Combination Therapy with Metolazone and Loop Diuretics in Outpatients with Refractory Heart Failure: An Observational Study and Review of the Literature

  title={Combination Therapy with Metolazone and Loop Diuretics in Outpatients with Refractory Heart Failure: An Observational Study and Review of the Literature},
  author={Jens Rosenberg and Finn Gustafsson and S{\o}ren Galatius and Per Rossen Hildebrandt},
  journal={Cardiovascular Drugs and Therapy},
SummaryMetolazone is a potent thiazide-like diuretic. It is recommended in severe congestive heart failure (HF). We conducted a review of the existing literature and found that the available information on the use of metolazone in HF is based on studies containing less than 250 patients in total. Nevertheless, metolazone is widely used, often in combination with a loop diuretic. Absorption of metolazone seems to be reduced in HF. Metolazone produces a diuretic response despite a low glomerular… 

Diuretic combinations in critically ill patients with respiratory failure: A systematic review and meta-analysis

Based on limited evidence, the addition of a second diuretic to a loop diuretics may promote diuresis and negative fluid balance in patients with respiratory failure, but only when using a thiazide.

Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis

The current findings suggest that until randomized control trial data prove otherwise, uptitration of loop diuretics may be a preferred strategy over routine early addition of thiazide type diuretic when diuresis is inadequate.

Combined aquaretic and diuretic therapy in acute heart failure

The strategy of treating AHF by achieving high UOP, while maintaining stable electrolytes and creatinine in a short period to euvolemic state, is safe.

Comparison of Bumetanide- and Metolazone-Based Diuretic Regimens to Furosemide in Acute Heart Failure

Compared to CIF, F + M or CIB was associated with greater increases in UO, and electrolyte abnormalities may be more prevalent when furosemide is combined with metolazone or when bumetanide is used.

Diuretic therapy in heart failure: current controversies and new approaches for fluid removal

Until other new agents become available, it is probably prudent to combine NPSD with aldosterone blocking agents that are known to improve outcomes, including vasopressine antagonists and adenosine blocking agents.

A Ceiling Dose with Furosemide in Systolic Heart Failure: A Myth or a Pertinent Clinical Consideration?

Limiting salt intake and avoiding the use of non-steroidal anti-inflammatory drugs (NSAIDs) should always be recommended before declaring a patient to be resistant to furosemide.

Diuretic Resistance in Cardio-Nephrology: Role of Pharmacokinetics, Hypochloremia, and Kidney Remodeling

In the presence of hyponatremia, high-saline solutions in addition to loop diuretics might be beneficial, whereas aquaretics require caution to avoid overcorrection, and a combination of different diuretic classes have been proposed.

Combination therapy with low-dose metolazone and furosemide: a “needleless” approach in managing refractory fluid overload in elderly renal failure patients under palliative care

A case series support the use of above regimen as a potential alternative in ESRF patients under palliative care, without bearing the parenteral route of treatment burden.



Combination diuretic treatment in severe heart failure: a randomised controlled trial.

Bendrofluazide and metolazone were equally effective in establishing a diuresis in patients with severe congestive cardiac failure resistant to loop diuretics, and Bendrofluzide was associated with fewer electrolyte disturbances.

Prescription patterns of diuretics in chronic heart failure: a contemporary background as a clue to their role in treatment.

In this wide series of stable HF outpatients, cardiologists prescribed diuretics in accordance with published guidelines, and independent predictors of their use overlapped with those of diuretic use.

[Furosemide and metolazone: a highly effective diuretic combination].

15 hospitalized patients with severe fluid retention who showed no reduction of body weight despite treatment with furosemide received metolazone in addition for 3 days, demonstrating the importance of daily checks on the patient's body weight after starting combined therapy with f Kurosemide and metolAZone.

Diuretic combinations in refractory oedema states: pharmacokinetic-pharmacodynamic relationships.

The rationale for and use of various diUREtic combinations, with particular emphasis on the metolazone-loop diuretic combination, is reviewed here and applied to the major disease states associated with diuretics resistance.

Clinical experience with metolazone--a new diuretic--in cases of edema and ascites due to hepatic cirrhosis, C.C.F., and malnutrition.

Forty male patients suffering from generalised edema due to various causes including 7 cases of congestive cardiac failure, 6 cases of malnutrition and 28 cases of hepatic cirrhosis were treated with metolazone given orally in a dose varying from 5 to 60 mg per day, finding it to be an effective orally active diuretic.

[Metolazone in the treatment of refractory heart insufficiency. Experience of 10 cases].

  • KirancumarP. LoureiroJ. M. Correia
  • Medicine
    Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
  • 1989
In eight of ten cases, metolazona had additive diuretic effect when associated to furosemide in patients with congestive heart failure, and good results were obtained in eight patients.

Combination of furosemide and metolazone in the treatment of severe congestive heart failure.

It is found that the furosemide-metolazone combination induced greater natriuresis, urinary output and weight loss than did furoSemide or metolaz one alone.

[Metolazone in the treatment of advanced therapy-resistant dilated cardiomyopathy].

Ten patients with advanced dilated cardiomyopathy with a mean fractional shortening in two-dimensional echocardiogram and a mean sodium excretion of 21 mmol per day, pretreated with digoxin, captopril and a means frusemide-dose without an effective diuresis improved considerably by additional metolazone-therapy.