Adult Dosing
Edema associated with CHF
Edema associated with renal failure
Hypertension
- Adults:2.5-5 mg PO Daily; Rapid-acting TABS: 0.5-1 mg PO Daily
Notes- Monitor electrolytes periodically
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Rapid onset of severe hyponatremia and/or hypokalemia has been reported rarely with diuretics. Monitor serum electrolytes; discontinue the drug and initiate supportive measures immediately, if severe imbalance occurs
- Hypokalemia causing weakness, cramps, and cardiac dysrhythmias has been reported, monitor serum potassium level periodically and institute dose reduction, potassium supplementation or addition of a potassium-sparing diuretic whenever indicated
- Hypokalemia is hazard in patients who are digitalized or who have history of or active ventricular arrhythmia, as it precipitate dangerous or fatal arrhythmias
- Do not administer with lithium as it reduces the renal clearance of lithium and add a high risk of lithium toxicity
- Metolazone can cause large or prolonged loss of fluids and electrolytes when coadministered with furosemide
- Cross-allergy can occur when metolazone is given to patients known to be allergic to sulfonamide-derived drugs
- Metolazone can cause sensitivity reactions like angioedema, bronchospasm with or without a history of allergy or bronchial asthma
- Fast acting tablets should not be interchanged with other formulations that have slow and incomplete bioavailability
- Patients receiving metolazone should be continuously monitored for clinical signs of fluid and/or electrolyte imbalance namely, hyponatremia, hypochloremic alkalosis and hypokalemia characterized by dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscle fatigue, hypotension, oliguria, tachycardia and gastrointestinal disturbances such as nausea and vomiting. Measure serum electrolyte level prior to initiating therapy and periodically thereafter
- Hyponatremia can occur at any time during long term therapy and, on rare occasions, can be life threatening
- Large doses, rapid diuresis, severe liver disease, concomitant use of corticosteroids, inadequate intake or excess loss of potassium increases the risk of hypokalemia
- Increases the excretion of magnesium resulting in hypomagnesemia
- Can raise blood glucose concentrations, causing hyperglycemia and glycosuria in patients with diabetes or latent diabetes
- Metolazone can cause increase in serum uric acid and occasionally precipitate gouty attacks
- Discontinue metolazone if azotemia and oliguria worsen during treatment of patients with severe renal disease
- Metolazone can cause orthostatic hypotension; effects may be potentiate by alcohol, barbiturates, narcotics, or concurrent therapy with other antihypertensive drugs
- It can exacerbated or activated systemic lupus erythematosus
- Monitor BUN/serum creatinine at baseline
Cautions: Use cautiously in
- Severe renal impairment,
- Hepatic impairment
- Volume depletion
- Electrolyte abnormalities
- Arrhythmias
- Digitalized patient
- Hyperuricemia
- History of gout
- Diabetes mellitus
- SLE
- High dose of vitamin D
- Hypersensitivity to sulfonamide
- Concomitant corticosteroids use
Pregnancy Category:B
Breastfeeding: Lactation might decrease because of intense diuresis. Do not discontinue breastfeeding if metolazone is required by the mother. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 1 April 2011). Because of the potential for serious adverse reactions in nursing infants from metolazone, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Zaroxolyn 10 MG TABS [Bottle] (UCB PHARMA)
30 mg = $79.99
90 mg = $229.97 - Zaroxolyn 5 MG TABS [Bottle] (UCB PHARMA)
30 mg = $88.99
90 mg = $259.97 - Metolazone 2.5 MG TABS [Bottle] (MYLAN)
30 mg = $42.99
90 mg = $109.97 - Metolazone 5 MG TABS [Bottle] (SANDOZ)
30 mg = $42.99
90 mg = $121.97 - Zaroxolyn 2.5 MG TABS [Bottle] (UCB PHARMA)
30 mg = $94.99
90 mg = $280.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
