metolazone IV / Academic Pharma - LARVOL DELTA

ACETAZOLAMIDE VERSUS THIAZIDES WITH LOOP DIURETICS IN ACUTE DECOMPENSATED HEART FAILURE - Allyson Chan (ACC 2025) - "Data collected for patients who received intravenous chlorothiazide, oral metolazone, or intravenous acetazolamide from September 2021 to August 2023. There is no significant difference in average daily net urine output or safety outcomes among patients with ADHF on thiazide and loop, acetazolamide and loop, or all three classes of diuretics, even after adjusting for potential confounders. Further studies are warranted to determine optimal timing and doses of each diuretic when used in combination."

Acute Kidney Injury • Cardiovascular • Congestive Heart Failure • Heart Failure • Nephrology • Renal Disease

Meta-Analysis Comparing Metolazone Versus Intravenous Chlorothiazide in Patients With Acute Decompensated Heart Failure. (PubMed, Ann Pharmacother) - No abstract available

Journal • Retrospective data • Cardiovascular • Congestive Heart Failure • Heart Failure

Needing bail-out therapy to stabilise outpatient worsening heart failure highlights a high-risk cohort for recurrent instability (HEART FAILURE 2024) - "All were initially treated as outpatients with escalation in oral diuretics and/or bail-out therapies (metolazone or intravenous diuretic)... This interim prospective analysis of WHF demonstrates a persistently high morbidity burden in patients initially stabilised in the community. Those stabilised initially with aggressive outpatient diuresis had a particularly high risk of future deterioration with 46% experiencing recurrent outpatient WHF or HFH at 3 months. This suggests that close, structured clinical follow-up, including home telemonitoring, akin to that after HFH, could be beneficial in this cohort"

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure

THE EFFECT OF ELECTRONIC HEALTH RECORD CHOICE ARCHITECTURE ON DIURETIC AUGMENTATION CHOICE (ACC 2024) - "Background: Metolazone and intravenous (IV) chlorothiazide are commonly used for sequential nephron blockade in acute decompensated heart failure (ADHF) with similar efficacy and safety, however, IV chlorothiazide is significantly more expensive... In patients treated for ADHF, modulating the EHR choice architecture through a simple alert significantly reduced chlorothiazide dispenses, providing an avenue for cost reduction in admissions for ADHF."

Cardiovascular • Congestive Heart Failure • Heart Failure

Outpatient worsening heart failure managed in dedicated heart failure unit --workload and outcomes (HEART FAILURE 2023) - "To be included all patients had to have been treated with an increase in oral diuretic or bailout therapy defined as metolazone or intravenous (IV) diuretics... This ongoing prospective analysis of WHF managed in an outpatient heart failure unit underlines that while the majority can be settled without the need for hospitalisation, the workload is significant and resource intensive often requiring a combination of different diuretic strategies. Only the minority return to baseline diuretic dose prior to the WHF episode indicating a concerning prognostic trend even in the group successfully managed in the community"

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure

Persistently high early morbidity following outpatient stabilisation of worsening heart failure: 1- and 3-month outcomes of worsening heart failure managed in an outpatient setting (HEART FAILURE 2023) - "All were initially treated as outpatients with escalation in oral diuretics and/or bailout therapies (metolazone and/or intravenous diuretic)... This interim prospective analysis of WHF demonstrates a persistently high morbidity burden in patients initially stabilised in the community, with over 25% experiencing recurrent outpatient WHF within 3 months. These data support the emerging awareness of the prognostic significance of outpatient WHF and the need for more vigilant follow-up in the early period after stabilisation akin to that post-HFH. They also suggest that, while patients may be defined clinically as stabilised, many may have residual subclinical congestion increasing risk of early future clinical deterioration."

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure

Metolazone versus intravenous chlorothiazide for decompensated heart failure sequential nephron blockade: A retrospective cohort study. (PubMed, J Card Fail) - "Chlorothiazide was not superior to metolazone in changing the net 24-hour UOP of ADHF patients with loop resistance. Preferential metolazone use in SNB is a potential cost-saving measure."

Journal • Retrospective data • Cardiovascular • Congestive Heart Failure • Heart Failure

Formulation, Characterization, and the Diuretic Effects of a New Intravenous Metolazone Emulsion. (PubMed, Drug Res (Stuttg)) - "This metolazone emulsion was capable of increasing urine volume output and demonstrated both natriuretic and kaliuretic properties."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure

[VIRTUAL] Evaluation of intravenous chlorothiazide use in the setting of acute decompensated heart failure. (ASHP 2020) - "Recent studies indicate there is no difference in clinical outcomes between patients who receive oral metolazone or intravenous (IV) chlorothiazide in this setting... In our review, an initial dose of metolazone was only given to 12.5% of patients with ADHF with loop diuretic resistance from September 2019 to August 2020. Metolazone has been shown to be non-inferior to chlorothiazide IV in increasing urine output in patients with ADHF. Given these results, we believe there is opportunity to increase utilization of metolazone, as well as potential to reduce institutional drug costs due to the significant cost difference between IV chlorothiazide and metolazone."

Cardiovascular • Congestive Heart Failure • Heart Failure

[VIRTUAL] Safety and efficacy of oral metolazone versus intravenous chlorothiazide in acute decompensated heart failure (ASHP 2020) - "Safety endpoints included electrolyte abnormalities, worsening renal function, and hypotension. Secondary objectives included change in net urine output at 12 and 24 hours, change in standing weight by 48 hours, readmission rate, and need for any form of renal replacement therapy."

Clinical • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Hypotension • Nephrology • Renal Disease • Transplantation

Oral Metolazone Versus Intravenous Chlorothiazide as an Adjunct to Loop Diuretics for Diuresis in Acute Decompensated Heart Failure With Reduced Ejection Fraction. (PubMed, Hosp Pharm) - " Both MTZ and CTZ similarly increased UOP when utilized as an adjunct to IV LD. These results suggest that while thiazide agents can substantially increase UOP in ADHF patients with HFrEF, MTZ and CTZ have comparable effects."

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