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Acetazolamide

EYE

ANTIGLAUCOMA - [ EYE ]

Acetazolamide is a diuretic belonging to the carbonic anhydrase inhibitor class. It inhibits the enzyme carbonic anhydrase in the proximal convoluted tubule of the nephron and the aqueous humor producing structure in the eye. This results in increased excretion of bicarbonate along-with sodium, chloride and potassium by the kidney and decreased production of aqueous humor in the eye.(1)

Adjunctive treatment of: chronic simple (open-angle) glaucoma secondary glaucoma preoperatively in acute angle-closure glaucoma where delay of surgery is desired in order to lower intraocular pressure. Prevention or amelioration of symptoms associated with acute mountain sickness (2)

Hypersensitivity to acetazolamide or any excipients in the formulation. Hypersensitivity to sulfonamides Situations in which sodium and/or potassium blood serum levels are depressed: in cases of marked kidney and liver disease or dysfunction in suprarenal gland failure in hyperchloremic acidosis. Cirrhosis because of the risk of development of hepatic encephalopathy. Long term administration of acetazolamide is contraindicated in patients with chronic non-congestive angle-closure glaucoma (2)

Headache, malaise, fatigue, fever, pain at injection site, flushing, growth retardation in children, flaccid paralysis, anaphylaxis. Gastrointestinal disturbances such as nausea, vomiting, diarrhea. Blood dyscrasias such as aplastic anemia, agranulocytosis, leukopenia, thrombocytopenic purpura, melena. Abnormal liver function, cholestatic jaundice, hepatic insufficiency, fulminant hepatic necrosis. Metabolic acidosis, electrolyte imbalance, including hypokalemia, hyponatremia, osteomalacia with long-term phenytoin therapy, loss of appetite, taste alteration, hyper/hypoglycemia. Drowsiness, paresthesia (including numbness and tingling of extremities and face), depression, excitement, ataxia, confusion, convulsions dizziness. Allergic skin reactions including urticaria, photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis. Hearing disturbances, tinnitus, transient myopia Crystalluria, increased risk of nephrolithiasis with long-term therapy, hematuria, glycosuria, renal failure polyuria (2)

Phenytoin, folic acid antagonists, amphetamine, quinidine, cyclosporine: Increased levels of these drugs Primidone, Methenamine, lithium : Decreased levels/action of these drugs Sodium bicarbonate: Increased risk of kidney stones. (2)

Safety and efficacy is not established in <12 years. Dosing in elderly patient should be cautious, since there is a greater frequency of decreased hepatic, renal or cardiac function and of concomitant disease or other drug therapy. Acetazolamide is excreted in human milk and can result in adverse effects in the nursing child. (2)

0.25 to 1g daily in divided doses. (3)

1. Reilly RF, Jackson EK. Regulation of renal function and vascular volume. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. USA: McGraw Hill; 2011:672-719. 2. Diamox Sequels [cited 2013 sept 11]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2005/12945s037,038lbl.pdf 3. National Formulary of India. 4 th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011.