Metolazone

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Generic Name of Metolazone - Learn More

Metolazone

Metolazone Precaution - What You Need to Know

Before using Metolazone, it is important for patients to consult with a healthcare provider to evaluate any potential risks or contraindications specific to their condition. Some key precautions include:
- Electrolyte Imbalances: Metolazone, like other diuretics, can cause significant electrolyte disturbances (such as low potassium, sodium, or magnesium). Regular monitoring of electrolytes, especially serum potassium, is crucial to avoid complications like arrhythmias.
- Renal Impairment: Metolazone should be used cautiously in patients with renal insufficiency or kidney disease, as it can exacerbate renal dysfunction. Dosage adjustments may be necessary, and close monitoring of renal function is recommended.
- Hypotension: The medication can lead to hypotension (low blood pressure), particularly after the first dose. Caution is advised when starting the treatment, especially in elderly patients or those with pre-existing cardiovascular conditions.
- Liver Disease: Caution is required in patients with liver disease, as liver impairment can affect the elimination of the drug, increasing the risk of side effects.
- Pregnancy: Metolazone is classified as Category C during pregnancy, meaning it should only be used if the potential benefits justify the risks to the fetus. It is not known whether the drug passes into breast milk, so its use in breastfeeding mothers should be approached with caution.

Metolazone Indication - Uses and Benefits

Metolazone is primarily used as a diuretic and is prescribed to manage several conditions, mainly related to fluid retention and edema:
- Congestive Heart Failure (CHF): Metolazone is often used in patients with CHF to reduce fluid retention and control symptoms such as swelling and shortness of breath.
- Edema: It is effective for the treatment of edema associated with conditions like chronic kidney disease, nephrotic syndrome, or cirrhosis. It helps reduce the swelling by increasing urine output.
- Hypertension: Metolazone may be used to help control high blood pressure (hypertension), often as part of a combination therapy with other antihypertensive agents, particularly in patients who require more potent diuretic action.
- Chronic Kidney Disease: In patients with chronic kidney disease or glomerulonephritis, Metolazone is sometimes used to manage fluid retention when other diuretics are not effective.

Metolazone Contraindications - Important Warnings

Metolazone is contraindicated in the following conditions:
- Anuria: Metolazone is contraindicated in patients who are anuric (i.e., have little or no urine production) as it may worsen renal failure.
- Severe renal dysfunction: It should not be used in patients with severe kidney disease or acute renal failure, as it can worsen renal function and fluid balance.
- Hypersensitivity: It should not be used in patients with known hypersensitivity to Metolazone or other thiazide-like diuretics, as it may cause allergic reactions such as rash, itching, or difficulty breathing.
- Severe electrolyte imbalances: Metolazone is contraindicated in patients with significant electrolyte disturbances (such as severe hypokalemia or hyponatremia) without proper correction, as these imbalances can be aggravated.
- Pregnancy (if severe): It is contraindicated in severe cases of pregnancy, where fluid management is critical, and only considered in life-threatening conditions where the benefit outweighs the risks.

Metolazone Side Effects - What to Expect

Common and severe side effects of Metolazone include:
- Electrolyte Imbalances: The most significant side effects are related to electrolyte disturbances, including hypokalemia (low potassium), hyponatremia (low sodium), hypomagnesemia (low magnesium), and hypercalcemia (high calcium).
- Dehydration and hypotension: Dehydration may occur, particularly in older adults or those with renal impairment, leading to low blood pressure (hypotension), dizziness, and fainting.
- Dizziness and lightheadedness: These symptoms can be particularly noticeable when standing up quickly (orthostatic hypotension).
- Gastrointestinal upset: Common GI side effects include nausea, vomiting, abdominal pain, and loss of appetite.
- Fatigue: Many patients may experience generalized fatigue or weakness, especially in the first few days of treatment.
- Rash or allergic reaction: Rarely, patients may experience an allergic reaction to Metolazone, including itching, rash, or more severe reactions like difficulty breathing.
- Muscle cramps: Due to the depletion of electrolytes like potassium, muscle cramps can occur.

Metolazone Pregnancy Category ID - Safety Information

2

Metolazone Mode of Action - How It Works

Metolazone is a thiazide-like diuretic, meaning it works similarly to thiazide diuretics but is more potent. Its mechanism of action includes:
- Inhibition of sodium reabsorption: Metolazone inhibits the sodium-chloride symporter in the distal convoluted tubule of the kidney. This action prevents the reabsorption of sodium, leading to increased sodium and water excretion.
- Increased urine output: By promoting sodium and water excretion, Metolazone increases urine output (diuresis), which helps to reduce fluid retention and swelling (edema).
- Electrolyte effects: The increased diuresis also results in the loss of other electrolytes, including potassium, magnesium, and calcium, which is why monitoring electrolyte levels is essential during treatment.

Metolazone Drug Interactions - What to Avoid

Metolazone can interact with various medications and substances, which may affect its efficacy or increase the risk of adverse effects:
- Lithium: Metolazone can increase the levels of lithium in the blood, raising the risk of lithium toxicity. Monitoring of lithium levels is required when these drugs are used together.
- Other diuretics: When combined with other potent diuretics (like furosemide), there is an increased risk of severe electrolyte imbalances, particularly hypokalemia. Potassium levels should be monitored.
- Antihypertensive drugs: When used with antihypertensive medications (such as ACE inhibitors, ARBs, or beta-blockers), there is a risk of hypotension. Blood pressure should be monitored closely.
- Digoxin: Metolazone may enhance the effects of digoxin, leading to an increased risk of digoxin toxicity, particularly if hypokalemia is present.
- Non-steroidal anti-inflammatory drugs (NSAIDs): The use of NSAIDs with Metolazone can reduce the effectiveness of the diuretic and increase the risk of renal damage, particularly in patients with pre-existing renal conditions.
- Corticosteroids: Corticosteroids may exacerbate potassium depletion when used with Metolazone, increasing the risk of hypokalemia.

Metolazone Adult Dose - Recommended Dosage

The typical adult dose of Metolazone varies depending on the condition being treated:
- For edema and heart failure: The usual starting dose is 2.5 mg to 5 mg once daily. The dose can be increased if necessary, up to a maximum of 20 mg per day.
- For hypertension: It is often used in combination with other antihypertensive agents, with doses starting at 2.5 mg to 5 mg once daily. Adjustments are made based on blood pressure response.
- Maximum dose: The maximum dose typically should not exceed 20 mg per day.

Metolazone Child Dose - Dosage for Children

For children, Metolazone is typically used for fluid retention:
- The pediatric dose is usually based on body weight and specific condition, with a typical starting dose of 0.05 to 0.2 mg/kg once daily.
- The maximum dose for children should not exceed 5 mg/day.

Metolazone Renal Dose - Dosage for Kidney Conditions

In patients with renal impairment, the dose of Metolazone should be reduced:
- Mild to moderate renal dysfunction (CrCl ≥30 mL/min): A standard starting dose can be used, but careful monitoring is required.
- Severe renal dysfunction (CrCl <30 mL/min): The dose should be reduced, typically starting at 2.5 mg once daily, with monitoring of renal function and electrolytes.
- End-stage renal disease (ESRD): Use with caution and only under medical supervision. Dose adjustments may be required depending on the patient's condition and renal clearance.