Metolazone is indicated for the following conditions-

• edema accompanying congestive heart failure
• edema accompanying renal diseases, including the nephrotic syndrome and states of diminished renal function. 

Edema

Congestive Heart Failure (CHF)

Kidney problems

• Edema of cardiac failure: Metolazone tablets, USP, 5 to 20 mg once daily.
• Edema of renal disease: Metolazone tablets, USP, 5 to 20 mg once daily.
• Mild to moderate essential hypertension: Metolazone tablets, USP, 2½ to 5 mg once daily.

Cardiovascular: Chest pain/discomfort, orthostatic hypotension, excessive volume depletion, hemoconcentration, venous thrombosis, palpitations.

Central And Peripheral Nervous System: Syncope, neuropathy, vertigo, paresthesia, psychotic depression, impotence, dizziness/lightheadedness, drowsiness, fatigue, weakness, restlessness (sometimes resulting in insomnia), headache.

Dermatologic/Hypersensitivity: Toxic epidermal necrolysis (TEN), Stevens-Johnson Syndrome, necrotizing angiitis (cutaneous vasculitis), skin necrosis, purpura, petechiae, dermatitis (photosensitivity), urticaria, pruritus, skin rashes.

Gastrointestinal: Hepatitis, intrahepatic cholestatic jaundice, pancreatitis, vomiting, nausea, epigastric distress, diarrhea, constipation, anorexia, abdominal bloating, abdominal pain.

Hematologic: Aplastic/hypoplastic anemia, agranulocytosis, leukopenia, thrombocytopenia. 

Metabolic: Hypokalemia, hyponatremia, hyperuricemia, hypochloremia, hypochloremic alkalosis, hyperglycemia, glycosuria, increase in serum urea nitrogen (BUN) or creatinine, hypophosphatemia, hypomagnesemia, hypercalcemia.

Musculoskeletal: Joint pain, acute gouty attacks, muscle cramps or spasm.

Other: Transient blurred vision, chills, dry mouth.

Chest pain	Dizziness	Drowsiness	Fatigue
Purpura	Pancreatitis	Joint Pain	Rash

• In patients with severe renal impairment, metolazone should be used with caution. Renal function should be checked on a regular basis while on thiazide therapy.
• Diuretic-induced hypokalemia can precipitate encephalopathy in patients with severe hepatic impairment.
• Fluid and electrolyte balance should be carefully monitored during Xaqua treatment, especially if the drug is used concurrently with other diuretics (risk of hypokalemia), corticosteroids, ACE-inhibitors, angiotensin-II-antagonists, and aldosterone antagonists.
• If the patient has primary adrenal insufficiency, also known as Addison's disease, diuretics should be avoided for hypertension treatment.
• Azotemia and hyperuricemia are possible side effects of thiazide therapy. Gout attacks in people with a history of gout have been reported infrequently.