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This medication comes with important safety information that you should be aware of before use. Please read the warnings carefully, and consult your healthcare provider if you have any questions or concerns.

• Electrolyte Imbalance and Dehydration: Metolazone may alter the levels of electrolytes such as sodium, potassium, magnesium, and calcium in your body. This risk is heightened if you take high doses or do not consume adequate fluids. Regular blood tests may be necessary to monitor these levels and your kidney health. Be vigilant for symptoms like dry mouth, weakness, fatigue, dizziness, muscle pain or cramps, rapid heartbeat, vomiting, or nausea. Factors that increase risk include kidney issues, dehydration, diarrhea or vomiting, concurrent use of other electrolyte-affecting medications, high doses of metolazone, and exposure to hot weather.

• Low Blood Pressure: Metolazone can lead to decreased blood pressure, causing lightheadedness or dizziness. These symptoms often resolve within a few days, but if they persist, contact your healthcare provider who may adjust your dosage or prescribe a different medication. The risk is higher if you consume alcohol or take other blood pressure-lowering medications.

• Life-Threatening Skin Reactions: Although rare, metolazone is associated with severe skin reactions like Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. These conditions can be fatal. Seek emergency medical attention if you experience a painful, blistering rash, peeling skin, or flu-like symptoms such as fever, chills, body aches, nausea, or vomiting.

• Severe Allergic Reactions: Individuals allergic to sulfa-containing medications may also react to metolazone. If you have a history of such allergies, inform your healthcare provider before starting treatment. Depending on the severity of past reactions, a lower dose may be recommended with close monitoring for signs of reaction. Seek immediate medical help if you notice a rash, hives, trouble breathing, or swelling of the face or neck.

• Gout: Metolazone can increase the risk of gout attacks. Inform your healthcare provider if you have a history of gout so they can monitor you more closely.

• Worsening Kidney Problems: In rare instances, metolazone may exacerbate kidney issues. Blood tests to assess kidney function are necessary before and during treatment. Report any decrease in urination or dark urine despite adequate fluid intake to your healthcare provider.

• High Blood Sugar: Metolazone might raise blood sugar levels in some cases. If you have diabetes, monitor your blood sugar levels more frequently as instructed by your healthcare provider.

Contraindications: Do not use metolazone if you are not urinating at all or if you are in a coma resulting from severe liver disease. Always consult your healthcare provider if you have these conditions before starting metolazone.

Common side effects:

• Dizziness
• Lightheadedness
• Headache
• Blurred vision
• Loss of appetite
• Stomach upset
• Diarrhea
• Constipation

Less common but important to monitor:

• Unusual dry mouth or thirst
• Muscle cramps or weakness
• Irregular heartbeat
• Fatigue
• Elevated uric acid levels

Serious side effects:

• Severe allergic reactions
• Trouble breathing
• Rash
• Swelling of the face, lips, tongue, or throat
• Signs of infection
• Persistent sore throat
• Fever
• Numbness or tingling of the limbs
• Decreased sexual ability
• Signs of liver or kidney problems
• Persistent nausea
• Yellowing eyes or skin
• Changes in urination

Interactions with high risk of serious adverse effects and should be avoided:

• Digoxin
• Dofetilide
• Lithium

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Aceclofenac
• Aspirin
• Celecoxib
• Ibuprofen
• Naproxen
• Furosemide
• Bumetanide
• Torsemide

Interactions with low risk that usually do not require a change in therapy:

• Aminolevulinic Acid
• Gossypol
• Licorice