Praxis Medical Insights

Est. 2024 • Clinical Guidelines Distilled

Made possible by volunteer editors from the University of Calgary & University of Alberta

Last Updated: 1/31/2026

Metolazone Addition to Loop Diuretic + Spironolactone Therapy in Chronic Heart Failure

Guideline Recommendations

Pharmacologic Rationale

Dosing and Initiation

Monitoring Requirements

Safety Considerations with Spironolactone

Loop Diuretic Optimization Before Adding Metolazone

Clinical Pitfalls to Avoid