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These brands contain the same active ingredient (Metolazone). Strength and form may differ — confirm substitution with your doctor or pharmacist before switching.
Indications & Uses
Metolaz is indicated for:
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Effective dosage of Metolazone should be individualized according to indications and patient response. A single daily dose is recommended. Therapy with Merozolyn should be titrated to gain an initial therapeutic response and to determine the minimal dose possible to maintain the desired therapeutic response. Usual dosages: for edema of cardiac failure, Metolazone 5 to 10 mg is given once daily. For edema of renal disease, Metolazone 5 to 20 mg is given once daily. Treatment of edematous states: the time interval for the initial dosage to show effect may vary; diuresis and saluresis usually begin within one hour and persist for 12 to 24 hours, depending on dosage. When a desired therapeutic effect has been obtained, it may be advisable to reduce the dose, if possible. The daily dose depends on the severity of the patient's condition, sodium intake and responsiveness. A decision to change the daily dose should be based upon the results of thorough clinical and laboratory determinations. If antihypertensive drugs or diuretics are given concurrently with Merozolyn, more careful dosage adjustment may be necessary. For patients with congestive cardiac failure who tend to experience paroxysmal nocturnal dyspnea, it is usually advisable to employ a dosage near the upper end of the range to ensure prolongation of diuresis and saluresis for a full 24 hour period. Hypertension: for mild to moderate essential hypertension, Metolazone 2.5 to 5 mg is given once daily. Treatment of hypertension: the time interval required for the initial dosage regimen of Metolazone to show effect may vary from three to four days, to three to six weeks, in the treatment of elevated blood pressure. Doses should be adjusted at appropriate intervals to achieve maximum therapeutic effect.
Side Effects
The following side effects have been reported with this medicine. Several occurred only once or a few times. Within each body system, the reactions are listed from more severe to less severe. Cardiovascular: chest pain or discomfort, a drop in blood pressure on standing, excessive fluid loss from the body, thickening of the blood, blood clots in the veins, and palpitations. Central and Peripheral Nervous System: fainting, nerve damage, vertigo, tingling or numbness sensations, psychotic depression, impotence, dizziness or lightheadedness, drowsiness, fatigue, weakness, restlessness (sometimes leading to insomnia), and headache. Dermatologic and Hypersensitivity reactions: necrotizing angitis (a form of skin vessel inflammation), purpura, dermatitis with sensitivity to sunlight, hives, and skin rashes. Gastrointestinal: hepatitis with jaundice caused by bile blockage within the liver, pancreatitis, vomiting, nausea, upper abdominal discomfort, diarrhea, constipation, loss of appetite, and abdominal bloating. Hematologic: aplastic or hypoplastic anemia, agranulocytosis, and low white blood cell counts. Metabolic: low potassium, low sodium, high uric acid, low chloride, a chloride-related alkalosis, high blood sugar, sugar in the urine, a rise in blood urea nitrogen (BUN) or creatinine, and low phosphate levels. Musculoskeletal: joint pain, acute gout attacks, and muscle cramps or spasms. Other: brief episodes of blurred vision and chills. In addition, other diuretics of a similar type used for high blood pressure have been reported to cause a bitter taste, dry mouth, inflammation of the salivary glands, yellow vision, breathing difficulty (including lung inflammation), a drop in platelet count, and severe allergic reactions, though these have not been reported to date with Merozolyn. Such reactions should still be considered as possible with clinical use of Merozolyn. Whenever side effects are moderate or severe, the dose of Merozolyn should be lowered or treatment stopped.
Cautions & Contraindications
Warnings & Precautions
Pre-diabetes or DM; gout; SLE; hepatic and renal impairment; hypercholesterolaemia. Correct electrolyte disturbances prior to therapy. Risk of cross-sensitivity with sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides and loop diuretics. Lactation.
Contraindications
Metolazone should not be used in patients with anuria, hepatic coma or pre-coma, or known allergy or hypersensitivity to metolazone. Rarely, severe hyponatremia and/or hypokalemia have been reported to develop rapidly after the first few doses of thiazide and non-thiazide diuretics. If symptoms of severe electrolyte imbalance appear rapidly, the drug should be stopped and supportive measures started immediately, and the appropriateness of continuing this class of drug should be carefully reconsidered. Hypokalemia can occur and may cause weakness, cramps, and cardiac arrhythmias; it is a particular hazard in patients on digitalis or with a current or past ventricular arrhythmia, in whom it may precipitate dangerous or fatal arrhythmias. Serum potassium levels should be checked regularly, with dose reduction, potassium supplementation, or addition of a potassium-sparing diuretic as needed. The risk of hypokalemia increases with dose. Azotemia and hyperuricemia may occur or be brought on during treatment with metolazone, and gouty attacks have occasionally been reported in patients with a history of gout. If azotemia and oliguria worsen in patients with severe renal disease, metolazone should be discontinued. Unusually large or prolonged loss of fluid and electrolytes can occur when metolazone is given together with furosemide. Special care is needed, particularly at the start of treatment, when metolazone is combined with antihypertensive drugs of a different class, to avoid an excessive drop in blood pressure.