title: [Metolazone in the treatment of advanced therapy-resistant dilated cardiomyopathy].
abstract: Ten patients (eight male/two female) with advanced dilated cardiomyopathy (NYHA III/IV) and a mean fractional shortening in two-dimensional echocardiogram of 20% (9 to 30%) and a mean sodium excretion of 21 mmol (8 to 40 mmol) per day, pretreated with digoxin, captopril and a mean frusemide-dose of 147 mg (80 to 500 mg) without an effective diuresis, were additional treated with 2.5 to 5 mg oral metolazone daily. All patients had a brisk diuresis within 24 hours and a mean weight loss of 8.9 kg (3 to 20 kg) until discharge. All patients improved considerably by additional metolazone-therapy. Seven patients developed a mild hyponatraemia (122 to 132 mmol/l), seven showed mild (greater than or equal to 3.2 mmol/l) and one had a serious hypokalaemia (2.8 mmol/l); spironolactone-pretreated patients developed no hypokalaemia. Notably none of the patients had serious blood pressure fluctuation or a deterioration of renal function. To avoid severe electrolyte-disturbances, additional metolazone-therapy should be practised in hospital, preferring low-dose metolazone and reducing frusemide-dose under careful biochemical monitoring after diuresis is started.
authors.affiliation: Medizinische Abteilung, Israelitischen Krankenhauses, in Hamburg.
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.forename: J
authors.initials: J
authors.lastname: Szuba
authors.forename: H
authors.initials: H
authors.lastname: Frenzel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy* / Q000652:urine; D004359:Drug Therapy, Combination; D004489:Edema, Cardiac / Q000188:drug therapy / Q000652:urine; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D006333:Heart Failure / Q000188:drug therapy / Q000652:urine; D006801:Humans; D008297:Male; D008788:Metolazone / Q000008:administration & dosage*; D008875:Middle Aged; D012964:Sodium / Q000652:urine
chemical_list: D005665:Furosemide; D012964:Sodium; D008788:Metolazone
vernacular_title: Metolazone in der Behandlung fortgeschrittener therapieresistenter dilatativer Kardiomyopathie.