Metolazone Pharmacology

Metolazone (Zaroxolyn) is a thiazide-like diuretic. It promotes the loss of water and sodium through the kidney.

The most common indication I see metolazone used for is for additional fluid loss in heart failure.

Potassium must be monitored as it can cause significant hypokalemia which is exacerbated when metolazone is used in combination with loop diuretics.

Hyperuricemia is a potential adverse effect with metolazone; this is critical to monitor for in patients at risk for gout attacks.

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Diltiazem Pharmacology

Diltiazem is a non-dihydropyridine calcium channel blocker that can be used in atrial fibrillation as well as hypertension.

One big downside to diltiazem is that it does have a few drug interactions via CYP3A4.

Aripiprazole, apixaban, and certain statins are all examples of medication that can have concentrations increased by adding diltiazem to a patient’s regimen.

Diltiazem works a little differently from dihydropyridine calcium channel blockers (like amlodipine) as it works on the heart AND the vessels.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!