Green - after consultant/specialist initiation
Decision Date:
May 2016


GREEN - after consultant/specialist initiation.  2nd line to bendroflumethiazide for heart failure.

Prescribe by brand. Recommended brand for new patients is Xaqua. (Decision date - September 2022)

Xaqua is not interchangeable with generic unlicensed metolazone. Primary care patients existing on unlicensed preparations to refer to heart failure specialist for advice.

See MHRA Jan 2023. Advice for healthcare professionals:

  • assess individual patient factors before switching from unlicensed imported metolazone products to Xaqua. Consider dose adjustment due to potential differences in bioavailability at the time of switching
  • monitor patients to assess the clinical impact of the switch – monitoring should be done on an individual basis after an assessment of the patient’s risk, and could include assessment of blood pressure, electrolytes and degrees of oedema and breathlessness
  • do not divide Xaqua tablets into quarters – when it is necessary to split tablets, this should be only into halves using the tablet score-line
  • tell the patient if their prescribed dose means that they have to split their Xaqua tablet and ensure that this is documented clearly on the medication label and in medication records where appropriate

Combination with loop diuretic should be initiated by specialist only. See Heart Failure guidance

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Derby and Derbyshire ICB

Derby and Derbyshire ICB

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