Metolazone and its role in edema management

Metolazone is commonly administered in conjunction with a loop diuretic to manage volume overload in patients otherwise resistant to loop diuretic therapy alone. Metolazone is a thiazide-type diuretic that is characterized by slow and sometimes erratic absorption when administered as the Zaroxylyn product. This absorptive profile together with the large volume of distribution and high degree of renal clearance for metolazone provide the pharmacologic basis for a favorable diuretic combination effect. Zaroxylyn should always be administered cautiously and only with a means of surveillance allowing the patient's weight to be carefully monitored so as to avoid excessive diuresis. If an excessive diuresis occurs with a metolazone and loop diuretic combination both drugs should be stopped temporarily. The temptation should be avoided to simply reduce the doses of either metolazone or the loop diuretic as a means to controlling an active diuresis.