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Metolazone, like other thiazide diuretics, may unmask latent diabetes mellitus or exacerbate gout, especially by interacting with medicines used to treat gout. In addition, thiazide diuretics, including metolazone, are sulfonamides; those with hypersensitivity to sulfonamides ("sulfa allergy") may also be allergic to metolazone. [4]
The sulfonylureas and thiazide diuretics are newer drug groups based upon the antibacterial sulfonamides. [1] [2] Allergies to sulfonamides are common. The overall incidence of adverse drug reactions to sulfa antibiotics is approximately 3%, close to penicillin; [3] hence medications containing sulfonamides are prescribed carefully.
Loop diuretics may also precipitate kidney failure in patients concurrently taking an NSAID and an ACE inhibitor—the so-called "triple whammy" effect. [ 19 ] Because furosemide, torsemide and bumetanide are technically sulfa drugs, there is a theoretical risk that patients sensitive to sulfonamides may be sensitive to these loop diuretics.
This suggests the long-term consequences of loop diuretics on hearing could be a more significant than previously thought and further research is required in this area. Other precautions include nephrotoxicity, sulfonamide (sulfa) allergy, and increased free thyroid hormone effects with large doses. [36]
The loop diuretic furosemide is associated with ototoxicity, particularly when doses exceed 240 mg per hour. [21] The related compound ethacrynic acid has a higher association with ototoxicity, and is therefore used only in patients with sulfa allergies. Diuretics are thought to alter the ionic gradient within the stria vascularis. [22]
Etacrynic acid or ethacrynic acid , trade name Edecrin, is a loop diuretic used to treat high blood pressure and the swelling caused by diseases like congestive heart failure, liver failure, and kidney failure. A con with ethacrynic acid compared to the other loop diuretic drugs such as furosemide is that it has a significantly steep dose ...
Author of The Demon Under the Microscope, a history of the discovery of the sulfa drugs; A History of the Fight Against Tuberculosis in Canada (Chemotherapy) Presentation speech, Nobel Prize in Physiology and Medicine, 1939; The History of WW II Medicine "Five Medical Miracles of the Sulfa Drugs". Popular Science, June 1942, pp. 73–78.
Thiazide diuretics inhibit this receptor, causing the body to release NaCl and water into the lumen, thereby increasing the amount of urine produced each day. [6] An example of a molecule that is chemically a thiazide but not used as a diuretic is methylchloroisothiazolinone , often found as an antimicrobial in cosmetics.