These reactions should be considered as possible occurrences with clinical usage of metolazone. Whenever adverse reactions are moderate or severe, metolazone dosage should be reduced or therapy withdrawn. Based on the pharmacological activities of metolazone, overdosage might lead to excessive diuresis with electrolyte depletion. In cirrhotic patients, overdosage might precipitate hepatic coma. There is no specific antidote.
Treatment is symptomatic and supportive.
Induce emesis or perform gastric lavage. Correct dehydration, electrolyte imbalance, hepatic coma, and hypotension by established procedures. Programs of therapy with metolazone should be titrated to gain a maximal initial therapeutic response and to determine the minimal dose possible to maintain that therapeutic response. When an initially desired therapeutic effect has been obtained, it is ordinarily advisable to reduce the dosage of metolazone to a lower maintenance level. The daily dosage depends on the severity of each patient's condition, his sodium intake, and his responsiveness.