Metolazone

About Metolazone

Metolazone works much like a thiazide diuretic, stopping the kidney tubules from reabsorbing sodium so that more salt and water leave in the urine. It is approved for swelling from congestive heart failure and from kidney disease, including the nephrotic syndrome, and for high blood pressure. Unlike the thiazides, it can still work when kidney function is badly reduced. Diuresis starts within about an hour of a dose and lasts a day or more.

Added to furosemide, it has produced a marked diuresis in some people whose swelling resisted diuretics given alone, but the label warns that the pair can cause unusually large or prolonged losses of fluid and salts. Low potassium is a particular risk; it can cause weakness, cramps and heart rhythm problems and is especially dangerous for people taking digoxin. Rarely, sodium and potassium have dropped severely after the first doses. Metolazone also raises uric acid, which can bring on gout, can raise blood sugar, and can make the skin sensitive to sunlight.

It is not used in people who are making no urine or who are in or near hepatic coma, and people allergic to sulfa drugs or thiazides may react to it. Generic labels still warn against interchanging these tablets with Mykrox, a faster-absorbed metolazone tablet that is now discontinued, and MedlinePlus advises against switching metolazone products without asking the prescriber or pharmacist.

Taking Metolazone

How to take it

Once a day at about the same time. Follow any advice you are given on salt, potassium-rich foods or a potassium supplement. Get up slowly, as it can make you dizzy, and limit alcohol.

If you miss a dose

Take it as soon as you remember, unless it is nearly time for your next dose; in that case skip the missed dose and carry on as usual. Never take two doses at once to make up.

Storage

At room temperature in the original container, tightly closed and protected from light, out of reach of children.

Interactions to know about

It raises lithium levels, so the two are generally not combined. With furosemide, fluid and salt losses can be large, and steroids add to potassium loss. Low potassium makes digoxin more likely to cause dangerous heart rhythms. Anti-inflammatories and aspirin can blunt its effect on blood pressure, and alcohol, barbiturates and opioids add to dizziness on standing. Mention any sulfa allergy, and limit sun exposure.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Metolazone differs from pharmacy to pharmacy

Metolazone has many generic makers, yet it costs pharmacies far more per tablet than hydrochlorothiazide, and its wholesale price has swung widely over the years. Some flat-price generic lists leave it out, so each pharmacy’s own pricing decides the quote.

Label doses run from 2.5 mg a day for blood pressure to 20 mg a day for swelling, so the strength written and the number of tablets in each dose shape the monthly cost.

Ways to pay less for Metolazone without insurance

• Ask whether metolazone is on the pharmacy’s flat-price generic list.
• Ask the prescriber to write each dose in the fewest tablets, such as one 10 mg tablet instead of two 5 mg tablets.
• Ask for a ninety-day prescription once the dose is settled.
• Once a pharmacy quotes well, stay with it so you keep the same manufacturer.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Metolazone

1. 1.How often will my potassium, sodium and kidney function be checked?
2. 2.Should I take a potassium supplement?
3. 3.Which signs of low potassium or dehydration should make me call?
4. 4.Is it safe with my digoxin, lithium or furosemide?
5. 5.Can I switch to another manufacturer’s tablets?

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