Download Statement from the pan-Dorset Cardiology Working

Statement from the pan-Dorset Cardiology Working Group on the use of
Metolazone
Metolazone is a thiazide like diuretic which holds a red traffic light status on the pan-Dorset
formulary. Prescribing is restricted to refractory heart failure by specialist clinicians in
secondary care or by a competent clinician only.
Metolazone 2.5mg tablets and Metenix® metolazone 5mg (Sanofi) were discontinued in
March 2012 due to the expiration of their license.
Unlicensed metolazone 2.5mg tablets (Zaroxolyn) for individual patients are available to
pharmacies to order as a special order, prices may vary. The drug must be imported from
Canada and its unlicensed status within the UK places additional legal considerations and
obligations upon the prescriber.
The first line licensed option will ordinarily be bendroflumethazide prescribed at the same
dose as would be used for metolazone, normally 2.5mg daily, before titrating up as
necessary.
The licensed dose in oedema for bendroflumethazide as monotherapy is 5-10mg in the
morning or on alternate days.
A review of metolazone by the pan-Dorset cardiology working group recommended that its
use remain restricted to refractory heart failure patients whom are intolerant to or have
achieved an inadequate response to licensed alternatives. Where a patient meets these
criteria there should be a clinical review in primary care (by a clinician with a specialist
interest in cardiology) or by secondary care, and that community heart failure nurses be
consulted, prior to treatment being initiated.
References:
K.S. Channer, K. A. Mclean, P. Lawson-Matthew, et al. Combination diuretic treatment in
severe heart failure: a randomised controlled trial. Br Heart J 1994 71:146-150
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012.
European Heart Journal (2012) 33, 1787–1847
Document first published
Reviewed by :
Approved by:
Next Review Date
November 2014
Cardiology Working Group November 2016
DMAG 17th January 2017
November 2018 or before, in light of new information