Metolazone

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Metolazone Brand Names- Mykrox | Zaroxolyn

What is Metolazone

Metolazone is an oral quinazoline diuretic used for the management of edema and hypertension.

Although it is not a true thiazide, metolazone is a sulfonamide derivative like the thiazides, and its site of action is similar.

However, unlike thiazide diuretics, metolazone may produce diuresis in patients with impaired renal function.

Zaroxolyn® is a tablet formulation of metolazone with relatively slow and incomplete absorption.

A more rapidly absorbed tablet formulation with more complete bioavailability,

Mykrox®, is no longer available in the US.

Metolazone was approved by the FDA in 1973.

A generic version of Zaroxolyn® was approved on December 19, 2003.

Indications

  • edema
  • heart failure
  • hypertension
  • nephrotic syndrome

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. anaphylactoid reactions
  4. anorexia
  5. anxiety
  6. aplastic anemia
  7. arthralgia
  8. asthenia
  9. azotemia
  10. blurred vision
  11. chest pain (unspecified)
  12. constipation
  13. depression
  14. diarrhea
  15. drowsiness
  16. dysgeusia
  17. dyspepsia
  18. elevated hepatic enzymes
  19. exfoliative dermatitis
  20. glycosuria
  21. gout
  22. hepatitis
  23. hypercalcemia
  24. hypercholesterolemia
  25. hyperglycemia
  26. hypertriglyceridemia
  27. hyperuricemia
  28. hypochloremia
  29. hypokalemia
  30. hypomagnesemia
  31. hyponatremia
  32. hypophosphatemia
  33. hypovolemia
  34. impotence (erectile dysfunction)
  35. insomnia
  36. jaundice
  37. leukopenia
  38. metabolic alkalosis
  39. muscle cramps
  40. myalgia
  41. nausea
  42. orthostatic hypotension
  43. palpitations
  44. pancreatitis
  45. paresthesias
  46. petechiae
  47. photosensitivity
  48. polyuria
  49. pruritus
  50. purpura
  51. rash
  52. restlessness
  53. sialadenitis
  54. Stevens-Johnson syndrome
  55. syncope
  56. thrombocytopenia
  57. thrombosis
  58. toxic epidermal necrolysis
  59. urticaria
  60. vasculitis
  61. vertigo
  62. visual impairment
  63. vomiting
  64. xerostomia

Monitoring Parameters

  • blood glucose
  • serum calcium
  • serum cholesterol profile
  • serum creatinine/BUN
  • serum electrolytes
  • serum magnesium
  • serum uric acid

Contraindications

  • anuria
  • breast-feeding
  • coma
  • diabetes mellitus
  • electrolyte imbalance
  • geriatric
  • gout
  • hepatic disease
  • hepatic encephalopathy
  • hypercalcemia
  • hyperglycemia
  • hyperuricemia
  • hypochloremia
  • hypokalemia
  • hypomagnesemia
  • hyponatremia
  • hypotension
  • hypovolemia
  • jaundice
  • metabolic alkalosis
  • neonates
  • orthostatic hypotension
  • pancreatitis
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • sulfonamide hypersensitivity
  • sunlight (UV) exposure
  • sympathectomy
  • syncope
  • systemic lupus erythematosus (SLE)

Interactions

  • Acarbose
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Acetazolamide
  • Acetohexamide
  • Aclidinium; Formoterol
  • Acrivastine; Pseudoephedrine
  • Albiglutide
  • Albuterol
  • Albuterol; Ipratropium
  • Aldesleukin, IL-2
  • Alemtuzumab
  • Alendronate; Cholecalciferol
  • Alfentanil
  • Allopurinol
  • Alogliptin
  • Alogliptin; Metformin
  • Alogliptin; Pioglitazone
  • Alpha-glucosidase Inhibitors
  • Alprostadil
  • Amifostine
  • Aminolevulinic Acid
  • Amiodarone
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphetamine; Dextroamphetamine Salts
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Amyl Nitrite
  • Angiotensin-converting enzyme inhibitors
  • Anticholinergics
  • Apomorphine
  • Apraclonidine
  • Arformoterol
  • Aripiprazole
  • Arsenic Trioxide
  • Articaine; Epinephrine
  • Asenapine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Atracurium
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Baclofen
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benazepril
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Benzhydrocodone; Acetaminophen
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzphetamine
  • Benztropine
  • Beta-agonists
  • Bortezomib
  • Bosentan
  • Brexpiprazole
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Budesonide; Formoterol
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Cabergoline
  • Calcium
  • Calcium Phosphate, Supersaturated
  • Calcium; Vitamin D
  • Canagliflozin
  • Canagliflozin; Metformin
  • Captopril
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cardiac glycosides
  • Cariprazine
  • Celecoxib
  • Cetirizine; Pseudoephedrine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chlordiazepoxide; Clidinium
  • Chloroprocaine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpropamide
  • Cholestyramine
  • Cidofovir
  • Cisapride
  • Cisatracurium
  • Citalopram
  • Clindamycin; Tretinoin
  • Clozapine
  • Co-Enzyme Q10, Ubiquinone
  • Cocaine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Colchicine; Probenecid
  • Colestipol
  • Conivaptan
  • Corticosteroids
  • Cosyntropin
  • Cyclophosphamide
  • Dapagliflozin
  • Dapagliflozin; Metformin
  • Dapagliflozin; Saxagliptin
  • Desloratadine; Pseudoephedrine
  • Desvenlafaxine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexlansoprazole
  • Dexmethylphenidate
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Quinidine
  • Diazoxide
  • Dichlorphenamide
  • Diclofenac
  • Diclofenac; Misoprostol
  • Dicyclomine
  • Diethylpropion
  • Diflunisal
  • Digitoxin
  • Digoxin
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Dobutamine
  • Dofetilide
  • Dolasetron
  • Dopamine
  • Doxacurium
  • Droperidol
  • Dulaglutide
  • Duloxetine
  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Enalapril, Enalaprilat
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Enflurane
  • Ephedrine
  • Epinephrine
  • Ergocalciferol, Vitamin D2
  • Ertugliflozin; Metformin
  • Ertugliflozin; Sitagliptin
  • Escitalopram
  • Esomeprazole
  • Esomeprazole; Naproxen
  • Estradiol
  • Estradiol Cypionate; Medroxyprogesterone
  • Ethanol
  • Etodolac
  • Etomidate
  • Exenatide
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Fentanyl
  • Fexofenadine; Pseudoephedrine
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Flavoxate
  • Fluocinolone; Hydroquinone; Tretinoin
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Flurbiprofen
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Fluvoxamine
  • Formoterol
  • Formoterol; Mometasone
  • Fosinopril
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Fospropofol
  • Gallium Ga 68 Dotatate
  • General anesthetics
  • Glimepiride
  • Glimepiride; Pioglitazone
  • Glimepiride; Rosiglitazone
  • Glipizide
  • Glipizide; Metformin
  • Glyburide
  • Glyburide; Metformin
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Granisetron
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Phenylephrine
  • Guaifenesin; Pseudoephedrine
  • Halobetasol; Tazarotene
  • Halofantrine
  • Haloperidol
  • Halothane
  • Homatropine; Hydrocodone
  • Hydralazine; Isosorbide Dinitrate, ISDN
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen
  • Ibuprofen lysine
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Icosapent ethyl
  • Iloperidone
  • Inamrinone
  • Incretin Mimetics
  • Indacaterol
  • Indacaterol; Glycopyrrolate
  • Indomethacin
  • Inotersen
  • Insulin Degludec; Liraglutide
  • Insulin Glargine; Lixisenatide
  • Insulins
  • Intravenous Lipid Emulsions
  • Isocarboxazid
  • Isoflurane
  • Isoproterenol
  • Isosorbide Dinitrate, ISDN
  • Isosorbide Mononitrate
  • Ketamine
  • Ketoprofen
  • Ketorolac
  • Lansoprazole
  • Lansoprazole; Naproxen
  • Lesinurad; Allopurinol
  • Levalbuterol
  • Levodopa
  • Levomethadyl
  • Levomilnacipran
  • Levorphanol
  • Linagliptin
  • Linagliptin; Metformin
  • Liraglutide
  • Lisdexamfetamine
  • Lisinopril
  • Lithium
  • Lixisenatide
  • Loop diuretics
  • Loratadine; Pseudoephedrine
  • Lovastatin; Niacin
  • Lurasidone
  • Magnesium Salts
  • Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate
  • Mannitol
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meglitinides
  • Meloxicam
  • Mepenzolate
  • Meperidine
  • Meperidine; Promethazine
  • Mequinol; Tretinoin
  • Mestranol; Norethindrone
  • Metaproterenol
  • Metformin
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Methadone
  • Methamphetamine
  • Methazolamide
  • Methenamine
  • Methenamine; Sodium Acid Phosphate
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methotrexate
  • Methoxsalen
  • Methscopolamine
  • Methylphenidate
  • Metoclopramide
  • Midodrine
  • Miglitol
  • Milnacipran
  • Milrinone
  • Mirtazapine
  • Mivacurium
  • Moexipril
  • Morphine
  • Morphine; Naltrexone
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nateglinide
  • Nefazodone
  • Nesiritide, BNP
  • Neuromuscular blockers
  • Niacin, Niacinamide
  • Niacin; Simvastatin
  • Nitrates
  • Nitroglycerin
  • Nitroprusside
  • Nonsteroidal antiinflammatory drugs
  • Norepinephrine
  • Octreotide
  • Olanzapine
  • Olodaterol
  • Omeprazole
  • Omeprazole; Amoxicillin; Rifabutin
  • Omeprazole; Sodium Bicarbonate
  • Ondansetron
  • Oprelvekin, rh-IL-11
  • Oxaprozin
  • Oxybutynin
  • Oxycodone
  • Oxymetazoline
  • Oxymorphone
  • Paliperidone
  • Pancuronium
  • Pantoprazole
  • Paroxetine
  • Pasireotide
  • Pentamidine
  • Pentazocine
  • Pentazocine; Naloxone
  • Pentoxifylline
  • Perindopril
  • Perindopril; Amlodipine
  • Phendimetrazine
  • Phenelzine
  • Phenothiazines
  • Phentermine
  • Phentermine; Topiramate
  • Phenylephrine
  • Phenylephrine; Promethazine
  • Photosensitizing agents (topical)
  • Pimozide
  • Pioglitazone
  • Pirbuterol
  • Piroxicam
  • Polycarbophil
  • Polyethylene Glycol; Electrolytes
  • Polyethylene Glycol; Electrolytes; Ascorbic Acid
  • Porfimer
  • Pramlintide
  • Prazosin
  • Prilocaine; Epinephrine
  • Probenecid
  • Procainamide
  • Procaine
  • Propantheline
  • Propofol
  • Pseudoephedrine
  • Quetiapine
  • Quinapril
  • Quinidine
  • Rabeprazole
  • Ramipril
  • Rapacuronium
  • Rasagiline
  • Remifentanil
  • Repaglinide
  • Risperidone
  • Ritodrine
  • Rocuronium
  • Rofecoxib
  • Rosiglitazone
  • Salicylates
  • Salmeterol
  • Saxagliptin
  • Scopolamine
  • Semaglutide
  • Serotonin norepinephrine reuptake inhibitors
  • Sertraline
  • Sevoflurane
  • Silodosin
  • Simvastatin; Sitagliptin
  • Sitagliptin
  • Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • Solifenacin
  • Streptozocin
  • Succinylcholine
  • Sufentanil
  • Sulfacetamide
  • Sulfacetamide; Sulfur
  • Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
  • Sulfinpyrazone
  • Sulfonylureas
  • Sulindac
  • Tapentadol
  • Tazarotene
  • Tegaserod
  • Terbutaline
  • Tetrabenazine
  • Tetracaine
  • Thiazolidinediones
  • Thiothixene
  • Tiotropium; Olodaterol
  • Tizanidine
  • Tolazamide
  • Tolbutamide
  • Tolmetin
  • Tolterodine
  • Tolvaptan
  • Toremifene
  • Tramadol
  • Trandolapril
  • Trandolapril; Verapamil
  • Tranylcypromine
  • Trazodone
  • Treprostinil
  • Tretinoin, ATRA
  • Trihexyphenidyl
  • Trospium
  • Tubocurarine
  • Umeclidinium; Vilanterol
  • Valdecoxib
  • Vecuronium
  • Venlafaxine
  • Verteporfin
  • Vilazodone
  • Vitamin D
  • Vitamin D analogs
  • Vorinostat
  • Vortioxetine
  • Yohimbine
  • Ziconotide
  • Ziprasidone

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