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Acetazolamide

Oral
Intravenous
Class
Diuretics
Subclass
Carbonic anhydrase inhibitors
Generic name
acetaZOLAMIDE
Brand names
Diamox®, Acetamox®
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment
Acute mountain sickness
•
500-1,000 mg PO daily, in divided doses, while at high altitudes or longer as needed
Alternative
•
250 mg PO BID
Episodic ataxia type 2 • Off-label
•
Start at: 125-250 mg PO daily
•
Maintenance: 500 mg PO daily
Idiopathic intracranial hypertension • Off-label
•
250-500 mg PO BID
Adjunctive treatment
Edema • Drug-induced
•
250-375 mg PO daily for 1-2 days, alternating with a rest day
Edema in patients with congestive HF
•
250-375 mg PO qAM given on alternate days or for 2 days alternating with a rest day
Epilepsy • Generalized seizures, absence seizures
•
Start at: 250 mg PO daily
•
Maintenance: 375-1,000 mg PO daily, in divided doses
Administered in combination with anticonvulsants.
Glaucoma • Open-angle
•
250-1,000 mg PO daily, in divided doses
Glaucoma • Acute, angle-closure
•
250 mg PO q4h for preoperative management
Alternative
•
Loading: 500 mg PO once
•
Maintenance: 125-250 mg PO q4h for preoperative management
Prevention
Prevention of acute mountain sickness
•
125-250 mg PO daily, in divided doses, initiated 24-48 hours before ascent and continued for 48 hours while at high altitudes
Alternative
•
125 mg PO BID initiated the day before ascent and continued for 2-4 days
Indications for use
Labeled indications
Adults
•
Treatment of acute mountain sickness
•
Adjunctive treatment for edema (drug-induced)
•
Adjunctive treatment for edema in patients with congestive HF
•
Adjunctive treatment for epilepsy (generalized seizures, absence seizures)
•
Adjunctive treatment for glaucoma (acute, angle-closure)
•
Adjunctive treatment for glaucoma (open-angle)
•
Prevention of acute mountain sickness
Off-label indications
Adults
•
Treatment of episodic ataxia type 2
•
Treatment of idiopathic intracranial hypertension
Safety risks
Contraindications
Hypersensitivity to acetazolamide or its components or sulfonamides
Adrenal insufficiency
Prolonged use in patients with non-congestive angle-closure glaucoma
Concomitant use of other carbonic anhydrase inhibitors
Warnings and precautions
Blood dyscrasias
•
Use caution in all patients. Obtain CBC and platelet count before initiating acetazolamide and at regular intervals throughout treatment.
Exacerbation of respiratory acidosis
•
Use caution in patients with pulmonary obstruction or emphysema with alveolar ventilation impairment. Monitor serum electrolytes.
Increased blood glucose, decreased blood glucose
•
Use caution in patients with diabetes or prediabetes. Monitor serum electrolytes.
Loss of appetite, tachypnea, lethargy, coma
•
Use caution in patients taking high-dose aspirin.
Somnolence
•
Use extreme caution in patients performing activities requiring mental alertness, such as driving or operating machinery.
Specific populations
Renal impairment
eGFR > 50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 10-50 mL/min/1.73 m²
•
Start at dose of 125-250 mg. Do not exceed frequency of BID. Monitor for electrolyte disturbances.
eGFR < 10 mL/min/1.73 m²
•
Do not use.
Renal replacement therapy
Continuous renal replacement
•
Do not use.
Intermittent hemodialysis
•
Do not use.
Peritoneal dialysis
•
Do not use.
Hepatic impairment
Any severity
•
Do not use.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Use only if benefits outweigh potential risks.
Very low levels in breastfed infants (< 5%).
No overt adverse effects reported in breastfed infants.
No overt adverse effects on lactation reported.
Adverse reactions
Unknown frequency
•
Acute liver failure, agranulocytosis, anaphylaxis, aplastic anemia, ataxia, ↓ blood neutrophil count, ↓ WBC count, ↓ serum potassium, ↓ serum sodium, flaccid paralysis, growth restriction, ↑ liver enzymes, ↑ serum uric acid, ↑ urine glucose, ↑ blood glucose, ↓ blood glucose, jaundice, metabolic acidosis, nephrolithiasis, purpura, ↓ platelet count, renal failure, confusion, depression, fatigue, fever, headache, hematuria, malaise, melena, nausea, dizziness, vomiting, paresthesia, polyuria, seizure, somnolence, tinnitus, angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis
Interactions
Drug(s)
Check Interactions
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