Details About Generic Salt ::  Metolazo

Main Medicine Class:: Thiazide-like diuretic   

(meh-TOLE-uh-ZONE)
Zaroxolyn
Class: Thiazide-like diuretic

 

Drugs Class ::

 Action Increases urinary excretion of sodium and chloride by inhibiting reabsorption in ascending limb of loop of Henle and early distal tubules.

Indications for Drugs ::

 Indications Treatment of edema and hypertension. Unlabeled use(s): Prevention of calcium nephrolithiasis; reduction of postmenopausal osteoporosis; reduction of urine volume in diabetes insipidus.

Drug Dose ::

 Route/Dosage

ADULTS: PO 0.5–1 mg/day (Mykrox) or 2.5–20 mg/day (Zaroxolyn). Do not interchange Mykrox with Zaroxolyn. Mykrox s absorbed more rapidly and more completely than Zaroxolyn.

Contraindication ::

 Contraindications Anuria; renal decompensation; hepatic coma or precoma.

Drug Precautions ::

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Not recommended for children. Fluid and electrolytes: May be altered; periodic determinations of serum electrolytes, BUN, uric acid and glucose are indicated. Hepatic impairment: May precipitate hepatic coma; use drug with caution. Hypersensitivity: May occur; cross-sensitivity to sulfonamides or thiazides possible. Hyperuricemia: May increase serum uric acid and precipitate gout. Lipids: May cause increases in total serum cholesterol, triglycerides and LDL. Lupus erythematosus: May be activated or exacerbated. Post-sympathectomy patients: Antihypertensive effects may be increased. Renal impairment: May precipitate azotemia; use drug with caution. Tartrazine-sensitivity: Some products contain tartrazine, which may cause allergic-type reactions eg, bronchial asthma).

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Rapid-acting formulation: Orthostatic hypotension; palpitations; hest pain; cold extremities; edema. Slow-acting formulation: Venous thrombosis, palpitations; chest pain; excessive volume depletion; hemoconcentration. CNS: Rapid-acting formulation: Dizziness; headache; weakness; “weird” eeling; neuropathy; fatigue; lethargy; lassitude; depression. Slow-acting formulation: Dizziness; syncope; neuropathy; vertigo; headache; weakness; atigue; lethargy; lassitude; anxiety; depression; nervousness. DERM: Rapid-acting formulation: Necrotizing angiitis; vasculitis; utaneous vasculitis; dry skin. Slow-acting formulation: Photosensitivity; ecrotizing angiitis; vasculitis; cutaneous vasculitis. EENT: Bitter taste. GI: Rapid-acting formulation: Nausea. Slow-acting formulation: Nausea; anorexia; ancreatitis. GU: Slow-acting formulation: Impotence. HEMA: Slow-acting formulation: Leukopenia; agranulocytosis; aplastic anemia. HEPA: Slow-acting formulation: Jaundice; hepatitis. META: Hypokalemia; hyperuricemia; hyponatremia; hypochloremia; hypochloremic alkalosis. RESP: Rapid-acting formulation: Cough; epistaxis; sinus congestion; ore throat. OTHER: Rapid-acting formulation: Impotence; joint pain; back pain; itching eyes; tinnitus; muscle cramps and spasms. Slow-acting formulation: Swelling; hills; acute gouty attack; hyperglycemia; glucosuria; muscle cramps and spasms.

Drug Mode of Action ::  

 Action Increases urinary excretion of sodium and chloride by inhibiting reabsorption in ascending limb of loop of Henle and early distal tubules.

Drug Interactions ::

 Interactions

Cholestyramine, colestipol: May decrease effects of metolazone by decreasing absorption. Diazoxide: Concurrent use may produce severe hyperglycemia. Digitalis glycosides (eg, digoxin): Urinary loss of potassium and magnesium may predispose patient to digitalis-induced arrhythmia. Lithium: Metolazone may decrease renal elimination of lithium, resulting in toxicity. Loop diuretics (eg, furosemide): Concurrent use may produce profound diuresis and electrolyte abnormalities. Sulfonylureas (eg, tolbutamide): Metolazone may decrease hypoglycemic effect of Sulfonylureas by increasing blood glucose.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Assess for signs of fluid or electrolyte imbalance (dry mouth, thirst, confusion, muscle fatigue, hypotension, tachycardia).
  • Maintain accurate I&O records.
  • Monitor blood sugar closely for diabetic patients.
  • Monitor serum uric acid levels periodically.
  • Assess initial and periodic determinations of serum electrolytes and uric acid levels.
  • For treatment of diabetic patients, monitor output. If output increases, dosage may need to be increased.
OVERDOSAGE: SIGNS & SYMPTOMS
  Orthostatic hypotension, syncope, lethargy, GI hypermotility, dizziness, electrolyte abnormalities, CNS depression, drowsiness, hemoconcentration, GI irritation

Drug Storage/Management ::

 Administration/Storage

  • For treatment of edema, establish schedule for intermittent therapy every other day or 3–5 days/wk schedule to reduce potential for electrolyte imbalance.
  • For treatment of hypertension, check orders for dosage adjustments of other agents to prevent hypotension.
  • Do not interchange product with other brand or generic forms because some formulations are more rapidly bioavailable and not therapeutically equivalent at same doses of other thiazides.
  • Administer medication in morning to prevent nocturia.
  • Store at room temperature in tight, light-resistant container.

Drug Notes ::

 Patient/Family Education

  • Advise patient to take early in day to avoid sleep disruption.
  • Tell patient to take with food if stomach upset occurs.
  • Explain significance of potential potassium loss, and identify appropriate supplemental food sources (eg, bananas, orange juice, dates, citrus fruits, apricots). Teach patient signs and symptoms of hypokalemia (muscle weakness, cramping).
  • Explain that dizziness or lightheadedness may occur if patient stands up too fast.
  • Tell patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing until tolerance to sunlight can be established.
  • Explain that BP should be checked periodically by patient or family member.
  • Review signs and symptoms of fluid imbalance.

Disclaimer ::

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