2.9.1.4 Thiazides and related diuretics

Safe Prescribing of Metolazone

In all new patients, Metolazone should be initiated by Cardiology or Renal specialists as branded, Xaqua® 5mg tablets.

Caution:

• There are key safety concerns around significant variation in bioavailability between alternative preparations of Metolazone.
• For new and existing patients, it is advised that Metolazone is prescribed by its licensed brand name Xaqua®.
• Please note: Xaqua 5mg is approximately equivalent to 10mg unlicensed metolazone, these products are not interchangeable. The starting dose for Xaqua should be 2.5mg daily.
• It is advised that specialists should manage the switching of patients established on an unlicensed metolazone preparation, to the licensed brand Xaqua® and that all subsequent prescriptions of Metolazone be brand specific.

Please see MHRA Drug Safety Update here

Please see the position statement here and information for patients here.