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Active Ingredient: Acetazolamide
Brand(s): Diamox

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What is Acetazolamide?

Acetazolamide is a carbonic anhydrase inhibitor. It’s chemically associated with the sulphonamides, but has no bacteriostatic exercise. The impact in glaucoma relies on lowering the secretion of fluids by inhibiting the enzyme carbonic anhydrase within the ciliary physique of the attention. The decreased provision of intraocular fluid results in a drop in intraocular stress. Period of motion after oral administration: 8–12 hours

Acetazolamide Drug Recommendation

Glaucoma treatment has to be carried out by an ophthalmologist. In open-chamber glaucoma, therapy consists of native drug therapy and/or laser therapy. If the eyeball stress can’t be sufficiently decreased by this therapy, surgical intervention could also be necessary. Eye drops containing a prostaglandin analogue are the primary alternative to drug remedies. If the impact of or intolerance to a prostaglandin analogue is inadequate, a -blocker is first really useful as monotherapy. Options to the above monotherapy are monotherapy with a neighbourhood carbonic anhydrase inhibitor or 2-agonist. When monotherapy doesn’t have an adequate impact, medicines with completely different modes of motion are mixed. In narrow-angle glaucoma, laser therapy and/or surgical procedure, supported by drug remedy, are most well-liked.

Acetazolamide has its place primarily in acute narrow-angle glaucoma when a speedy and substantial reduction in eye stress is required; its use in open-angle glaucoma is out of date.

What Should You Discuss With Your Doctor Before Using This Medicine?

  • Being pregnant
    • Teratogenesis: A restricted variety of human knowledge doesn’t point out an elevated threat of congenital anomalies. In  100 pregnancies with first trimester publicity (case stories and case sequences, particularly with intracranial hypertension), there isn’t clear proof of an elevated threat of congenital anomalies, but the numbers are too low to make an announcement in regards to the threat. In animals at supratherapeutic doses, there may be proof of harm (limb abnormalities). There are over 1000 pregnancies with publicity within the 2 orwereharmbuthypertension) sequences of 3 trimesters (knowledge primarily from one previous, not well documented publication); the variety of abnormalities was not elevated.
    • A couple of instances of metabolic acidosis within the new child have been reported after maternal use of acetazolamide shortly after starting. Acetazolamide is a spinoff of the sulphonamides. Sulfonamides could cause hyperbilirubinemia (with kernicterus) within the neonate when used over the past few months of being pregnant.
    • On account of inadequate or restricted expertise, use solely on very strict indications.

  • Lactation
    • Transition in breast milk: Sure, to a minor extent (roughly 2% of the maternal dose).
    • Based on the producer, this low concentration in breast milk is unlikely to trigger antagonistic results in the toddler.
    • can, in all probability, be used safely.

Acetazolamide Dosage

  • persistent non-congestive closed-chamber glaucoma;
  • sodium and potassium depletion.
  • hypochloremic acidosis;
  • extreme renal impairment;
  • hepatic illness or extreme hepatic impairment;
  • Addison;
  • cor pulmonale;
  • hypersensitivity to sulphonamides.

Diamox Indications

  1. Glaucoma:
    • as an adjuvant.
    • Secondary glaucoma
    • preoperatively in acute narrow-angle glaucoma.
  2. Oedema:
    • Together with different diuretics within the therapy of oedema, if an impact on the completely different elements of the nephron is desired (Diamox tablets/injection),
    • Premenstrual oedema (acetazolamide tablets).
    • Prophylaxis of pulmonary oedema at very excessive altitude (registered indication of acetazolamide tablets).
    • prophylaxis and therapy of altitude illness.
  3. Different:
    • as an adjuvant or monotherapy (Diamox tablets).

Acetazolamide Drug Interactions

Sulfonamides equivalent to acetazolamide might improve the effects of folic acid antagonists, blood sugar-reducing brokers, and oral anticoagulants.

Keep away from concomitant use with acetylsalicylic acid as salicylates and acetazolamide improve one another’s toxicity. Salicylates improve the focus of free acetazolamide within the plasma by displacement from the protein binding site and by inhibition of renal excretion, thus increasing the danger of (extreme) metabolic acidosis (even with regular renal function) and central nervous system toxicity (equivalent to lethargy, somnolence, confusion, tinnitus, anorexia).

Dose changes could also be obligatory when utilised concomitantly with cardiac glycosides equivalent to digoxin (because of the impact of acetazolamide on potassium ranges) or antihypertensive brokers. Mixtures with different diuretics, equivalent to thiazides, might improve the diuretic impact and the danger of hypokalaemia.

Acetazolamide might improve serum phenytoin ranges, and there have been stories of decreased primidone serum ranges and elevated carbamazepine serum ranges. Extreme osteomalacia has additionally been reported together with different antiepileptic medicines. On account of the unpredictable impact of acetazolamide on blood glucose ranges, further monitoring is really useful when utilising blood glucose reducing brokers.

Acetazolamide makes the pH of the tubular urine alkaline. This will likely have an effect on the excretion of weak acids (accelerated excretion) and bases equivalent to ephedrine and methadone (delayed excretion). For instance, acetazolamide decreases the urinary excretion of amphetamine and quinidine. Acetazolamide will increase the excretion of lithium, thereby lowering the impact of lithium.

Ciclosporin ranges within the blood might improve, so monitor these sufferers intently. Don’t use concurrently with different carbonic anhydrase inhibitors attributable to additive results. The plasma half-life of procaine could also be extended when acetazolamide is used concomitantly. There’s an elevated threat of kidney stones with concomitant use of sodium hydrogen carbonate.

Acetazolamide Dosage

Verify blood dependencies earlier and often throughout therapy; discontinue use if these adjustments are not made.  The 250 mg pill has a double break mark, permitting it to be dosed in 62.5 mg increments. For youngsters, oral suspension (drink) can be utilised.

  1. Persistent open-chamber glaucoma: as an adjuvant to standard remedy
    • Adults: Oral: 250 mg 1-4 /day Doses above 1000 mg/day often don’t produce a larger therapeutic impact.

  2. Secondary glaucoma and pre-operative acute narrow-angle glaucoma
    • Adults
      • Oral: 250 mg every 4 hours; or 250 mg twice a day for short-term remedy.
      • Oral, intravenous: 500 mg without delay, followed by 125-250 mg every 4 hours, based on scientific image.
  3. Remedy for oedema, together with different diuretics
    • Adults: Oral, intravenous: 250-375 mg 12/day in the morning for 2 days, followed by sooner or later of relaxation; then repeat schedule. Or administer acetazolamide every 2 days. Overdosage or too frequent dosing often results in therapy failure and will trigger elevated uncomfortable side effects.
    • Kids > 1 month: Oral: 5 mg/kg physique weight 1/day (max. 375 mg/day) in the morning for 2 days, followed by sooner or later of relaxation; then repeat schedule. Or administer acetazolamide every 2 days.

  4. Premenstrual oedema
    • Adults: Oral: 250 or 375 mg 5-10 days earlier than the beginning of menstruation and 2-3/week as wanted.

  5. Excessive-altitude pulmonary oedema prophylaxis
    • Adults: Oral: 250-375 mg sooner or later, earlier than reaching altitude, then 2-3/week for long-term stays.

  6. Offlabel: prophylaxis of altitude illness
    • Adults and kids  40 kg: Oral: 125 mg twice a day; begin 24 hours earlier than reaching an altitude of 3000 metres and proceed till two days after reaching the utmost altitude (or shorter if descending earlier).
    • Kids  40 kg: Oral: 2.5 mg/kg physique weight, 2/day; begin 24 hours earlier than reaching an altitude of 3000 metres and proceed till two days after reaching the utmost altitude (or shorter if descending earlier).
    • Basic: Take into account prophylaxis if there’s an excessive threat of altitude illness. The prophylaxis could also be interrupted if the ascent can be interrupted by a stay of > 2 days at roughly the identical altitude. Then restart prophylaxis while climbing once more.

  7. Off-label: therapy of altitude illness
    • Adults and kids  40 kg: oral: 250 mg twice/day for 3 days, or shorter if descending earlier.
    • Kids  40 kg: Oral: 2.5 mg/kg physique weight, 2/day for 3 days, or shorter if descending earlier.
    • The traveller ought to begin taking the drug on the first signs of headache, even when the signs are mild and the affected person later climbs higher. If there isn’t an additional ascent, you possibly can wait if you have gentle signs. If signs happen once more throughout additional climbing, take the treatment once more for 3 days. When staying at an altitude of > 4000 m, prescribe tablets for six days.

  8. as an adjuvant to anticonvulsants
    • Adults: Oral: beginning dose of 250 mg without delay; improving based on scientific image; standard dose is 375-1000 mg day by day.
    • Kids > 1 month:
      • Oral: 8-30 mg/kg physique weight per day in divided doses.
      • Oral: 8-30 mg/kg/day in 2-3 doses, max. 1500 mg/day.
      • Intravenous: in emergency instances solely: 8-30 mg/kg/day in 2-3 doses, max 1500 mg/day.

Use in extreme renal impairment (creatinine clearance  30 ml/min) is contraindicated.

Use in case of liver illness or extreme hepatic impairment is contraindicated.

Signs of Overdose

  • drowsiness
  • confusion
  • Paraesthesia

Acetazolamide Precautions

Blood depend ought to be checked earlier than and often throughout therapy due to the danger of blood depend abnormalities (acute haemolytic anaemia, agranulocytosis, aplastic anaemia, thrombocytopenia, and eosinophilia). If there’s a change within the blood depend, discontinue use. Don’t use in liver illness or extreme hepatic impairment (particularly cirrhosis) attributable to an elevated risk of hepatic encephalopathy.

Severe hypersensitivity reactions, generally deadly, to sulphonamides (together with acetazolamide) equivalent to Stevens-Johnson syndrome, poisonous epidermal necrolysis, and fulminant hepatic necrosis have been reported but not often. Hypersensitivity reactions might recur if a sulphonamide or its spinoff is run once more, whatever the route of administration. The initial incidence of therapy of a generalised erythema with fever accompanied by pustules could also be a symptom of acute generalised exanthematous pustulosis (AGEP). Have sufferers report any unusual pores and skin rash; if hypersensitivity or other severe reactions happen, discontinue therapy immediately.

Lengthy-term use is contraindicated in persistent non-congestive closed-angle glaucoma. Natural occlusion of the chamber angle might happen, whereas worsening of the glaucoma is masked by decreased intraocular stress.

Verify serum electrolytes often. Acetazolamide might trigger disturbances in the electrolyte stability, together with hyponatraemia, hypokalaemia, and metabolic acidosis. Use caution in sufferers affected by circumstances associated with, or predisposing them to, electrolyte or acid/base imbalances, equivalent to sufferers with renal dysfunction or affected by impaired alveolar air flow (pulmonary obstruction, emphysema). Use warning when there’s a threat of hypokalaemia, equivalent to main hyperaldosteronism and Cushing’s syndrome.

Growing the dose doesn’t improve diuresis and will result in a rise in uncomfortable side effects equivalent to drowsiness and paraesthesia. Each improved and reduced glucose ranges have been reported. Warning needs to be exercised in instances of impaired glucose tolerance or diabetes mellitus.

When practising mountain sports activities, a speedy ascent (inside 24 hours) from sea level to above 3,000 m and a chronic stay at this altitude could cause altitude illness. Above 3,000 m, climb at least 500 m/evening. After any ascent of greater than 500 m, spend no less than two nights at the identical altitude. Based on the LCR’s journey recommendation on altitude illness, take into account the preventive use of acetazolamide if there’s an excessive threat of altitude illness:

  • After experiencing altitude illness at the same (or lower) altitude,
  • When ascending > 600 m/day above 3000 m,
  • when rising from sea level to > 3500 m, sooner or later.

Cirpo Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur, they may require medical attention. Check with your doctor immediately if any of the following side effects occur:

  • Bone marrow melancholy, aplastic anaemia, agranulocytosis, leukopenia, thrombocytopenia, thrombocytopenic purpura, pancytopenia.
  • Listening to impairment and tinnitus
  • Melena
  • Irregular liver function
  • pores and skin rash, urticaria, erythema multiforme
  • Stevens-Johnson syndrome, poisonous epidermal necrolysis
  • Crystalluria, renal and ureteral colic, haematuria, glucosuria, renal failure
  • Metabolic acidosis, transient hypokalaemia, hyponatraemia, hyperglycaemia, hypoglycaemia, osteomalacia.
  • convulsions, weak point, indicators of paralysis
  • Hepatitis, cholestatic icterus, fulminant hepatic necrosis
  • Itching, photosensitisation

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.


Information concerning psychotic disorders, included within the review of Acetazolamide, is used for the informative features exclusively and should not be thought of as an alternative to licenced healthcare or referral from the well-being treatment distributor.



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Frequently asked questions

  • What is Acetazolamide Diamox?

    Acetazolamide is an effective medication for both preventing and treating the symptoms of altitude sickness. This medication helps reduce symptoms such as headaches, tiredness, nausea, dizziness, and shortness of breath that can occur when ascending to high altitudes rapidly (generally above 3,048 metres or 10,000 feet).

  • What to do if you miss a dose?

    If you realise that you have forgotten to take your dose of acetazolamide, take it as soon as you remember. However, if it is almost time for the next dose you are supposed to take, you should skip the dose you missed and go back to your regular dosing schedule. Do not increase the dosage by two.

  • What if u take too much Diamox?

    In the event of an overdose, contact your primary care physician or the emergency room of the hospital closest to you. It's possible that you need to seek emergency medical attention right away. You could also try getting in touch with the hospital's poison management team in your area.

  • How to store Acetazolamide?

    Keep your medications out of the reach of light and moisture at a temperature between 68 and 77 degrees Fahrenheit (20 and 25 degrees Celsius), which is room temperature.

  • What Should I Avoid While Taking Acetazolamide?

    When you are taking Diamox, you should refrain from drinking alcohol and using any illegal medications. They might make the treatment less effective (for example, by making your confusion even worse) while simultaneously making its adverse effects (such as sedation) more severe.

  • What are the side effects of Acetazolamide Diamox?

    Dizziness, lightheadedness, an increase in the amount of urine, blurred vision, dry mouth, drowsiness, headaches, and other symptoms are among the most common adverse reactions to this medication.

  • What are the Contraindication?

    Patients who are known to have an allergic reaction to any of the components of the tablet, as well as pregnant women and children, are advised to avoid taking this medication.

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