acetazolamide (Diamox)
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Introduction
Tradename: Diamox.
Indications
- management of edema secondary to chronic heart failure (CHF)
- glaucoma
- adjunct for therapy of open angle glaucoma
- closed angle glaucoma[7]
- secondary glaucoma[7]
- idiopathic intracranial hypertension (pseudotumor cerebri)[5]
- adjunct to other anticonvulsants in prophylactic management of epilepsy, especially absence (petit mal) seizures
- high altitude sickness
- motion sickness
- treatment of metabolic alkalosis in patients with hypervolemia & sodium overload (urinary alkalinization)[5][6][7]
- hydrocephalus[7]
- intracranial hemorrhage
- familial periodic paralysis
- anoxia[7]
Dosage
- adults
- children
Tabs: 125, 250, 500 mg.
Adverse effects
- common (> 10%)
- uncommon (< 1%)
- other
- kidney stones (renal calculi), uncommon < 1%
- diminished uric acid secretion
- crystalluria
- dysuria
- seizures
- bone marrow suppression (rare)
- hypertrichosis
- nausea/vomiting
- sedation
- headache
- sulfa hypersensitivity reactions
- hemolytic anemia
- kidney stones (renal calculi), uncommon < 1%
- drug adverse effects of sulfonamides
- drug adverse effects of diuretics
- drug adverse effects of carbonic anhydrase inhibitor(s)
- drug adverse effects of antihypertensive agents
Drug interactions
- increased lithium excretion
- enhanced activity of other diuretics
- via alkalinization of the urine
- diminished excretion of amphetamines, procainamide, quinidine, tricyclic antidepressants
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) SGLT2 inhibitors (flozins) with diuretics
- drug interaction(s) of diuretics in combination with Zn+2
- drug interaction(s) of antiarrhythmic agents in combination with diuretics
- drug interaction(s) of calcium channel blockers with diuretics
- drug interaction(s) of antibiotics with warfarin
- drug interaction(s) of diuretics with angiotensin II receptor antagonists
- drug interaction(s) of diuretics with ACE inhibitors
- drug interaction(s) of NSAIDs, diuretics & angiotensin II receptor antagonists
- drug interaction(s) of NSAIDs, diuretics & ACE inhibitors
- drug interaction(s) of NSAIDs & antihypertensives
Laboratory
Mechanism of action
- reversible inhibitor of carbonic anhydrase
- diuretic
- alkalinization of urine
- increases urine volume (promptly after administration)
- normally acidic urine pH becomes alkaline.
- increases urinary excretion of bicarbonate & Na+
- urinary concentration of bicarbonate increases; matched by Na+ & substantial amounts of K+
- urinary concentration of Cl- falls
- the increased alkalinity of the urine is necessarily accompanied by a decrease in the excretion of
- titratable acid
- ammonia
- indirect inhibition of H+ secretion by the renal tubules through inhibition of carbonic anhydrase
- for glaucoma, acetazolamide works by decreasing formation of aqueous humor
- lowers pulmonary vascular resistance[4]
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill pg 716
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 4.0 4.1 Teppema LJ, Balanos GM, Steinback CD et al Effects of acetazolamide on ventilatory, cerebrovascular, and pulmonary vascular responses to hypoxia. Am J Respir Crit Care Med. 2007 Feb 1;175(3):277-81 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17095745
- ↑ 5.0 5.1 5.2 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015
- ↑ 6.0 6.1 Galla JH. Metabolic alkalosis. J Am Soc Nephrol. 2000 Feb;11(2):369-75. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10665945
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Deprecated Reference