Thiazide and loop diuretic combinations

A combination of a thiazide and a loop diuretic is thought to be beneficial in patients with heart failure unresponsive to either drug alone. Patients placed on this regime are susceptible to massive changes in electrolytes and water balance. Regular monitoring is advised.

• a literature review and the observational study support the use of low-dose metolazone (< or =5 mg) on top of oral loop diuretics, as an effective and relatively safe treatment in contemporary outpatients with refractory heart failure (1)

The combination of frusemide and metolazone is commonly used.

Reference:

• Rosenberg J et al.Combination therapy with metolazone and loop diuretics in outpatients with refractory heart failure: an observational study and review of the literature. Cardiovasc Drugs Ther. 2005 Aug;19(4):301-6.