FDA-filed SPL labeling · retrieved through openFDA

Metolazone

Metolazone is a diuretic (water pill) used to treat fluid retention (edema) caused by heart failure or kidney disease, and to lower high blood pressure.

Brand names ZaroxolynMykrox
Drug class Thiazide-like Diuretic
Rx Form 1 Route Oral
Dr. Brian Staiger, PharmD, BCPS
Reviewed by Last reviewed Jul 10, 2026
🧬 Where this information comes from Click to expand

The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 32 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →

At a glance
Linked label effectiveOct 1, 2019
Clinical labels in scope 32
AvailabilityRx
Earliest approval/marketing year 1973
FDA-listed product records 147
Boxed warningNone found in compared labels
How we combine label and product data →
No current FDA shortage listed · checked Sep 23, 2026
Metolazone at a glance The quick version — the full detail is in the Patient Information Guide below.
💊
HelloPharmacist Editorial Team Bottom Line
Metolazone is a once-daily diuretic (water pill) that helps remove excess fluid from the body and lower high blood pressure. It's generally well tolerated, but keeping potassium levels in a safe range is critical — especially if you also take heart medications like digoxin. Regular lab monitoring and close communication with your prescriber are key to using it safely.

📖 Metolazone: Patient Information Guide

A plain-language walkthrough of Metolazone — what it treats, how it works, how it’s taken, side effects, warnings and interactions. Tap any section to expand it.

🎯What it's used for

Metolazone tablets are approved to treat fluid-related and blood pressure conditions. Here is the full set of supported uses:

  • Edema (fluid retention) caused by congestive heart failure
  • Edema caused by kidney diseases, including nephrotic syndrome and states of reduced kidney function
  • High blood pressure (hypertension), used alone or combined with other antihypertensive medications
  • Edema during pregnancy when caused by a medical (pathologic) condition — routine use in otherwise healthy pregnant women is not recommended
⚙️How it works

Metolazone is a quinazoline diuretic that works similarly to thiazide diuretics. It acts mainly in the kidneys, blocking the reabsorption of sodium and chloride at the cortical diluting site — and to a lesser extent at the proximal convoluted tubule. Less sodium reabsorption means more sodium (and water) is excreted in the urine, reducing fluid buildup and blood pressure. Because more sodium reaches the distal tubule, potassium is also lost in the urine, which is why monitoring potassium levels matters.

Notably, metolazone can still produce diuresis (increased urine output) even in patients with significantly reduced kidney function — unlike standard thiazide diuretics. When used together with furosemide, it can produce a markedly stronger diuretic effect in patients with stubborn fluid retention.

💊How it's taken

Metolazone tablets are taken by mouth, once daily. Dosing is always individualized — your prescriber will start at an appropriate level for your condition and adjust based on how you respond, aiming for the lowest dose that works. The diuretic effect typically begins within one hour and can last 24 hours or longer.

  • For edema (heart failure or kidney disease): once-daily dosing, adjusted based on severity and response
  • For high blood pressure: effect may take three days to six weeks to become fully apparent — doses are adjusted at appropriate intervals
  • Do not change your dose or stop taking metolazone without talking to your prescriber first
🤒Side effects — in detail

Most people tolerate metolazone well, and many side effects are mild. The most common include:

  • Low potassium — muscle weakness, cramps, irregular heartbeat
  • Low sodium — fatigue, confusion, nausea
  • Dizziness or lightheadedness, especially when standing up quickly
  • Headache and drowsiness
  • Nausea, upset stomach, diarrhea, or constipation
  • Increased sensitivity to sunlight (photosensitivity)
  • Muscle cramps or joint pain
  • Increased blood sugar or uric acid levels

Seek immediate medical attention for signs of a severe allergic reaction (facial swelling, difficulty breathing), serious skin reactions (blistering, peeling rash), signs of liver problems (yellowing skin or eyes), or symptoms of very low potassium or sodium (rapid weakness, fainting, or dangerous heart rhythms).

⚠️Warnings & precautions
  • Low potassium (hypokalemia): This is the most important ongoing risk. Low potassium can cause muscle weakness, cramps, and dangerous heart rhythm problems — especially in people taking digoxin. Regular blood tests are needed to catch this early.
  • Rapid electrolyte drops: Rarely, severe low sodium or potassium can happen quickly after starting treatment. If you suddenly feel very weak or unwell, stop the medication and get medical help right away.
  • Serious allergic/sensitivity reactions: Swelling, bronchospasm (airway tightening), and severe skin reactions can occur — sometimes with the very first dose. Seek emergency help immediately if this happens.
  • Blood pressure drop with other medications: Combining metolazone with other blood pressure drugs can cause blood pressure to fall too low, especially at the start of treatment.
  • Lithium toxicity: Metolazone reduces the kidneys' ability to clear lithium, raising blood levels to potentially dangerous amounts.
  • Surgery: Metolazone may enhance the effects of muscle-relaxing drugs used in surgery; it may be advisable to stop it a few days before elective procedures.
🔀What it interacts with

Metolazone interacts with several medications and substances. Key ones to know about:

  • Furosemide and loop diuretics: Combined use can cause large, sudden losses of fluid and electrolytes — requires close monitoring
  • Lithium: Metolazone raises lithium blood levels, increasing the risk of lithium toxicity
  • Digoxin and digitalis medicines: Low potassium from metolazone makes the heart more sensitive to digoxin, which can lead to serious arrhythmias
  • Other blood pressure medications: Blood pressure may fall too low; dose adjustments are often needed
  • Corticosteroids or ACTH: Increase potassium loss and fluid retention risk
  • NSAIDs and aspirin: May blunt metolazone's blood pressure-lowering effect
  • Alcohol, barbiturates, narcotics: Can worsen blood pressure-lowering effects, leading to dizziness or fainting
  • Anticoagulants (blood thinners): Metolazone may alter how well these drugs work; dose adjustments may be necessary
  • Insulin and oral diabetes medications: Blood sugar control may be affected; monitor glucose levels carefully
  • Curariform (neuromuscular blocking) drugs used in surgery: Low potassium from metolazone can intensify muscle relaxation, potentially affecting breathing

This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

📋Before taking it
  • Do not take metolazone if you have anuria (no urine output), hepatic coma or pre-coma, or a known allergy to metolazone
  • Tell your doctor if you are allergic to sulfonamide drugs, thiazide diuretics, or quinethazone — cross-allergy is possible
  • Tell your doctor if you have heart rhythm problems or take digoxin — low potassium greatly increases arrhythmia risk
  • Tell your doctor if you have diabetes — metolazone can raise blood sugar and cause glucose to appear in the urine
  • Tell your doctor if you have gout — metolazone can raise uric acid and trigger acute attacks
  • Tell your doctor if you have liver disease — metolazone can cause liver-related side effects
  • Pregnancy: Use is only appropriate when edema has a medical cause; routine use in healthy pregnant women is not recommended — discuss risks with your doctor
  • Tell your doctor about all medications you take, especially lithium, blood pressure drugs, diuretics, and blood thinners
  • If you are scheduled for elective surgery, tell your care team — metolazone may need to be stopped a few days beforehand
🚑If you take too much

Taking too much metolazone can cause dizziness, drowsiness, fainting, and significant loss of fluids and electrolytes. In serious overdose, blood pressure can drop sharply and, at high doses, drowsiness may progress to coma. There is no specific antidote — treatment focuses on supportive care, including maintaining fluid balance and monitoring heart and kidney function.

If you suspect an overdose, seek emergency medical help immediately. Do not try to treat it at home.

📡Pharmacodynamics — effects in the body

Metolazone increases urine output by blocking sodium and chloride reabsorption in the kidneys, leading to loss of salt and water in the urine. Potassium, phosphate, and magnesium are also excreted in greater amounts. This reduction in fluid volume lowers blood pressure and reduces swelling from fluid buildup in the body. The diuretic effect typically starts within one hour of a dose and can last 24 hours or more, with stronger effects at higher doses.

🔬Pharmacokinetics — how your body processes it

After a metolazone tablet is taken by mouth, blood levels peak at around eight hours after the dose. The drug is only minimally broken down by the body — most of it is excreted unchanged in the urine. A single daily dose is effective because the diuretic action can persist for 24 hours or longer. Unlike standard thiazide diuretics, metolazone can still work in patients with significantly reduced kidney (glomerular) filtration rates.

📦How to store it

Store at 25°C (77°F); excursions permitted to 15°-30°C (59°-86°F) . Protect from light. Keep out of the reach of children.

📄 Written from Metolazone’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Every point is grounded in that labeling — nothing is invented. How we use AI →

222

Supplements & herbs that interact with Metolazone

222 supplements and herbal products have documented interactions with Metolazone in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.

Severity mix
  • Major · 8
  • Moderate · 190
  • Minor · 24
Every supplement checked against Metolazone — ranked by severity The full interaction hub: 8 major · 190 moderate · 24 minor · every one linked to its full report. Check Metolazone against your exact supplements

Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.

8

Nutrient depletion considerations

Metolazone has been associated with lower levels of 8 nutrients in the clinical literature. This does not mean a deficiency will occur — it means these may be worth discussing with your pharmacist or healthcare provider, especially with long-term use.

Evidence & significance mix
  • Higher significance · 2
  • Moderate · 3
  • Unrated · 3
See the full Metolazone nutrient depletion report

Educational information from a licensed clinical database (Natural Medicines) — not medical advice. Do not start or stop medications or supplements without professional guidance.

🩺 Pharmacist Counseling Corner

Quick, plain-English answers to the questions patients ask most about Metolazone — the kind of thing our pharmacy team would talk through with you at the counter.

What is metolazone actually doing in my body?
Think of your kidneys as a filter. Normally, they reabsorb a lot of the sodium (salt) that passes through them. Metolazone blocks that process, so more sodium — and the water that follows it — gets flushed out in your urine. That's how it reduces fluid buildup and helps bring blood pressure down. It's sometimes called a 'water pill' for exactly that reason.
Why does my doctor keep checking my blood levels while I'm on this?
Because metolazone makes your kidneys flush out more than just water — it also causes you to lose potassium, sodium, and magnesium. If those levels drop too low, you can develop muscle cramps, weakness, or even heart rhythm problems. Blood tests help your doctor catch any imbalance early and adjust your dose or add a supplement if needed. It's a routine but important part of staying safe on this medication.
Should I be worried about taking metolazone with my other medications?
There are a few important combinations to know about. If you take lithium, digoxin, or other blood pressure medications, tell your doctor — metolazone can raise lithium levels to a dangerous point, and low potassium from metolazone can make digoxin more likely to cause heart rhythm problems. Even common drugs like ibuprofen or aspirin can reduce how well metolazone controls your blood pressure. Bring a full list of your medications to every appointment so your prescriber can check for interactions.
What side effects are common, and which ones should make me call my doctor?
Most people do fine on metolazone — dizziness when standing up, mild muscle cramps, and more frequent urination are the most common experiences and are usually manageable. But call your doctor right away if you notice severe muscle weakness, an irregular or fast heartbeat, sudden confusion, or if you faint. These can be signs of low potassium or sodium, which need prompt attention. A severe rash, face swelling, or trouble breathing after taking a dose also warrants immediate medical help.
Is it safe to take metolazone if I'm pregnant?
It depends on the reason for the swelling. Metolazone is only appropriate during pregnancy when the edema is caused by a medical condition — not for the normal fluid retention that comes with being pregnant. Routine use in otherwise healthy pregnant women is not recommended and can be risky for both mom and baby. If you're pregnant or planning to become pregnant, have an honest conversation with your doctor about whether metolazone is appropriate for your specific situation.
How long does it take for metolazone to work?
For fluid retention (edema), you'll usually notice increased urination within about an hour of your first dose, and the effect can last up to 24 hours. For high blood pressure, it's slower — it may take three days to several weeks before you see the full benefit. Don't get discouraged if your blood pressure doesn't change right away; your doctor will reassess and adjust your dose over time as needed.
Is Metolazone available over the counter?
Metolazone is dispensed by prescription according to its FDA labeling, so it isn't sold over the counter. Your prescriber and pharmacist will determine if it's appropriate for you.
When was Metolazone first available?
Metolazone has been available in the United States since at least 1973, based on FDA approval history (Drugs@FDA) and product marketing records.
Who makes Metolazone?
Metolazone is supplied by 30 manufacturers listed in the FDA NDC Directory, including Bryant Ranch Prepack, Golden State Medical Supply, Inc., Major Pharmaceuticals.

💬 Answers drafted from Metolazone’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Grounded in that labeling — nothing is made up. How we use AI →

🧰 Keep exploring

💊 How Metolazone comes

Metolazone is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.

Tablet

By mouth
How this form is used
What it may be used for
  • Metolazone tablets are used to treat edema (fluid retention) caused by congestive heart failure
  • Metolazone tablets are used to treat edema caused by kidney diseases, including nephrotic syndrome and reduced kidney function
  • Metolazone tablets are used to treat high blood pressure (hypertension), alone or with other blood pressure medications
Important instructions
  • Metolazone tablets are taken by mouth once daily
  • Dosing is individualized — your prescriber will set and adjust the dose based on your response
  • Diuretic effect usually begins within one hour and can last 24 hours or more
  • Follow your prescriber's instructions; do not change your dose without consulting them
Available strengths 3 strengths
142 FDA-listed product records

📊 Metolazone across the U.S. market

How Metolazone appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.

1
Dose forms
30
Manufacturers
1
Brand names
147
FDA-listed product records
1973
First marketed

Also listed with the FDA, not a patient dose form: Powder (5) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.

Bryant Ranch Prepack13%
Golden State Medical Supply, Inc.8%
Major Pharmaceuticals6%
Alembic Pharmaceuticals Limited6%
Aarkish Pharmaceuticals NJ Inc.4%
Advagen Pharma Limited4%
Other makers59%

Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.

📈 How widely Metolazone is used

A general measure of how commonly Metolazone is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.

Think of this as a proxy for how widely Metolazone is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.

56,621
Medicaid prescriptions filled (Q1–Q4 2025)
$910,760 gross Medicaid reimbursement (before mandatory rebates — net cost is lower)

How commonly is Metolazone prescribed? Of the 1,596 medications we measure, Metolazone ranks #615 by Medicaid prescriptions — more than 61% of them.

Where Metolazone ranks among the drugs we measure · Q1–Q4 2025 · neighbors ±5

Utilization by Metolazone product

Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.

The 2.5 mg oral tablet is the most-dispensed Metolazone product — about 51% of these Medicaid prescriptions.

metolazone 2.5 MG Oral Tablet Most dispensed

28,927 Medicaid prescriptions (Q1–Q4 2025) 51% of Metolazone prescriptions shown $403,682 gross reimbursement (before rebates) ≈ $14 per prescription (gross)

Summed across the 8 of 48 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 197979

metolazone 5 MG Oral Tablet

26,199 Medicaid prescriptions (Q1–Q4 2025) 46% of Metolazone prescriptions shown $463,602 gross reimbursement (before rebates) ≈ $18 per prescription (gross)

Summed across the 7 of 48 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 311671

metolazone 10 MG Oral Tablet

1,495 Medicaid prescriptions (Q1–Q4 2025) 3% of Metolazone prescriptions shown $43,476 gross reimbursement (before rebates) ≈ $29 per prescription (gross)

Summed across the 7 of 28 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 197978

Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.

Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Metolazone, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 22 of 124 listed Metolazone NDCs with Medicaid activity.

🔍 Compare Metolazone products

A representative set of FDA-listed product records for Metolazone — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)

Showing 147 of 147 products — FDA National Drug Code Directory. See every product, package size and price: browse all 147 Metolazone NDCs →

RxNorm Concept Web — From Ingredient to Every Form and Strength

This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.

Ingredient (IN) Metolazone RxCUI 6916 1 dose form · 4 strengths
  1. Dose form (SCDF) Oral Tablet RxCUI 372888 In current FDA listings
    Clinical drug / strength (SCD) 0.5 MG RxCUI 197977 2.5 MG RxCUI 197979 5 MG RxCUI 311671 10 MG RxCUI 197978

Look up RxCUI 6916 in the RxCUI Atlas →

RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.

🏷️ Sold under these brand names

Zaroxolyn Mykrox

🏭 Manufacturers & labelers

Bryant Ranch Prepack 19 Golden State Medical Supply, Inc. 12 Major Pharmaceuticals 9 Alembic Pharmaceuticals Limited 9 Aarkish Pharmaceuticals NJ Inc. 6 Advagen Pharma Limited 6 Alembic Pharmaceuticals Inc. 6 American Health Packaging 6 Marlex Pharmaceuticals, Inc. 6 Amici Pharmaceuticals LLC. 6 Ingenus Pharmaceuticals LLC 6 Mylan Pharmaceuticals Inc. 6 Method Pharmaceuticals, LLC 6 Aphena Pharma Solutions - Tennessee, LLC 5 Safecor Health LLC 4 Mylan Institutional Inc. 4 Micro Labs Limited 3 Eon Labs, Inc. 3 Sandoz Inc 3 Unichem Pharmaceuticals (USA), Inc. 3 Lannett Company, Inc. 3 Bayshore Pharmaceuticals LLC 3 Amici Pharma, Inc 3 AACE Pharmaceuticals, Inc. 3

…and 6 more on the FDA NDC directory.

RxNorm drug class

Metolazone belongs to the Thiazide-like Diuretic class.

Pharmacologic class Thiazide-like Diuretic
Drug family (ATC) Sulfonamides, plain

Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.

🔬 Where this comes from

Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.

📄
FDA-filed drug labels (SPL) Uses, dosing, warnings & side effects from SPL records retrieved through openFDA; the linked representative set can be verified on DailyMed. ✓ Linked label effective Oct 1, 2019
🏭
Forms, brands & labelersAggregated from ingredient-matched FDA National Drug Code Directory product records for Metolazone.
📈
Real-world reportsThe FDA Adverse Event Reporting System (FAERS), served through openFDA.
🚨
Recalls & shortagesopenFDA drug-enforcement reports and the FDA drug-shortage database.
🧾 Clinical label set — FDA-filed SPL labels retained for Metolazone after exact ingredient or ingredient-combination matching and applicable route/form matching
Clinical labels in scope
32
NDC products indexed
147
Distinct labelers/manufacturers represented
30
Linked representative label
Mylan Pharmaceuticals Inc.
Linked label effective
Oct 1, 2019
Composite sections available
18
Linked SPL Set ID
6639d111-eb21-4997-b964-f5c61bc088f2
Linked SPL Document ID
80dfdc38-4f24-4670-9341-bee52a95fd49
Open the linked representative label on DailyMed ↗

How we combine label and product data

HelloPharmacist combines public FDA and NLM records; we don’t author the underlying clinical facts. We identified 32 FDA-filed SPL label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. The representative label is the starting point for the displayed reference monograph; the 12 largest stored in-scope SPL records, which may include that representative, are compared section by section, and the longest available version of each section is retained. Forms, routes, brands, labelers, product-listed strengths, and product-record counts are aggregated separately from ingredient-matched FDA NDC Directory records; package records listed above are associated with the linked SPL; and the normalized concept hierarchy comes from NLM RxNorm.

For canonical ingredient pages, bounded product-attributed indication and administration excerpts may be added to the AI evidence, and the generator is instructed to preserve available product, brand, route, and form qualifiers instead of treating one label as universal. Where a section is identified as AI-written, its plain-language text is generated from bounded label evidence. New draft drug pages remain in the admin review queue before first publication. Mylan Pharmaceuticals Inc. is the representative DailyMed label linked for verification and dates; it is not the sole source used for the page.

This is general education, not medical advice — always consult your doctor or pharmacist about your medications and any medical condition. For the exact wording of the linked representative label, view that label on DailyMed; some displayed composite sections may come from other in-scope SPL labels. Learn how we use AI and our data sources & update cadence.