Comprehensive medication guide to Metolazone including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$20 copay for generic on Tier 2 of most Medicare Part D and commercial plans; some plans require prior authorization before covering metolazone.
Estimated Cash Pricing
$60–$85 retail for a 30-day supply without discounts; as low as $9–$14 with GoodRx or SingleCare coupons at major pharmacy chains.
Medfinder Findability Score
72/100
Summarize with AI
On this page
Metolazone is a quinazoline diuretic (water pill) belonging to the thiazide-like class of medications. It is FDA-approved to treat fluid retention (edema) caused by congestive heart failure or chronic kidney disease, and to manage high blood pressure (hypertension) alone or in combination with other antihypertensive medications.
Originally sold under brand names Zaroxolyn, Mykrox, and Diulo — all of which have been discontinued — metolazone is now available exclusively as a generic medication in the United States. It is manufactured by several companies including Mylan, Sandoz, and Aphena Pharma, and comes in 2.5 mg, 5 mg, and 10 mg oral tablets.
Metolazone is particularly valued for its ability to continue producing diuresis even in patients with significantly reduced kidney function — a characteristic that distinguishes it from standard thiazides like hydrochlorothiazide. This property makes it an important option for patients with chronic kidney disease (CKD) and for heart failure patients who are resistant to loop diuretics alone.
We have a 99% success rate finding medications, even during nationwide shortages.
Need this medication?
Metolazone works primarily by blocking the sodium-chloride cotransporter (NCC) in the cortical diluting segment of the distal convoluted tubule of the kidney. This prevents sodium and chloride from being reabsorbed back into the bloodstream. Since water follows sodium, more water remains in the tubular fluid and is excreted as urine, reducing total body fluid volume.
Unlike standard thiazide diuretics, metolazone also acts at the proximal convoluted tubule — an earlier segment of the nephron. This dual-site mechanism allows metolazone to produce effective diuresis even when the glomerular filtration rate (GFR) falls below 20 mL/min, a threshold at which hydrochlorothiazide becomes ineffective.
When combined with loop diuretics (like furosemide), metolazone creates a sequential nephron blockade — blocking sodium reabsorption at two separate points in the filtration system simultaneously. This combination dramatically increases urine output and is used in patients whose edema does not respond adequately to loop diuretics alone. Diuresis begins within 1 hour of dosing and can persist for 24 hours or more.
2.5 mg — tablet
Lowest dose; used for hypertension management; least commonly stocked at retail pharmacies
5 mg — tablet
Most commonly prescribed dose; used for edema management and hypertension
10 mg — tablet
Higher dose for significant edema; often used in heart failure with loop diuretic combination therapy
As of 2026, metolazone is not listed on the FDA's Drug Shortage Database, meaning there is no active national shortage. Multiple generic manufacturers supply the U.S. market, providing reasonable overall supply stability. Most large chain pharmacies — CVS, Walgreens, Walmart — generally carry the 5 mg and 10 mg strengths with some regularity.
However, localized stock-outs do occur, particularly for the 2.5 mg tablet (the least frequently dispensed strength) and in markets served by fewer pharmacy chains. Patients may occasionally need to call multiple pharmacies or wait 1–2 days for a restocking shipment. The 2.5 mg strength is the most difficult to find consistently.
If you're having trouble locating metolazone at your pharmacy, medfinder can call pharmacies near you to find out which ones have your specific dose in stock, then text you the results — saving you hours of phone calls.
Metolazone is not a controlled substance and carries no DEA scheduling restrictions, meaning any licensed prescriber in the United States can write a prescription. There are no special DEA registration requirements, no prescription length limits beyond standard state pharmacy laws, and no restrictions on telehealth prescribing.
Metolazone is most commonly prescribed by the following types of healthcare providers:
Cardiologists — for heart failure edema management and diuretic-resistant fluid overload
Nephrologists — for edema and fluid management in chronic kidney disease
Internal Medicine Physicians — for resistant hypertension and complex chronic disease management
Primary Care Physicians (PCPs) — for hypertension and mild edema in stable chronic patients
Nurse Practitioners (NPs) and Physician Assistants (PAs) — fully authorized to prescribe metolazone in all U.S. states
Metolazone can be prescribed via telehealth for appropriate patients — particularly those with stable hypertension or established patients seeking refills. Complex cardiac or renal conditions generally require in-person evaluation and specialist management. Platforms such as PlushCare, Teladoc, and MDLive can prescribe metolazone for qualifying patients.
No. Metolazone is not a controlled substance and has no DEA schedule. This means there are no special restrictions on how it is prescribed, how many refills can be authorized, or which licensed healthcare providers can write a prescription. Any physician, nurse practitioner, or physician assistant can prescribe metolazone without special DEA registration.
Metolazone can also be prescribed via telehealth platforms without any controlled substance restrictions. Prescriptions can be sent electronically to any pharmacy and can be written for up to a 90-day supply. Unlike controlled substances, there are no mandatory waiting periods or DEA reporting requirements associated with metolazone prescriptions.
The most common and clinically important side effects of metolazone are related to its diuretic mechanism — fluid and electrolyte changes:
Hypokalemia (low potassium) — most significant; causes muscle cramps, weakness, fatigue, and heart palpitations
Hyponatremia (low sodium) — can cause headache, confusion, and nausea
Dizziness and orthostatic hypotension (lightheadedness when standing)
Dry mouth and increased thirst
Headache, nausea, constipation, or diarrhea
Hyperuricemia (elevated uric acid — may trigger gout)
Hyperglycemia (elevated blood sugar — relevant for diabetics)
Serious side effects requiring immediate medical attention:
Severe electrolyte imbalance (rapid hypokalemia/hyponatremia) — can cause seizures or cardiac arrest
Cardiac arrhythmias (especially in patients also taking digoxin)
Stevens-Johnson syndrome or toxic epidermal necrolysis (rare severe skin reactions)
Aplastic anemia, agranulocytosis (rare blood disorders)
Acute kidney injury from over-diuresis (decreased urine output, rising creatinine)
Know what you need? Skip the search.
Hydrochlorothiazide (HCTZ)
Most widely prescribed thiazide diuretic; appropriate for hypertension with normal to mildly reduced kidney function; loses effectiveness below eGFR 30 mL/min, making it a poor substitute for metolazone in CKD.
Chlorthalidone
Long-acting thiazide-like diuretic (half-life 45-60 hours) with strong cardiovascular outcome evidence; preferred by some hypertension guidelines over HCTZ; may partially retain activity in moderate CKD but less effective than metolazone in severe renal impairment.
Furosemide (Lasix)
Loop diuretic; typically first-line for heart failure edema; metolazone is often added to furosemide when loop diuretics alone are insufficient. Different mechanism than metolazone — works at the loop of Henle.
Torsemide
Loop diuretic with more predictable oral absorption than furosemide; used in heart failure and edema; some studies suggest better outcomes than furosemide in HFrEF.
Indapamide
Thiazide-like diuretic with additional vasodilatory properties; used primarily for hypertension; may retain some antihypertensive effect in CKD; weaker diuretic than metolazone for fluid overload states.
Prefer Metolazone? We can find it.
Lithium
majorMetolazone reduces renal lithium clearance, increasing the risk of lithium toxicity. Concurrent use generally contraindicated; frequent lithium level monitoring required if combination unavoidable.
Digoxin
majorMetolazone-induced hypokalemia increases myocardial sensitivity to digitalis, risking serious arrhythmias including ventricular tachycardia and fibrillation. Monitor potassium and digoxin levels closely.
Furosemide / Loop Diuretics
majorCombination creates unusually large fluid and electrolyte losses. Risk of severe hypokalemia, dehydration, and acute kidney injury. Use only under close medical supervision with frequent lab monitoring.
NSAIDs (ibuprofen, naproxen)
moderateReduce antihypertensive effects of metolazone and may impair renal function. Use acetaminophen as safer alternative for pain relief.
Antihypertensive drugs
moderateAdditive blood pressure lowering; risk of excessive hypotension, especially at initiation of combination therapy. Dose adjustment often needed.
Corticosteroids
moderateIncreased risk of hypokalemia when combined with metolazone. Monitor serum potassium more frequently.
Warfarin
moderateMetolazone may alter hypoprothrombinemic response. Monitor INR more frequently when metolazone is started, stopped, or dose-changed.
Metolazone is a time-tested, clinically important diuretic that occupies a unique niche in the management of heart failure, kidney disease, and hypertension. Its ability to produce effective diuresis even in patients with severely impaired kidney function — where other thiazides fail — makes it irreplaceable for many patients with complex chronic conditions.
As a generic-only medication with no active manufacturer-sponsored savings programs, cost management relies primarily on discount coupons (GoodRx, SingleCare), insurance optimization, and 90-day mail-order supplies. Availability is generally stable at the national level, though localized pharmacy stock-outs — particularly for the 2.5 mg strength — can affect patients at the retail level.
If you're struggling to find metolazone at your local pharmacy, medfinder makes it easy to locate which pharmacies near you have metolazone in stock — without spending hours calling pharmacy after pharmacy. Simply provide your medication, dose, and ZIP code, and medfinder will do the searching for you.
Medfinder Editorial Standards
Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
ChatGPT
Claude
Perplexity
Grok
Gemini