Details
| Stereochemistry | UNKNOWN |
| Molecular Formula | C16H16ClN3O3S |
| Molecular Weight | 365.835 |
| Optical Activity | ( - ) |
| Defined Stereocenters | 0 / 1 |
| E/Z Centers | 0 |
| Charge | 0 |
SHOW SMILES / InChI
SMILES
CC1NC2=CC(Cl)=C(C=C2C(=O)N1C3=C(C)C=CC=C3)S(N)(=O)=O
InChI
InChIKey=AQCHWTWZEMGIFD-UHFFFAOYSA-N
InChI=1S/C16H16ClN3O3S/c1-9-5-3-4-6-14(9)20-10(2)19-13-8-12(17)15(24(18,22)23)7-11(13)16(20)21/h3-8,10,19H,1-2H3,(H2,18,22,23)
Metolazone is a thiazide-like diuretic marketed under the brand names Mykrox and Zaroxolyn. Zaroxolyn is indicated for the treatment of salt and water retention including:
• Edema accompanying congestive heart failure;
• Edema accompanying renal diseases including the
nephrotic syndrome and states of diminished renal
function.
Zaroxolyn is also indicated for the treatment of hypertension, alone or in combination with other antihypertensive drugs of a different class. Metolazone is a quinazoline diuretic, with properties generally similar to the thiazide diuretics. The actions of Metolazone result from interference with the renal tubular mechanism of electrolyte reabsorption. Metolazone acts primarily to inhibit sodium reabsorption at the cortical diluting site and to a lesser extent in the proximal convoluted tubule. Sodium and chloride ions are excreted in approximately equivalent amounts. The increased delivery of sodium to the distal tubular exchange site results in increased potassium excretion. Metolazone does not inhibit carbonic anhydrase. A proximal action of Metolazone has been shown in humans by increased excretion of phosphate and magnesium ions and by a markedly increased fractional excretion of sodium in patients with severely compromised glomerular filtration. This action has been demonstrated in animals by micropuncture studies.
Approval Year
Targets
| Primary Target | Pharmacology | Condition | Potency |
|---|---|---|---|
Conditions
| Condition | Modality | Targets | Highest Phase | Product |
|---|---|---|---|---|
| Primary | ZAROXOLYN Approved UseMetolazone tablets USP are indicated for the treatment of salt and water retention including: • edema accompanying congestive heart failure; • edema accompanying renal diseases, including the nephrotic syndrome and states of diminished renal function. Metolazone tablets USP are also indicated for the treatment of hypertension, alone or in combination with other antihypertensive drugs of a different class. Mykrox® tablets, a more rapidly available form of metolazone, are intended for the treatment of new patients with mild to moderate hypertension. A dose titration is necessary if Mykrox® tablets are to be substituted for Zaroxolyn® tablets and other formulations of metolazone that share its slow and incomplete bioavailability, in the treatment of hypertension. Usage In Pregnancy The routine use of diuretics in an otherwise healthy woman is inappropriate and exposes mother and fetus to unnecessary hazard. Diuretics do not prevent development of toxemia of pregnancy, and there is no evidence that they are useful in the treatment of developed toxemia. Edema during pregnancy may arise from pathologic causes or from the physiologic and mechanical consequence of pregnancy. Metolazone tablets USP are indicated in pregnancy when edema is due to pathologic causes, just as it is in the absence of pregnancy (see PRECAUTIONS). Dependent edema in pregnancy resulting from restriction of venous return by the expanded uterus is properly treated through elevation of the lower extremities and use of support hose; use of diuretics to lower intravascular volume in this case is illogical and unnecessary. There is hypervolemia during normal pregnancy which is harmful to neither the fetus nor the mother (in the absence of cardiovascular disease), but which is associated with edema, including generalized edema, in the majority of pregnant women. If this edema produces discomfort, increased recumbency will often provide relief. In rare instances, this edema may cause extreme discomfort which is not relieved by rest. In these cases, a short course of diuretics may be appropriate. Launch Date1.23206402E11 |
|||
| Primary | ZAROXOLYN Approved UseMetolazone tablets USP are indicated for the treatment of salt and water retention including: • edema accompanying congestive heart failure; • edema accompanying renal diseases, including the nephrotic syndrome and states of diminished renal function. Metolazone tablets USP are also indicated for the treatment of hypertension, alone or in combination with other antihypertensive drugs of a different class. Mykrox® tablets, a more rapidly available form of metolazone, are intended for the treatment of new patients with mild to moderate hypertension. A dose titration is necessary if Mykrox® tablets are to be substituted for Zaroxolyn® tablets and other formulations of metolazone that share its slow and incomplete bioavailability, in the treatment of hypertension. Usage In Pregnancy The routine use of diuretics in an otherwise healthy woman is inappropriate and exposes mother and fetus to unnecessary hazard. Diuretics do not prevent development of toxemia of pregnancy, and there is no evidence that they are useful in the treatment of developed toxemia. Edema during pregnancy may arise from pathologic causes or from the physiologic and mechanical consequence of pregnancy. Metolazone tablets USP are indicated in pregnancy when edema is due to pathologic causes, just as it is in the absence of pregnancy (see PRECAUTIONS). Dependent edema in pregnancy resulting from restriction of venous return by the expanded uterus is properly treated through elevation of the lower extremities and use of support hose; use of diuretics to lower intravascular volume in this case is illogical and unnecessary. There is hypervolemia during normal pregnancy which is harmful to neither the fetus nor the mother (in the absence of cardiovascular disease), but which is associated with edema, including generalized edema, in the majority of pregnant women. If this edema produces discomfort, increased recumbency will often provide relief. In rare instances, this edema may cause extreme discomfort which is not relieved by rest. In these cases, a short course of diuretics may be appropriate. Launch Date1.23206402E11 |
Cmax
| Value | Dose | Co-administered | Analyte | Population |
|---|---|---|---|---|
8.225 ng/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/29145890 |
0.5 mg single, oral dose: 0.5 mg route of administration: Oral experiment type: SINGLE co-administered: |
METOLAZONE plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: FASTED |
|
3.63 ng/mL DRUG LABEL http://products.sanofi.ca/en/zaroxolyn.pdf |
2.5 mg 1 times / day unknown, oral dose: 2.5 mg route of administration: Oral experiment type: UNKNOWN co-administered: |
METOLAZONE unknown | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
AUC
| Value | Dose | Co-administered | Analyte | Population |
|---|---|---|---|---|
50.51 ng × h/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/29145890 |
0.5 mg single, oral dose: 0.5 mg route of administration: Oral experiment type: SINGLE co-administered: |
METOLAZONE plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: FASTED |
|
99.74 ng × h/mL DRUG LABEL http://products.sanofi.ca/en/zaroxolyn.pdf |
2.5 mg 1 times / day unknown, oral dose: 2.5 mg route of administration: Oral experiment type: UNKNOWN co-administered: |
METOLAZONE unknown | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
T1/2
| Value | Dose | Co-administered | Analyte | Population |
|---|---|---|---|---|
7.47 h EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/29145890 |
0.5 mg single, oral dose: 0.5 mg route of administration: Oral experiment type: SINGLE co-administered: |
METOLAZONE plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: FASTED |
Funbound
| Value | Dose | Co-administered | Analyte | Population |
|---|---|---|---|---|
7.5% DRUG LABEL http://products.sanofi.ca/en/zaroxolyn.pdf |
2.5 mg 1 times / day unknown, oral dose: 2.5 mg route of administration: Oral experiment type: UNKNOWN co-administered: |
METOLAZONE unknown | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
Doses
| Dose | Population | Adverse events |
|---|---|---|
150 mg single, oral Highest studied dose Dose: 150 mg Route: oral Route: single Dose: 150 mg Sources: Page: p.197 |
unhealthy, 18, 19 n = 2 Health Status: unhealthy Condition: Chronic renal failure Age Group: 18, 19 Sex: M+F Population Size: 2 Sources: Page: p.197 |
|
20 mg 1 times / day multiple, oral (max) Recommended Dose: 20 mg, 1 times / day Route: oral Route: multiple Dose: 20 mg, 1 times / day Sources: |
unhealthy Health Status: unhealthy Condition: Edema Sources: |
Disc. AE: Hyponatremia, Hypokalemia... AEs leading to discontinuation/dose reduction: Hyponatremia (severe) Sources: Hypokalemia (severe) |
20 mg 1 times / day multiple, oral (max) Recommended Dose: 20 mg, 1 times / day Route: oral Route: multiple Dose: 20 mg, 1 times / day Sources: Page: p.3 |
unhealthy Health Status: unhealthy Condition: Edema Sources: Page: p.3 |
Disc. AE: Azotemia, Hyperuricemia... AEs leading to discontinuation/dose reduction: Azotemia Sources: Page: p.3Hyperuricemia |
AEs
| AE | Significance | Dose | Population |
|---|---|---|---|
| Hypokalemia | severe Disc. AE |
20 mg 1 times / day multiple, oral (max) Recommended Dose: 20 mg, 1 times / day Route: oral Route: multiple Dose: 20 mg, 1 times / day Sources: |
unhealthy Health Status: unhealthy Condition: Edema Sources: |
| Hyponatremia | severe Disc. AE |
20 mg 1 times / day multiple, oral (max) Recommended Dose: 20 mg, 1 times / day Route: oral Route: multiple Dose: 20 mg, 1 times / day Sources: |
unhealthy Health Status: unhealthy Condition: Edema Sources: |
| Azotemia | Disc. AE | 20 mg 1 times / day multiple, oral (max) Recommended Dose: 20 mg, 1 times / day Route: oral Route: multiple Dose: 20 mg, 1 times / day Sources: Page: p.3 |
unhealthy Health Status: unhealthy Condition: Edema Sources: Page: p.3 |
| Hyperuricemia | Disc. AE | 20 mg 1 times / day multiple, oral (max) Recommended Dose: 20 mg, 1 times / day Route: oral Route: multiple Dose: 20 mg, 1 times / day Sources: Page: p.3 |
unhealthy Health Status: unhealthy Condition: Edema Sources: Page: p.3 |
PubMed
| Title | Date | PubMed |
|---|---|---|
| Muscle cramps, collapse, and seizures in two patients taking metolazone. | 1976 Jun 5 |
|
| Severe electrolyte disturbances associated with metolazone and furosemide. | 1978 Apr |
|
| Hypoplastic anemia associated with metolazone. | 1979 Jul 13 |
|
| Palpable acute necrotizing arteritis secondary to metolazone. | 1982 Jul |
|
| Excessive potassium depletion with metolazone and furosemide. | 1983 Jul-Aug |
|
| Use of a bioassay in healthy men to evaluate diuretic-spironolactone combinations. | 1983 May |
|
| Case report: metolazone-associated hypercalcemia and acute pancreatitis. | 1991 Oct |
|
| Vasculitis due to metolazone. | 1991 Sep |
|
| Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. | 2002 |
|
| Diuretic resistance predicts mortality in patients with advanced heart failure. | 2002 Jul |
|
| Functional expression of mutations in the human NaCl cotransporter: evidence for impaired routing mechanisms in Gitelman's syndrome. | 2002 Jun |
|
| Difficulties of introducing the National Service Framework for heart failure into general practice in the UK. | 2003 Jun |
|
| Metolazone and its role in edema management. | 2003 Mar-Apr |
|
| Pathophysiology of functional mutations of the thiazide-sensitive Na-Cl cotransporter in Gitelman disease. | 2004 Aug |
|
| Combination therapy with metolazone and loop diuretics in outpatients with refractory heart failure: an observational study and review of the literature. | 2005 Aug |
|
| Screening procedure for detection of diuretics and uricosurics and/or their metabolites in human urine using gas chromatography-mass spectrometry after extractive methylation. | 2005 Aug |
|
| How much responsibility should heart failure nurses take? | 2005 Mar 16 |
|
| [Diuretic therapy in heart failure]. | 2006 Jan-Feb |
|
| Pre-dosing metolazone with loop diuretic combination regimens. | 2006 Jan-Feb |
|
| Cardiomyopathy, familial dilated. | 2006 Jul 13 |
|
| Reported medication use in the neonatal intensive care unit: data from a large national data set. | 2006 Jun |
|
| Affinity-defining domains in the Na-Cl cotransporter: a different location for Cl- and thiazide binding. | 2006 Jun 23 |
|
| Beneficial effects of metolazone in a rat model of preeclampsia. | 2006 Sep |
|
| Determination of metolazone in human blood by liquid chromatography with electrospray ionization tandem mass spectrometry. | 2007 Jan 1 |
|
| The evaluation of the diuretic action of parenteral formulations of metolazone. | 2007 Jan-Feb |
|
| Treatment of diuretic refractory pleural effusions with bevacizumab in four patients with primary systemic amyloidosis. | 2007 May |
|
| Premenstrual syndrome. | 2007 May 1 |
|
| Vitamin C-induced hyperoxaluria causing reversible tubulointerstitial nephritis and chronic renal failure: a case report. | 2007 Nov 27 |
|
| The pK(a) Distribution of Drugs: Application to Drug Discovery. | 2007 Sep 17 |
|
| Diuretics: from classical carbonic anhydrase inhibitors to novel applications of the sulfonamides. | 2008 |
|
| Hydroxychloroquine-induced hyperpigmentation: the staining pattern. | 2008 Dec |
|
| Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management. | 2008 Feb |
|
| Carbonic anhydrase inhibitors. Sulfonamide diuretics revisited--old leads for new applications? | 2008 Jul 21 |
|
| Non-healing painful ulcers in a patient with chronic kidney disease and role of sodium thiosulfate: a case report. | 2008 Sep 23 |
|
| Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. | 2009 |
|
| How to use diuretics in heart failure. | 2009 Dec |
|
| [Renal effect of treatment for heart failure]. | 2009 Feb 23 |
|
| How 40 kilograms of fluid retention can be overlooked: two case reports. | 2009 Jan 8 |
|
| Effects of increased dose of diuretics on symptoms, weight, 6-minute walk distance, and echocardiographic measurements of left ventricular systolic and diastolic function in 51 patients with symptomatic heart failure caused by reduced left ventricular ejection fraction treated with beta blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. | 2009 Jan-Feb |
|
| Role of SLC12A10.2, a Na-Cl cotransporter-like protein, in a Cl uptake mechanism in zebrafish (Danio rerio). | 2009 May |
|
| Drugs associated with more suicidal ideations are also associated with more suicide attempts. | 2009 Oct 2 |
|
| Characterizing environmental and phenotypic associations using information theory and electronic health records. | 2009 Sep 17 |
|
| Advances in systolic heart failure. | 2010 Apr 27 |
|
| Development of a list of potentially inappropriate drugs for the korean elderly using the delphi method. | 2010 Dec |
|
| Clinical effectiveness of telmisartan alone or in combination therapy for controlling blood pressure and vascular risk in the elderly. | 2010 Dec 3 |
|
| Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. | 2010 Mar |
|
| A single residue in transmembrane domain 11 defines the different affinity for thiazides between the mammalian and flounder NaCl transporters. | 2010 Nov |
|
| Improved outcomes with early collaborative care of ambulatory heart failure patients discharged from the emergency department. | 2010 Nov 2 |
|
| Screening of a chemical library reveals novel PXR-activating pharmacologic compounds. | 2015 Jan 5 |
|
| Systems pharmacological analysis of drugs inducing stevens-johnson syndrome and toxic epidermal necrolysis. | 2015 May 18 |
Patents
Sample Use Guides
Usual Adult Dose for Hypertension
Initial dose: 2.5 mg orally once a day (Zaroxolyn) or
0.5 mg orally once a day (Mykrox).
Usual Adult Dose for Edema
Initial dose: 5 mg orally once a day (Zaroxolyn) or
0.5 mg orally once a day (Mykrox).
Route of Administration:
Oral
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Systematic Name | English |
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NN9U607695
Created by
admin on Sat Dec 16 10:21:33 UTC 2023 , Edited by admin on Sat Dec 16 10:21:33 UTC 2023
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56436-32-9
Created by
admin on Sat Dec 16 10:21:33 UTC 2023 , Edited by admin on Sat Dec 16 10:21:33 UTC 2023
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SUBSTANCE RECORD
