Hey all, welcome back to another episode of the Real Life Pharmacology podcast.

Today, I'm looking at the drug metolazone, which has a brand name of Xerox, which has a brand name of Xeroxylene.

Now, I have covered thyside diuretics, and thyside-like diuretics in a general sense.

There are a lot of clinical quirks and pearls with metolazone specifically that I really wanted

to cover this drug specifically in a little more detail.

So that classification, it is considered a thiaside-like, thiaside similar, diuretic.

The primary indications where I see this used in clinical practice is, number one, at least in my geriatric patient population, is in augmentation of fluid loss in patients

experiencing symptoms in CHF.

Okay, so that's augmentation in combination with a loop diuretic, typically ferrosamide,

as kind of an add-on therapy where maybe we've escalated doses and the patient didn't

tolerate higher doses of a ferrosamide or we've gone up on doses and we, you know, don't want to go

any higher, so we want to add another diuretic that maybe works by a different mechanism of action.

Now, metolazone can be used for hypertension.

I have seen it a few times, maybe more so in combination with CHF and fluid relief or relief of edema.

So there are a couple other rare indications that you may see it for, but I would say by

large, I see it mostly used for fluid loss in CHF.

Mechanistically, how this drug works is it blocks sodium reabsorption in distal tubules.

Now, with that sodium loss, water, potassium, potentially magnesium, hydrogen ions,

potentially all go with that out of the body and obviously out through the urine.

So you can obviously postulate from that mechanism of action what you're going to see in

adverse drug reactions and electrolyte abnormalities are definitely a big, big concern.

In clinical practice, I've definitely seen profound potassium wasting

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