Metolazone for Adult Patients – Bioavailability of New Licensed Product Xaqua®
Key messages
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All adult patients prescribed metolazone should receive the new licensed product Xaqua®
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The unlicensed product should no longer be used and patients should be switched. Refer to MHRA alert for considerations and advice on switching.
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Xaqua® has a two-fold increased bioavailability compared with other metolazone products and therefore should be prescribed and ordered by brand
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Xaqua® is only available in a 5mg strength, requiring the scored tablet to be halved for patients on lower doses. Quartering Xaqua® tablets is off-label. Ensure patients are aware if tablets need to be split.
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When switching from the unlicensed product to the licensed product, clinical response and renal function should be closely monitored and patients should be aware of signs and symptoms of electrolyte imbalance or if dose is too low
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Acute adult hospital sites should ensure only the licensed product is available and any remaining stocks of unlicensed metolazone are returned to pharmacy following local procedure
Metolazone is a thiazide-like diuretic, indicated for the treatment of oedema related to kidney disease or congestive heart failure. It is restricted to specialist initiation in NHSGGC.
Several years ago, the licensed metolazone product became unavailable and an unlicensed product was imported for use. Recently a new licensed metolazone product (Xaqua®) has become available. It is expected that most adult patients in NHSGGC will already have transitioned to the licensed Xaqua® product. If you require further advice on this please see the joint British Society for Heart Failure/UK Clinical Pharmacy Association prescribing advice here and information from the Specialist Pharmacy Service (SPS) here.
Published: 10/02/2023. Medicines Update blogs are correct at the time of publishing.