Drug interactions
Metolazone + Sacubitril / valsartan
Severity: Moderate
Metolazone and Sacubitril / valsartan: moderate 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 is often combined with sacubitril/valsartan in heart failure, but the pair can cause marked hypotension, volume depletion and renal impairment. The valsartan component raises potassium while metolazone lowers it, so potassium may move in either direction.
What this interaction means in plain words
Metolazone and Sacubitril / valsartan can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Additive hypotensive and renal hemodynamic effects, with opposing potassium effects of RAAS blockade and thiazide-type diuresis.
What to do
Monitor blood pressure, renal function and serum potassium and sodium after initiation and dose changes. Reduce the diuretic dose if hypotension or volume depletion develops.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Metolazone
Frequently asked questions
Can I take Metolazone with Sacubitril / valsartan?
MediHelp rates the interaction as moderate. Metolazone and Sacubitril / valsartan can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Metolazone is often combined with sacubitril/valsartan in heart failure, but the pair can cause marked hypotension, volume depletion and renal impairment. The valsartan component raises potassium while metolazone lowers it, so potassium may move in either direction.
How serious is the interaction between Metolazone and Sacubitril / valsartan?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood pressure, renal function and serum potassium and sodium after initiation and dose changes. Reduce the diuretic dose if hypotension or volume depletion develops.
What other medicines interact with Metolazone?
MediHelp also lists interactions of Metolazone with, for example, Amifostine, Amlodipine-hydrochlorothiazide-valsartan, Amlodipine-olmesartan-hydrochlorothiazide. The full list is on the Metolazone page.
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