Drug interactions
Enalapril-hydrochlorothiazide + Metolazone
Severity: Major
Enalapril-hydrochlorothiazide and Metolazone: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Metolazone combined with hydrochlorothiazide produces additive, sometimes profound diuresis with a risk of hypokalemia, hyponatremia, hypomagnesemia, volume depletion and renal impairment. Enalapril increases the risk of hypotension and renal dysfunction in volume-depleted patients.
What this interaction means in plain words
Enalapril-hydrochlorothiazide and Metolazone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Enalapril-hydrochlorothiazide belongs to Cardiovascular; Metolazone belongs to Cardiovascular.
Why it happens
Additive inhibition of distal tubular sodium reabsorption, with ACE inhibitor-related hemodynamic effects on the kidney.
What to do
Avoid combining two thiazide-type agents unless specifically intended. If used, monitor electrolytes, renal function, weight and blood pressure closely.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Enalapril-hydrochlorothiazide
- Aliskiren + Enalapril-hydrochlorothiazide Contraindicated
- Dofetilide + Enalapril-hydrochlorothiazide Contraindicated
- Enalapril-hydrochlorothiazide + Protein a column Contraindicated
- Enalapril-hydrochlorothiazide + Sacubitril / valsartan Contraindicated
- Amifostine + Enalapril-hydrochlorothiazide Major
- Amiloride + Enalapril-hydrochlorothiazide Major
Other interactions of Metolazone
Frequently asked questions
Can I take Enalapril-hydrochlorothiazide with Metolazone?
MediHelp rates the interaction as major. Enalapril-hydrochlorothiazide and Metolazone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Metolazone combined with hydrochlorothiazide produces additive, sometimes profound diuresis with a risk of hypokalemia, hyponatremia, hypomagnesemia, volume depletion and renal impairment. Enalapril increases the risk of hypotension and renal dysfunction in volume-depleted patients.
How serious is the interaction between Enalapril-hydrochlorothiazide and Metolazone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid combining two thiazide-type agents unless specifically intended. If used, monitor electrolytes, renal function, weight and blood pressure closely.
What other medicines interact with Enalapril-hydrochlorothiazide?
MediHelp also lists interactions of Enalapril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Protein a column. The full list is on the Enalapril-hydrochlorothiazide page.
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