Hospital Pharmacy - December 2019 - 355
355
Bohn et al
Figure 3. Secondary urine output outcomes including baseline urine outputs.
Note. UOP = urine output; MTZ = metolazone oral; CTZ = chlorothiazide intravenous; BL = baseline; COT = course of therapy.
Table 2. Adverse Effects.
Adverse effects
Hyponatremia (Na <135 mEq/L)
Hypernatremia (Na >145 mEq/L)
Hypokalemia (K <3.3 mEq/L)
Hyperkalemia (K >4.9 mEq/L)
Hypochloremia (Cl <97 mEq/L)
Hyperchloremia (Cl >110 mEq/L)
Hypocalcemia (Ca <8.5 mg/dL)
Hypercalcemia (Ca >10.3 mg/dL)
Hypomagnesemia (Mg <1.4 mg/dL)
Hypermagnesemia (Mg >2.5 mg/dL)
Hypotension (SBP <90 mm Hg)
CTZ (n = 108), n (%)
22 (20.4)
5 (4.6)
17 (15.7)
9 (8.3)
26 (24.1)
4 (3.7)
13 (12)
11 (10.2)
0
6 (5.6)
26 (24.1)
MTZ (n = 60), n (%)
P value
19 (31.7)
2 (3.3)
9 (15)
7 (11.6)
17 (28.3)
2 (3.3)
8 (13.3)
4 (6.7)
0
4 (6.7)
10 (16.7)
.102
.687
.899
.481
.544
.901
.808
.443
-
.771
.262
Note. CTZ = chlorothiazide; MTZ = metolazone; Na = sodium; K = potassium; Cl = chloride; Ca = calcium; Mg = magnesium; SBP = systolic blood
pressure.
Table 3. Subgroup Analysis, Patients Receiving Vasopressor in the ICU.
CTZ (n = 34)
BL total UOP (mL)
Total 24-hour UOP (mL)
Change in 24-hour UOP (mL)
K <3.3 mEq/L
Cl <97 mEq/L
1810 (169, 3789)
3881 (555, 7207)
1865 (302, 3428)
8 (23.5%)
5 (14.7%)
MTZ (n = 16)
2097.5 (936.5, 3258.5)
3962.5 (2072.5, 5852.5)
1622.5 (59.5, 3185.5)
3 (18.8%)
4 (25%)
P value
.647
.852
.506
1.00
.442
Note. ICU = intensive care unit; CTZ = chlorothiazide; MTZ = metolazone; BL = baseline; UOP = urine output; K = potassium; Cl = chloride.
(Table 3). No difference was seen between the two groups
with respect to adverse effects, including hypokalemia and
hypochloremia.
Discussion
The purpose of this study was to determine whether there
was a difference in efficacy or safety when administering
CTZ or MTZ as an adjunct to IV loop diuretic therapy in
patients with ADHF and reduced EF. No differences were
seen in the primary endpoint or any secondary UOP outcomes or adverse effects measured in this specific patient
population. When IV loop diuretic therapy is insufficient to
resolve ADHF, the 2010 heart failure treatment guidelines
recommend the addition of spironolactone, MTZ, or CTZ1;
however, few studies compare MTZ and CTZ for efficacy. A
recent retrospective cohort study, conducted by Shulenberger
et al, compared the addition of CTZ and MTZ in patients
Hospital Pharmacy - December 2019
Table of Contents for the Digital Edition of Hospital Pharmacy - December 2019
TOC/Verso
A New Pharmaceutical Care Concept: More Capable, Motivated, and Timely
Oral Metolazone Versus Intravenous Chlorothiazide as an Adjunct to Loop Diuretics for Diuresis in Acute Decompensated Heart Failure With Reduced Ejection Fraction
Effect of Pharmacist Clinic Visits on 30-Day Heart Failure Readmission Rates at a County Hospital
State of Privileging in Pharmacy: A Survey of Vizient-Affiliated Institutions
Therapeutic Enoxaparin in the Morbidly Obese Patient: A Case Report and Review of the Literature
Critically Ill Recipients of Weight-Based Fluconazole Meeting Drug-Induced Liver Injury Network Criteria
Cultural Competence Considerations for Health-System Pharmacists
Cost Comparison of Atypical Antipsychotics: Paliperidone ER and Risperidone
Effects of Drug Concentration, Rate of Infusion, and Flush Volume on G-CSF Drug Loss When Administered Intravenously
Hospital Pharmacy - December 2019 - TOC/Verso
Hospital Pharmacy - December 2019 - Cover2
Hospital Pharmacy - December 2019 - 345
Hospital Pharmacy - December 2019 - 346
Hospital Pharmacy - December 2019 - 347
Hospital Pharmacy - December 2019 - A New Pharmaceutical Care Concept: More Capable, Motivated, and Timely
Hospital Pharmacy - December 2019 - 349
Hospital Pharmacy - December 2019 - 350
Hospital Pharmacy - December 2019 - Oral Metolazone Versus Intravenous Chlorothiazide as an Adjunct to Loop Diuretics for Diuresis in Acute Decompensated Heart Failure With Reduced Ejection Fraction
Hospital Pharmacy - December 2019 - 352
Hospital Pharmacy - December 2019 - 353
Hospital Pharmacy - December 2019 - 354
Hospital Pharmacy - December 2019 - 355
Hospital Pharmacy - December 2019 - 356
Hospital Pharmacy - December 2019 - 357
Hospital Pharmacy - December 2019 - Effect of Pharmacist Clinic Visits on 30-Day Heart Failure Readmission Rates at a County Hospital
Hospital Pharmacy - December 2019 - 359
Hospital Pharmacy - December 2019 - 360
Hospital Pharmacy - December 2019 - 361
Hospital Pharmacy - December 2019 - 362
Hospital Pharmacy - December 2019 - 363
Hospital Pharmacy - December 2019 - 364
Hospital Pharmacy - December 2019 - State of Privileging in Pharmacy: A Survey of Vizient-Affiliated Institutions
Hospital Pharmacy - December 2019 - 366
Hospital Pharmacy - December 2019 - 367
Hospital Pharmacy - December 2019 - 368
Hospital Pharmacy - December 2019 - 369
Hospital Pharmacy - December 2019 - 370
Hospital Pharmacy - December 2019 - Therapeutic Enoxaparin in the Morbidly Obese Patient: A Case Report and Review of the Literature
Hospital Pharmacy - December 2019 - 372
Hospital Pharmacy - December 2019 - 373
Hospital Pharmacy - December 2019 - 374
Hospital Pharmacy - December 2019 - 375
Hospital Pharmacy - December 2019 - 376
Hospital Pharmacy - December 2019 - 377
Hospital Pharmacy - December 2019 - Critically Ill Recipients of Weight-Based Fluconazole Meeting Drug-Induced Liver Injury Network Criteria
Hospital Pharmacy - December 2019 - 379
Hospital Pharmacy - December 2019 - 380
Hospital Pharmacy - December 2019 - 381
Hospital Pharmacy - December 2019 - 382
Hospital Pharmacy - December 2019 - 383
Hospital Pharmacy - December 2019 - 384
Hospital Pharmacy - December 2019 - Cultural Competence Considerations for Health-System Pharmacists
Hospital Pharmacy - December 2019 - 386
Hospital Pharmacy - December 2019 - 387
Hospital Pharmacy - December 2019 - 388
Hospital Pharmacy - December 2019 - Cost Comparison of Atypical Antipsychotics: Paliperidone ER and Risperidone
Hospital Pharmacy - December 2019 - 390
Hospital Pharmacy - December 2019 - 391
Hospital Pharmacy - December 2019 - 392
Hospital Pharmacy - December 2019 - Effects of Drug Concentration, Rate of Infusion, and Flush Volume on G-CSF Drug Loss When Administered Intravenously
Hospital Pharmacy - December 2019 - 394
Hospital Pharmacy - December 2019 - 395
Hospital Pharmacy - December 2019 - 396
Hospital Pharmacy - December 2019 - 397
Hospital Pharmacy - December 2019 - 398
Hospital Pharmacy - December 2019 - 399
Hospital Pharmacy - December 2019 - 400
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