I’m biased against Metolazone , I’ve seen to many patients hospitalized with hypokalemia over the years
October 21, 2025 at 2:00 PM
I’m biased against Metolazone , I’ve seen to many patients hospitalized with hypokalemia over the years
Not sure furosemide is good for BP much beyond volume?
I also wonder if there’s hyponatremia - but just wanted to give Joel a hard time 😏
I don’t think metolazone is necessarily superior - bet 100 mg chlorthalidone might be just as good? Maybe someone has the old citations!
I also wonder if there’s hyponatremia - but just wanted to give Joel a hard time 😏
I don’t think metolazone is necessarily superior - bet 100 mg chlorthalidone might be just as good? Maybe someone has the old citations!
October 21, 2025 at 1:43 PM
Not sure furosemide is good for BP much beyond volume?
I also wonder if there’s hyponatremia - but just wanted to give Joel a hard time 😏
I don’t think metolazone is necessarily superior - bet 100 mg chlorthalidone might be just as good? Maybe someone has the old citations!
I also wonder if there’s hyponatremia - but just wanted to give Joel a hard time 😏
I don’t think metolazone is necessarily superior - bet 100 mg chlorthalidone might be just as good? Maybe someone has the old citations!
Could it be too much for volume and K+ to combine loop + HCTZ? Or does That combination not have the same effect as loop + metolazone?
October 21, 2025 at 1:40 PM
Could it be too much for volume and K+ to combine loop + HCTZ? Or does That combination not have the same effect as loop + metolazone?
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July 3, 2025 at 9:46 PM
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just drop by every grillfest with some metolazone
May 26, 2025 at 12:44 AM
just drop by every grillfest with some metolazone
Took a new medication (Metolazone) yesterday in hopes of it helping my diuretics to get rid of this fluid and tonight I’ve had 3 rounds of leg cramps. I’m not going to take that medicine again. UGH
May 1, 2025 at 9:19 AM
Took a new medication (Metolazone) yesterday in hopes of it helping my diuretics to get rid of this fluid and tonight I’ve had 3 rounds of leg cramps. I’m not going to take that medicine again. UGH
in this one case the description of the tablets didn't match the tablets so the tech removed the description??? and then the pharmacist didn't notice??? and it was supposed to be metolazone but the tech had filled with methotrexate
April 15, 2025 at 2:59 PM
in this one case the description of the tablets didn't match the tablets so the tech removed the description??? and then the pharmacist didn't notice??? and it was supposed to be metolazone but the tech had filled with methotrexate
Day 7: Having similar characteristics to the thiazide family of drugs, #metolazone is a quinazoline-sulfonamide; therefore there is a risk of allergic reaction in cases of sulfonamide allergy, albeit a lower risk than for sulfonamide antibiotics
March 18, 2025 at 6:45 PM
Day 7: Having similar characteristics to the thiazide family of drugs, #metolazone is a quinazoline-sulfonamide; therefore there is a risk of allergic reaction in cases of sulfonamide allergy, albeit a lower risk than for sulfonamide antibiotics
Day 6: Most ‘severe’ drug-drug interactions relate to hypokalaemia e.g aripiprazole, citalopram or risk of renal failure e.g NSAIDs. #metolazone can also increase the concentration of lithium. Many DDIs also increase risk of hypotension e.g alcohol, other antihypertensives
(NOT exhaustive)
(NOT exhaustive)
March 17, 2025 at 4:08 PM
Day 6: Most ‘severe’ drug-drug interactions relate to hypokalaemia e.g aripiprazole, citalopram or risk of renal failure e.g NSAIDs. #metolazone can also increase the concentration of lithium. Many DDIs also increase risk of hypotension e.g alcohol, other antihypertensives
(NOT exhaustive)
(NOT exhaustive)
Day 4 (cont). #metolazone is believed not to induce renin-angiotensin-aldosterone system, which supports overcoming issues with diuretic resistance. Electrolyte monitoring required
March 15, 2025 at 1:42 PM
Day 4 (cont). #metolazone is believed not to induce renin-angiotensin-aldosterone system, which supports overcoming issues with diuretic resistance. Electrolyte monitoring required
Day 4: #metolazone inhibits NaCl symporter & thus Na reabsorption. The action is predom in distal tubule, increasing urine volume & reducing fluid accumulation, but some Na absorption inhibition occurs in proximal tubule. K+excretion may be less affected compared to other diuretics
March 15, 2025 at 1:40 PM
Day 4: #metolazone inhibits NaCl symporter & thus Na reabsorption. The action is predom in distal tubule, increasing urine volume & reducing fluid accumulation, but some Na absorption inhibition occurs in proximal tubule. K+excretion may be less affected compared to other diuretics
Day 3 (cont) States of oedema can affect bioavailability for #metolazone; monitor for response variability
March 15, 2025 at 1:31 PM
Day 3 (cont) States of oedema can affect bioavailability for #metolazone; monitor for response variability
Day 3; #metolazone has good oral absorption;take same time daily relative to meal;cmax~1.5hrs. High Vd & protein binding. ~ 10% hydroxylated to inactive metabolites/some enterohepatic recycling. Most excreted unchanged in urine/small % biliary excretion. T½ 8-10hrs
March 15, 2025 at 1:30 PM
Day 3; #metolazone has good oral absorption;take same time daily relative to meal;cmax~1.5hrs. High Vd & protein binding. ~ 10% hydroxylated to inactive metabolites/some enterohepatic recycling. Most excreted unchanged in urine/small % biliary excretion. T½ 8-10hrs
Okay hold the metolazone
March 14, 2025 at 11:36 PM
Okay hold the metolazone
Day 2: #metolazone is licensed in adults for oedema of heart failure or kidney disease, as well as hypertension. Licensed in the UK as Xaqua® as 5mg divisible tablet (care re switching as imports had other strengths/differences in bioavailability). Dose is 2.5 to 5mg daily a.m.
March 13, 2025 at 9:14 PM
Day 2: #metolazone is licensed in adults for oedema of heart failure or kidney disease, as well as hypertension. Licensed in the UK as Xaqua® as 5mg divisible tablet (care re switching as imports had other strengths/differences in bioavailability). Dose is 2.5 to 5mg daily a.m.
Day 1: A potent long-acting oral thiazide-like diuretic, #metolazone was discovered in the 1970s. Can be used in combination with loop diuretics for acute heart failure; potentiates effect & postulated to help with diuretic resistance. Mostly used short-term, but some require long-term management
March 12, 2025 at 5:37 PM
Day 1: A potent long-acting oral thiazide-like diuretic, #metolazone was discovered in the 1970s. Can be used in combination with loop diuretics for acute heart failure; potentiates effect & postulated to help with diuretic resistance. Mostly used short-term, but some require long-term management
7 days of #metolazone starting today 😁
March 12, 2025 at 5:32 PM
7 days of #metolazone starting today 😁
I am a bit perplexed that anyone has to reach for any adjunct diuretic not named metolazone. Wonder inpatient med (scary outpt med). If it doesn't work, terrible harbinger of 7-day mortality in my experience.
February 22, 2025 at 3:39 AM
I am a bit perplexed that anyone has to reach for any adjunct diuretic not named metolazone. Wonder inpatient med (scary outpt med). If it doesn't work, terrible harbinger of 7-day mortality in my experience.
Idk that I'd call it GREAT (see pic), granted I know of no studies comparing max dose metolazone against max dose, only smaller studies comparing middling doses of loop/metolazone/indapamide...
February 22, 2025 at 3:13 AM
Idk that I'd call it GREAT (see pic), granted I know of no studies comparing max dose metolazone against max dose, only smaller studies comparing middling doses of loop/metolazone/indapamide...
None are superior if you dose them in equivalence, metolazone has been the best examined inpatient against chlorothiazide
February 22, 2025 at 1:14 AM
None are superior if you dose them in equivalence, metolazone has been the best examined inpatient against chlorothiazide
I know...but metolazone and diuril are the common thiazides combined with loop diuretics for inpatient diuresis.
Why're you using chlorthalidone?
Why're you using chlorthalidone?
February 9, 2025 at 6:53 PM
I know...but metolazone and diuril are the common thiazides combined with loop diuretics for inpatient diuresis.
Why're you using chlorthalidone?
Why're you using chlorthalidone?
Metolazone is very different than diuril (chlorothiazide)
Metolazone has a half life of 2 days, chlorothiazide has a half life of 90 minutes
Metolazone has a half life of 2 days, chlorothiazide has a half life of 90 minutes
February 9, 2025 at 6:51 PM
Metolazone is very different than diuril (chlorothiazide)
Metolazone has a half life of 2 days, chlorothiazide has a half life of 90 minutes
Metolazone has a half life of 2 days, chlorothiazide has a half life of 90 minutes
But metolazone also has a looooong half life (2 days) so the idea of loading dose would be equally applicable.
www.nejm.org/doi/full/10....
www.nejm.org/doi/full/10....
February 9, 2025 at 6:43 PM
But metolazone also has a looooong half life (2 days) so the idea of loading dose would be equally applicable.
www.nejm.org/doi/full/10....
www.nejm.org/doi/full/10....
Never seen a loading for this but then again clinicians around here use metolazone most of the time for fluid removal. If there is evidence out there of increased benefit and w/o increase in risk using the loading, I'm listening.
February 9, 2025 at 5:22 PM
Never seen a loading for this but then again clinicians around here use metolazone most of the time for fluid removal. If there is evidence out there of increased benefit and w/o increase in risk using the loading, I'm listening.
Need an edit button...should be a period there.
You didn't say that. Metolazone is same as diuril.
Why chlorthalidone?
You didn't say that. Metolazone is same as diuril.
Why chlorthalidone?
February 9, 2025 at 4:30 PM
Need an edit button...should be a period there.
You didn't say that. Metolazone is same as diuril.
Why chlorthalidone?
You didn't say that. Metolazone is same as diuril.
Why chlorthalidone?