Drug interactions
Metolazone + Sotalol
Severity: Major
Metolazone and Sotalol: 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 can cause hypokalemia and hypomagnesemia, which markedly increase the risk of QT prolongation and torsades de pointes with sotalol. This is a potentially fatal arrhythmia risk.
What this interaction means in plain words
Metolazone and Sotalol 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 belongs to Cardiovascular; Sotalol belongs to Cardiovascular.
Why it happens
Diuretic-induced hypokalemia and hypomagnesemia potentiate the QT-prolonging effect of sotalol.
What to do
Check and correct potassium and magnesium before and during treatment, and monitor ECG and QTc. Consider an alternative to the diuretic or antiarrhythmic if electrolytes cannot be kept stable.
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 Metolazone
Other interactions of Sotalol
- Arsenic trioxide + Sotalol Contraindicated
- Artemether / lumefantrine + Sotalol Contraindicated
- Disopyramide + Sotalol Contraindicated
- Dofetilide + Sotalol Contraindicated
- Dronedarone + Sotalol Contraindicated
- Droperidol + Sotalol Contraindicated
Frequently asked questions
Can I take Metolazone with Sotalol?
MediHelp rates the interaction as major. Metolazone and Sotalol 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 can cause hypokalemia and hypomagnesemia, which markedly increase the risk of QT prolongation and torsades de pointes with sotalol. This is a potentially fatal arrhythmia risk.
How serious is the interaction between Metolazone and Sotalol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Check and correct potassium and magnesium before and during treatment, and monitor ECG and QTc. Consider an alternative to the diuretic or antiarrhythmic if electrolytes cannot be kept stable.
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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