Acetazolamide

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[edit] BRAND NAMES

[edit] STRUCTURE

Acetazolamide.jpg

[edit] MECHANISM OF ACTION

Acetazolamide is a potent, sulfa-based drug which inhibits the enzyme carbonic anhydrase. In the eye this inhibitory action of acetazolamide decreases the secretion of aqueous humour and results in a drop in intraocular pressure.

Evidence seems to indicate that Acetazolamide has utility as an adjuvant in the treatment of certain dysfunctions of the central nervous system (e.g. epilepsy). Inhibition of carbonic anhydrase in this area appears to retard abnormal, paroxysmal, excessive discharge from central nervous system neurons.

The drug also causes the kidneys to excrete bicarbonate ions, that carry out sodium, water and potassium, resulting in diuresis and alkalinization of the urine and metabolic acidosis

[edit] INDICATIONS

  • Prevention or amelioration of symptoms associated with acute mountain sickness
  • treatment of idiopathic intracranial hypertension (pseudotumor cerebri)
  • Short term treatment of high intraocular pressure in acute glaucoma or treatment of acute ocular hypertension following surgical procedures
  • As an adjunct to maximal topical medical therapy prior to surgery for glaucoma
  • Adjunctive treatment of epileptic seizures- The best results have been seen in petit mal in children. Good results, however, have been seen in both adult and pediatric patients, in other types of seizures such as grand mal, mixed seizure patterns, myoclonic jerk pattern etc.
  • Treatment of metabolic or respiratory alkalosis
  • Adjunctive treatment of edema due to congestive heart failure

[edit] DOSAGE

  • Glaucoma: Adults: 250mg-1000mg (1-4 tablets) every 24 hours, in divided doses.
  • Epilepsy:
    • Adults: the recommended dose is 250-1000mg daily in divided doses.
    • Pediatric patients: The recommended dose in pediatric patients is 8-30 mg/kg daily in divided doses not to exceed 750 mg/day.

When Acetazolamide is given in combination with any other anticonvulsant, it is suggested that the starting dose should be 250 mg once daily in addition to the existing medication. This can be increased to the levels indicated above. The change from other medication to Acetazolamide should be gradual in accordance with usual practice in epilepsy therapy.

[edit] CONTRAINDICATIONS

  • Hypersensitivity to acetazolamide, sulfonamides, or sulfonamide derivatives such as co-trimoxazole, Septrin™, Bactrim™
  • Liver or kidney disease
  • Patients with acidosis

[edit] PRECAUTIONS

[edit] INTERACTIONS

  • May increase excretion of Lithium.
  • May decrease excretion of Quinidine leading to cardiac arrhythmias.

[edit] PREGNANCY AND LACTATION

[edit] SIDE EFFECTS

Possible side effects include: parathesias (numbness and tingling) in lips, fingers and toes, metallic taste when drinking carbonated drinks, hyponatremia (low blood sodium), hypokalemia (low blood potassium), metabolic acidosis (acidic blood), increased risk of kidney stones.

Rarer side effects include: flushing, headache, dizziness, nausea, diarrhoa and tiredness

[edit] RELATED LINKS

Understanding Glaucoma

[edit] REFERENCES

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