MZM Disease Interactions

The use of carbonic anhydrase inhibitors may rarely cause bone marrow suppression and blood dyscrasias at recommended dosages. Aplastic anemia, thrombocytopenia or thrombocytopenia purpura, leukopenia, agranulocytosis, and hemolytic anemia have been reported. Extreme caution should be exercised if carbonic anhydrase inhibitors are administered to patients with these preexisting conditions. A baseline CBC and platelet count is recommended, as well as monitoring at regular intervals during therapy.

The use of carbonic anhydrase inhibitors is contraindicated in patients with adrenal insufficiency. The carbonic anhydrase inhibitor effect may exacerbate electrolyte problems that can occur with primary adrenal insufficiency. Extreme caution should be exercised if a carbonic anhydrase inhibitor is administered to these patients. Monitoring electrolyte levels is recommended.

The use of carbonic anhydrase inhibitors is contraindicated in patients with closed-angle glaucoma. Carbonic anhydrase inhibitors may mask worsening glaucoma due to decreased intraocular pressure. Extreme caution should be exercised if carbonic anhydrase inhibitors is administered to these patients.

The use of carbonic anhydrase inhibitors is contraindicated in patients with hypokalemia . Carbonic anhydrase inhibitors may cause increased potassium excretion. Extreme caution should be exercised if a carbonic anhydrase inhibitor is administered and monitoring electrolyte levels is recommended.

The use of carbonic anhydrase inhibitors is contraindicated in patients with hyponatremia . Carbonic anhydrase inhibitors may cause sodium excretion. Extreme caution should be exercised if a carbonic anhydrase inhibitor is administered and monitoring electrolyte levels is recommended.

The use of some carbonic anhydrase inhibitors is contraindicated in patients with severe kidney disease. Dysuria, crystalluria, renal colic, and other renal lesions have been reported during therapy with carbonic anhydrase inhibitors.

The use of carbonic anhydrase inhibitors is contraindicated in patients with marked liver disease or cirrhosis. Carbonic anhydrase inhibitors increase the risk of developing hepatic encephalopathy in these patients. Extreme caution should be exercised if carbonic anhydrase inhibitors are administered in patients with mild to moderate liver disease as the clearance of the drug can be decreased. A dose reduction might be needed and monitoring of the liver function is recommended.

Carbonic anhydrase inhibitors may exacerbate pulmonary disease in patients with elevated pCO2 levels. Respiratory acidosis may be precipitated or increased in these patients. Therapy with carbonic anhydrase inhibitors should be administered cautiously in patients with respiratory acidosis, and conditions where alveolar ventilation may be impaired (pulmonary obstruction, emphysema, etc) and can precipitate or aggravate acidosis. Respiratory status should be monitored during therapy.

Elevation of blood glucose, possibly caused by hypokalemia, and glycosuria have been reported rarely in diabetics receiving carbonic anhydrase inhibitors. Therapy with carbonic anhydrase inhibitors should be administered cautiously in patients with diabetes mellitus. Routine glucose monitoring is recommended during therapy.

Uric acid excretion is decreased during therapy with carbonic anhydrase inhibitors, and gout may be exacerbated. Therapy with carbonic anhydrase inhibitors should be administered cautiously in patients with gout. Elevated serum uric acid levels return to normal when the drug is discontinued. Monitoring of uric acid levels is recommended in these patients.

Reduced plasma bicarbonate levels and, in some instances, elevated plasma chloride levels may result in metabolic acidosis during long-term therapy with carbonic anhydrase inhibitors. Therapy with carbonic anhydrase inhibitors should be administered cautiously in patients with metabolic or hyperchloremic acidosis or with conditions that predispose to acidosis (renal disease, severe respiratory disorders, diarrhea). The measurement of baseline and periodic serum bicarbonate is recommended. If metabolic acidosis develops (it may be corrected by administration of sodium bicarbonate), and persists, a dose reduction or treatment discontinuation should be considered.