contraindications

Anuria, hepatic coma or precoma, known allergy or hypersensitivity.

Precautions

Metolazone may make your skin sensitive to sunlight. you should know that metolazone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position.

Contraindications:

Side Effects:

cardiovascular. Chest pain/discomfort, orthostatic hypotension, excessive volume depletion, hemoconcentration, venous thrombosis, palpitations.

Central And Peripheral Nervous System. Syncope, neuropathy, vertigo, paresthesias, psychotic depression, impotence, dizziness/lightheadedness, drowsiness, fatigue, weakness, restlessness (sometimes resulting in insomnia), headache.

Dermatologic/Hypersensitivity. Toxic epidermal necrolysis (TEN), Stevens-Johnson Syndrome, necrotizing angiitis (cutaneous vasculitis), skin necrosis, purpura, petechiae, dermatitis (photosensitivity), urticaria, pruritus, skin rashes.

Gastrointestinal. Hepatitis, intrahepatic cholestatic jaundice, pancreatitis, vomiting, nausea, epigastric distress, diarrhea, constipation, anorexia, abdominal bloating, abdominal pain.

Hematologic. Aplastic/hypoplastic anemia, agranulocytosis, leukopenia, thrombocytopenia.

Metabolic. Hypokalemia, hyponatremia, hyperuricemia, hypochloremia, hypochloremic alkalosis, hyperglycemia, glycosuria, increase in serum urea nitrogen (BUN) or creatinine, hypophosphatemia, hypomagnesemia, hypercalcemia.

Musculoskeletal. Joint pain, acute gouty attacks, muscle cramps or spasm.

Other. Transient blurred vision, chills, dry mouth.

Cautions:

Precautions:

Interaction:

Diuretics. Can cause unusually large or prolonged losses of fluid and electrolytes  

Other Antihypertensives . Care must be taken, especially during initial therapy. Dosage adjustments of other antihypertensives may be necessary.

Alcohol, Barbiturates, and Narcotics. The hypotensive effects of these drugs may be potentiated by the volume contraction that may be associated with Metolazone therapy.

Digitalis Glycosides. Diuretic-induced hypokalemia can increase the sensitivity of the myocardium to digitalis. Serious arrhythmias can result.

Corticosteroids Or ACTH. May increase the risk of hypokalemia and increase salt and water retention.

Lithium. Serum lithium levels may increase  

Curariform Drugs. Discontinue Metolazone three days before elective surgery.

Sympathomimetics. Metolazone may decrease arterial responsiveness to norepinephrine, but this diminution is not sufficient to preclude effectiveness of the pressor agent for therapeutic use.

Methenamine. Efficacy may be decreased due to urinary alkalizing effect of Metolazone.

Anticoagulants. Metolazone, as well as other thiazide-like diuretics, may affect the hypoprothrombinemic response to anticoagulants. dosage adjustments may be necessary.

May interact with lithium, furosemide, other antihypertensive drugs, diuretics, alcohol, barbiturates, narcotics, digitalis, corticosteroids or ACTH, curariform drugs, salicylates and other nonsteroidal anti-inflammatory drugs (NSAIDs), sympathomimetics, insulin and oral antidiabetic agents, methenamine.

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: