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What brand names are available for metolazone?
What special precautions should I follow?
Before taking metolazone,
- tell your doctor and pharmacist if you are allergic to metolazone, sulfa drugs, thiazides, any other medications, or any of the ingredients in metolazone tablets. Ask your pharmacist for a list of the ingredients.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); corticotropin; digoxin (Lanoxin); furosemide (Lasix); insulin or other medications for diabetes; lithium (Eskalith, Lithobid); medications for asthma and colds; medications for pain or seizures; methenamine (Hiprex, Urex); other medications for high blood pressure; sedatives; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); tranquilizers; and vitamin D. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have kidney or liver failure. Your doctor will probably tell you not to take metolazone.
- tell your doctor if you have or have ever had diabetes, gout, systemic lupus erythematosus (SLE, a chronic inflammatory condition), or parathyroid, heart, kidney, or liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking metolazone, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking metolazone.
- you should know that metolazone may make you dizzy or drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- ask your doctor about the safe use of alcoholic beverages while you are taking metolazone. Alcohol can make the side effects from metolazone worse.
- plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Metolazone may make your skin sensitive to sunlight.
- you should know that metolazone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking metolazone. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
Mykrox Drug Class
Mykrox is part of the drug class:
Low Ceiling Sulfonamide Diuretics
Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:
- other medications for high blood pressure
- "loop diuretics" such as furosemide (Lasix) or torsemide (Demadex) and others
- nonsteroidal anti-inflammatory medications such as ibuprofen (Motrin, Nuprin) or naproxen (Aleve) and salicylates
- corticosteroids such as prednisone, hydrocortisone (Cortef), and dexamethasone (Decadron, Dexone, Hexadrol)
- lithium (Eskalith, Lithobid)
- medications for diabetes
- probenecid (Benemid)
- barbiturates such as amobarbital (Amytal), butalbital (Fioricet, Fiorinal), phenobarbital (Luminal) and others
- warfarin (Coumadin, Jantoven)
This is not a complete list of metolazone drug interactions. Ask your doctor or pharmacist for more information.
Before taking metolazone, tell your doctor about all of your medical conditions. Especially tell your doctor if you:
- have liver disease
- have kidney disease
- have diabetes
- have systemic lupus erythematosus (SLE)
- have gout
- have electrolyte imbalances
- are allergic to sulfa medications or any other medications
- are pregnant or breastfeeding
Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.
Mykrox and Lactation
Tell your doctor if you are breastfeeding or plan to breastfeed.
Metolazone has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from metolazone, a choice should be made whether to stop nursing or to stop use of metolazone. The importance of the drug to the mother should be considered.
Before Using Mykrox
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of metolazone in the pediatric population. Safety and efficacy have not been established .
Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of metolazone in the elderly. However, elderly patients are more likely to have age-related kidney, liver, or heart problems, which may require an adjustment in the dose for patients receiving metolazone .
|All Trimesters||B||Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.|
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amtolmetin Guacil
- Arsenic Trioxide
- Choline Salicylate
- Ethacrynic Acid
- Flufenamic Acid
- Mefenamic Acid
- Niflumic Acid
- Nimesulide Beta Cyclodextrin
- Salicylic Acid
- Sodium Salicylate
- Tiaprofenic Acid
- Tolfenamic Acid
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aminolevulinic Acid
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Anuria (not able to pass urine) or
- Liver disease, severe (e.g., hepatic coma)—Should not be used in patients with these conditions .
- Asthma or
- Diabetes or
- Gout or
- Hypercalcemia (high calcium in the blood) or
- Hyperuricemia (high uric acid in the blood) or
- Hypochloremia (low chloride in the blood) or
- Hypokalemia (low potassium in the blood) or
- Hypomagnesemia (low magnesium in the blood) or
- Hyponatremia (low sodium in the blood) or
- Systemic lupus erythematosus—Use with caution. This medicine may make these conditions worse .
- Kidney disease or
- Liver disease—Use with caution. The effects of the medicine may be increased because of slower removal of the medicine from the body .
Mykrox® Tablets (metolazone tablets, USP)
DO NOT INTERCHANGE:
Mykrox TABLETS ARE A RAPIDLY AVAILABLE FORMULATION OF METOLAZONE FOR ORAL ADMINISTRATION. Mykrox TABLETS AND OTHER FORMULATIONS OF METOLAZONE THAT SHARE ITS MORE RAPID AND COMPLETE BIOAVAILABILITY ARE NOT THERAPEUTICALLY EQUIVALENT TO ZAROXOLYN® TABLETS AND OTHER FORMULATIONS OF METOLAZONE THAT SHARE ITS SLOW AND INCOMPLETE BIOAVAILABILITY. FORMULATIONS BIOEQUIVALENT TO Mykrox AND FORMULATIONS BIOEQUIVALENT TO ZAROXOLYN SHOULD NOT BE INTERCHANGED FOR ONE ANOTHER.
Rapid Onset Hyponatremia and/or Hypokalemia
Rarely, the rapid onset of severe hyponatremia and/or hypokalemia has been reported following initial doses of thiazide and non-thiazide diuretics. When symptoms consistent with severe electrolyte imbalance appear rapidly, drug should be discontinued and supportive measures should be initiated immediately. Parenteral electrolytes may be required. Appropriateness of therapy with this class of drugs should be carefully reevaluated.
Hypokalemia may occur with consequent weakness, cramps, and cardiac dysrhythmias. Serum potassium should be determined at regular and appropriate intervals, and dose reduction, potassium supplementation or addition of a potassium-sparing diuretic instituted whenever indicated. Hypokalemia is a particular hazard in patients who are digitalized or who have or have had a ventricular arrhythmia; dangerous or fatal arrhythmias may be precipitated. Hypokalemia is dose related.
In controlled clinical trials, 1.5% of patients taking ½ mg and 3.1% of patients taking 1 mg of Mykrox daily developed clinical hypokalemia (defined as hypokalemia accompanied by signs or symptoms); 21% of the patients taking ½ mg and 30% of the patients taking 1 mg of Mykrox daily developed hypokalemia (defined as a serum potassium concentration below 3.5 mEq/L); in another controlled clinical trial in which the patients started therapy with a serum potassium level greater than 4.0 mEq/L, 8% of patients taking ½ mg of Mykrox daily developed hypokalemia (defined as a serum potassium concentration below 3.5 mEq/L).
In general, diuretics should not be given concomitantly with lithium because they reduce its renal clearance and add a high risk of lithium toxicity. Read prescribing information for lithium preparations before use of such concomitant therapy.
Unusually large or prolonged losses of fluids and electrolytes may result when metolazone is administered concomitantly to patients receiving furosemide (see PRECAUTIONS, Drug Interactions).
Other Antihypertensive Drugs
When Mykrox Tablets are used with other antihypertensive drugs, particular care must be taken to avoid excessive reduction of blood pressure, especially during initial therapy.
Cross-allergy may occur when Mykrox Tablets are given to patients known to be allergic to sulfonamide-derived drugs, thiazides, or quinethazone.
Sensitivity reactions (e.g., angioedema, bronchospasm) may occur with or without a history of allergy or bronchial asthma and may occur with the first dose of Mykrox.