metolazone
Metolazone is a thiazide-like diuretic (water pill). It's used to lower blood pressure and to treat swelling (edema) caused by certain conditions, such as heart failure and kidney problems, in adults. Metolazone works in the kidneys to help get rid of extra fluids. This medication is taken by mouth, typically once daily. Some common side effects of metolazone include dizziness and electrolyte imbalance.
What is Metolazone?
What is Metolazone used for?
Edema (swelling from fluid) related to kidney problems
Edema related to heart failure
How Metolazone works
Metolazone is a thiazide-like diuretic (water pill) which works in the kidney to get rid of extra fluid from your body to lower swelling and blood pressure.
Drug Facts
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What are the side effects of Metolazone?
Common Side Effects
- Dizziness
- Electrolyte imbalance (low sodium, magnesium, and potassium)
Other Side Effects
- Muscle cramps
- Fatigue (feeling very tired)
- High uric acid levels
Serious Side Effects
- Allergic reactions: trouble breathing, rash or hives, swelling in your face, lips, tongue, or throat
- Serious skin reaction: fever, chills, body aches, cough, itchiness, blistering or peeling skin, severe rash
- Electrolyte imbalance: weakness, muscle pain or cramps, dizziness, fast heartbeat, or vomiting
- Kidney problems: fatigue, confusion, swelling in your feet or ankles, or little to no urination
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Black, tarry stools
bleeding gums
blistering, peeling, or loosening of skin
blood in urine or stools
blurred vision
bone pain
chills
clay-colored stools
cold sweats
coma
confusion
convulsions
dark urine
decreased urine
dizziness, faintness, or lightheadedness when getting up from lying or sitting position
drowsiness
fast, irregular, pounding, or racing heartbeat or pulse
flushed, dry skin
fruit-like breath odor
general tiredness and weakness
headache
incoherent speech
increased hunger
increased thirst
increased urination
indigestion
irritability
joint or muscle pain
light-colored stools
loss of appetite
lower back or side pain
metallic taste
mood changes
muscle pain or cramps
numbness or tingling in hands, feet, or lips
pain in lower legs
painful or difficult urination
pinpoint red spots on skin
rash
red irritated eyes
red skin lesions, often with a purple center
redness or swelling of lower leg
shortness of breath
sores, ulcers, or white spots in mouth or on lips
sugar in the urine
sweating
swelling of face, ankles, or hands
swollen or painful glands
tightness in chest
trembling
troubled breathing
unexplained weight loss
unpleasant breath odor
unusual bleeding or bruising
unusual tiredness or weakness
upper right abdominal pain
vomiting of blood
weak pulse
yellow eyes and skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Fainting
irregular, fast or slow, or shallow breathing
pale or blue lips, fingernails, or skin
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
weakness and heaviness of legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Blue-green to black skin discoloration
burning, tingling, numbness, or pain in the hands, arms, feet, or legs
cracked, dry, or scaly skin
decreased interest in sexual intercourse
feeling of constant movement of self or surroundings
hives or welts
inability to have or keep an erection
loss in sexual ability, desire, drive, or performance
pain, redness, or sloughing of skin at place of injection
restlessness
sensation of pins and needles
sensation of spinning
stabbing pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Metolazone
Pros
Taken by mouth once daily
Lower-cost generic available
Can be used in people who've kidney problems (if prescribed by provider)
Cons
Requires close monitoring with blood tests
Makes you urinate more (effect lasts 24 hours or longer)
Can cause serious problems with your electrolytes (like sodium and potassium)
Pharmacist tips for Metolazone
You might feel mild dizziness for the first few days after starting metolazone. This should get better over time as your body adjusts to your new (lower) blood pressure. Tell your provider if your dizziness doesn't go away.
Since this medication is considered a water pill, it can cause you to urinate more often. It's best to take your metolazone dose in the morning or afternoon to avoid waking up in the middle of the night to go to the bathroom.
Metolazone can make your skin more sensitive to sunlight. Use proper protection (like hats, sunscreen, etc.) and avoid long periods of time in the sun.
Metolazone can cause electrolyte imbalances (low sodium, magnesium, potassium), which can be dangerous. Tell your provider right away if you have any weakness, muscle pain or cramps, dizziness, fast heartbeat, or vomiting.
You're recommended to avoid drinking alcohol while taking metolazone because doing so can raise your risk of side effects, such as dizziness, headaches, and changes to your blood pressure.
Frequently asked questions about Metolazone
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What are the risks and warnings for Metolazone?
Metolazone can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Electrolyte imbalance and dehydration
Risk factors: kidney problems | Dehydration | Diarrhea or vomiting | Taking other medications that affect electrolytes | Taking higher doses of metolazone | Hot weather
Metolazone can cause changes in your body's electrolyte levels, including sodium, potassium, magnesium, and calcium. Your risk is higher is you're taking higher doses of metolazone or aren't drinking enough water. To be safe, your provider will likely ask you to get blood tests regularly to monitor your electrolyte levels and kidney health. Let your healthcare provider know if you experience symptoms of electrolyte imbalance, such as dry mouth, weakness, tiredness, dizziness, muscle pain or cramps, fast heart rate, vomiting, or nausea.
Low blood pressure
Risk factors: Taking other medications that lower blood pressure | Drinking alcohol
Metolazone lowers your blood pressure and can make you feel lightheaded or dizzy. This should go away after a few days, but talk to your provider if it doesn't. They might change your dose or put you on a different medication.
Life-threatening skin reaction
Although rare, metolazone has been linked to Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (TEN). Even though it's rare, these reactions can be deadly and you should know what the signs are. If you have a painful, blistering rash that's peeling or flu-like symptoms (fever, chills, body aches, nausea, vomiting), call 911 right away.
Severe allergic reaction
Risk factors: Allergy to sulfa drugs (e.g. sulfa antibiotics, like sulfamethoxazole)
Though not likely, there's a possibility that people with allergies to other sulfa-containing medications can have a reaction to metolazone. Before taking metolazone. let your provider know if you've had a severe reaction to sulfa medications before. Depending on how serious your reaction was, they might have you take a lower dose of metolazone and observe you for any reaction. Get medical help right away if you notice a rash, hives, trouble breathing, or swelling around your face or neck.
Gout
Risk factors: History of gout | Current kidney problems
Metolazone can raise your risk of gout attacks. Tell your healthcare provider if you've had gout attacks in the past or currently have gout so that they can monitor your condition closely.
Worsening kidney problems
Risk factors: History of kidney problems
In some rare cases, metolazone can make your kidneys worse. You'll need blood tests done to check your kidneys before starting metolazone and regularly after. Tell your provider if you aren't urinating as much as usual, or if your urine is dark in color even after you drink more fluids.
High blood sugar
Risk factors: History of diabetes | Uncontrolled diabetes
In some rare cases, metolazone can raise your blood sugar levels. If you have diabetes, your healthcare provider might have you check your blood sugar levels more often when you start metolazone.
Metolazone dosage forms
Typical dosing for Metolazone
Edema: The typical starting dose ranges from 5 mg to 20 mg by mouth once daily. Your provider might adjust your dose as needed based on your symptoms and lab work.
High blood pressure: The typical starting dose ranges from 2.5 mg to 5 mg by mouth once daily. Your provider might adjust your dose every few days or weeks, depending on your blood pressure level.
Interactions between Metolazone and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aceclofenac
- Acemetacin
- Acetyldigoxin
- Amtolmetin Guacil
- Arsenic Trioxide
- Aspirin
- Bepridil
- Bromfenac
- Bufexamac
- Bumetanide
- Celecoxib
- Choline Salicylate
- Clonixin
- Deslanoside
- Desmopressin
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Digitalis
- Digitoxin
- Digoxin
- Dipyrone
- Dofetilide
- Droperidol
- Droxicam
- Ethacrynic Acid
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Flecainide
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Furosemide
- Ibuprofen
- Indomethacin
- Ketanserin
- Ketoprofen
- Ketorolac
- Levomethadyl
- Lithium
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Metildigoxin
- Morniflumate
- Nabumetone
- Naproxen
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Phenylbutazone
- Piketoprofen
- Piroxicam
- Proglumetacin
- Propyphenazone
- Proquazone
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sodium Salicylate
- Sotalol
- Sulindac
- Tenoxicam
- Tiaprofenic Acid
- Tolfenamic Acid
- Tolmetin
- Torsemide
- Valdecoxib
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aminolevulinic Acid
- Gossypol
- Licorice
How much does Metolazone cost?
Metolazone contraindications
Not urinating at all
Coma caused by severe liver disease
What are alternatives to Metolazone?
Edema (swelling from fluid) related to kidney problems
Edema related to heart failure
Swelling (edema) due to heart failure, liver problems, or kidney problems
Swelling in the body from fluid buildup (edema)
Metolazone images
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References
Best studies we foundAarkish Pharmaceuticals NJ Inc. (2023). Metolazone tablet [package insert]. DailyMed.
Cheng, H. W. B., et al. (2014). Combination therapy with low-dose metolazone and furosemide: A “needleless” approach in managing refractory fluid overload in elderly renal failure patients under palliative care. International Urology and Nephrology.
Hoyt, R. E., et al. (2001). Reducing readmissions for congestive heart failure. American Family Physician.
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