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acetazolamide

Generic Name: acetazolamide (a SEET a ZOLE a mide)
Brand Name: Diamox, Diamox Sequels

What is acetazolamide?

Acetazolamide reduces the activity of a protein in your body called carbonic anhydrase. Blocking this protein can help reduce the build-up of certain fluids in the body.

Acetazolamide is used in people with certain types of glaucoma to reduce the amount of fluid in the eye, which decreases pressure inside the eye.

Acetazolamide is also used as a diuretic ("water pill") in people with congestive heart failure, to reduce the build-up of fluid in the body. This build-up is called edema.

Acetazolamide is also used to treat certain types of seizures, and to treat or prevent altitude sickness.

Acetazolamide may also be used for purposes not listed in this medication guide.

What is the most important information I should know about acetazolamide?

You should not use this medicine if you have cirrhosis, severe liver or kidney disease, an electrolyte imbalance, adrenal gland failure, or an allergy to acetazolamide or sulfa drugs.

What should I discuss with my healthcare provider before taking acetazolamide?

You should not use acetazolamide if you are allergic to it, or if you have:

  • severe liver disease, or cirrhosis;

  • severe kidney disease;

  • an electrolyte imbalance (such as acidosis or low levels of potassium or sodium in your blood);

  • adrenal gland failure; or

  • an allergy to sulfa drugs.

To make sure acetazolamide is safe for you, tell your doctor if you have:

  • severe breathing problems;

  • angle closure glaucoma; or

  • if you also take aspirin in high doses.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Acetazolamide can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

Acetazolamide is not approved for use by anyone younger than 18 years old.

How should I take acetazolamide?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Your dose of this medicine will depend on the condition you are treating. If you take acetazolamide for congestive heart failure, your doctor may tell you to skip your medication for a day. Follow your doctor's dosing instructions very carefully.

Take this medicine with a full glass of water.

While using acetazolamide, you may need frequent blood tests.

Acetazolamide may be only part of a complete treatment program that may also include other medications. Follow your doctor's instructions very closely.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking acetazolamide?

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid exposure to sunlight or tanning beds. Acetazolamide can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Acetazolamide side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • blood in urine or stools;

  • a seizure (convulsions);

  • loss of movement in any part of your body;

  • a blood cell disorder--sudden weakness or ill feeling, fever, chills, sore throat, mouth sores, pale skin, feeling tired or short of breath, rapid heart rate, nosebleeds, bleeding gums;

  • liver problems--nausea, upper stomach pain or swelling, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • signs of metabolic acidosis--confusion, vomiting, lack of energy, irregular heartbeats;

  • signs of a kidney stone--pain in your side or lower back, blood in your urine, painful or difficult urination; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • nausea, vomiting, loss of appetite, diarrhea;

  • numbness or tingling, especially in your arms and legs;

  • drowsiness, confusion;

  • hearing problems, ringing in your ears;

  • increased urination; or

  • altered sense of taste.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Side Effects (complete list)

Acetazolamide dosing information

Usual Adult Dose for Edema:

Initial dose: 250 to 375 mg orally/IV once a day
-If after initial response there is a lack of response, hold therapy for a day
Maintenance dose: One dose every other day or once a day for 2 days alternating with a day of rest

Comments:
-Best diuretic results are obtained when taken on alternate days or when taken once daily for 2 days alternating with a day of rest.
-Too frequent dosage or too high a dose may result in therapeutic failure.
-For diuresis in congestive heart failure, the starting dose is approximately 5 mg/kg.

Uses: For adjunctive treatment of edema due to congestive heart failure or drug-induced edema.

Usual Adult Dose for Acute Mountain Sickness:

500 to 1000 mg orally per day in divided doses
-May use immediate-release or extended-release as appropriate

Acute Mountain Sickness (AMS)/High Altitude Cerebral Edema (HACE) Prevention:
Guideline dose: 125 mg orally twice a day

AMS Treatment:
Guideline dose: 250 mg orally twice a day

Comments:
-Higher doses (1000 mg) are appropriate for rapid ascent, such as in rescue or military operations.
-Dosing should be to initiated 24 to 48 hours before ascent and continue for 48 hours while at high altitude, or longer as necessary to control symptoms.
-According to Wilderness Medical Society Consensus Guidelines, while higher doses are effective they are associated with more frequent and/or increased side effects.

Use: For the prevention or amelioration of symptoms associated with acute mountain sickness despite gradual ascent.

Usual Adult Dose for Glaucoma:

Open-Angle Glaucoma:
-Immediate-release (IR) tablets: 250 to 1000 mg orally per day; amounts over 250 mg should be administered in divided doses
-Extended-release (ER) capsules: 500 mg orally 2 times a day
Maintenance: Adjust doses individually based on symptomatology and ocular tension; for patients inadequately controlled on ER capsules 1 g/day, may supplement with IR tablets
-Doses in excess of 1 g/24 hours generally do not produce increased effects

Preoperatively in Closed-Angle Glaucoma:
-Various regimens have been used including: 250 mg orally every 4 hours; 250 mg orally twice a day; OR 500 mg orally followed by 125 mg or 250 mg orally every 4 hours

Comments:
-In acute cases, IV therapy (at same oral dosage) has been used for rapid relief of ocular tension.
-A complementary effect has been observed when used in conjunction with miotics or mydriatics.

Uses: For the adjunctive treatment of chronic simple (open-angle) glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma where a delay of surgery is desirable so as to decrease intraocular pressure.

Usual Adult Dose for Glaucoma (Open Angle):

Open-Angle Glaucoma:
-Immediate-release (IR) tablets: 250 to 1000 mg orally per day; amounts over 250 mg should be administered in divided doses
-Extended-release (ER) capsules: 500 mg orally 2 times a day
Maintenance: Adjust doses individually based on symptomatology and ocular tension; for patients inadequately controlled on ER capsules 1 g/day, may supplement with IR tablets
-Doses in excess of 1 g/24 hours generally do not produce increased effects

Preoperatively in Closed-Angle Glaucoma:
-Various regimens have been used including: 250 mg orally every 4 hours; 250 mg orally twice a day; OR 500 mg orally followed by 125 mg or 250 mg orally every 4 hours

Comments:
-In acute cases, IV therapy (at same oral dosage) has been used for rapid relief of ocular tension.
-A complementary effect has been observed when used in conjunction with miotics or mydriatics.

Uses: For the adjunctive treatment of chronic simple (open-angle) glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma where a delay of surgery is desirable so as to decrease intraocular pressure.

Usual Adult Dose for Seizure Prophylaxis:

Initial dose: 8 to 30 mg/kg orally/IV in divided doses
Range: 375 to 1000 mg per day

Initial dose for patients on other anticonvulsants: 250 mg orally/IV once a day

Comments:
-The above range represents an optimum range for most patients; some patients respond to a lower dose; for most patients, doses in excess of 1 g do not appear to produce better results.
-Children with petit mal have had the best results; good results have been seen in both children and adult with other seizures such as grand mal, mixed seizure pattern, myoclonic jerk patterns, etc.
-Extended-release capsules are not indicated for use in this condition.

Use: For the adjunct treatment of centrencephalic epilepsies such as petit mal, and unlocalized seizures.

Usual Pediatric Dose for Acute Mountain Sickness:

12 years or older:
Extended-release capsules: 500 mg orally once or twice a day

Guideline dose (immediate-release): 2.5 mg/kg orally every 12 hours
Maximum: 125 mg per dose

Comments:
-Therapy should be initiated 24 to 48 hours before ascent and continued for 48 hours while at high altitude, or longer as necessary to control symptoms.
-Guideline dose is from the Wilderness Medical Society Consensus Guidelines; according to Wilderness Medical Society Consensus Guidelines, higher doses are effective but they are associated with more frequent and/or increased side effects.

Use: For the prevention or amelioration of symptoms associated with acute mountain sickness despite gradual ascent.

Usual Pediatric Dose for Glaucoma:

12 years or older:
Extended-release (ER) capsules: 500 mg orally 2 times a day

Comments: Doses in excess of 1 g/24 hours generally do not produce increased effects.

Uses: For the adjunctive treatment of chronic simple (open-angle) glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma where a delay of surgery is desirable so as to decrease intraocular pressure.

Usual Pediatric Dose for Glaucoma (Open Angle):

12 years or older:
Extended-release (ER) capsules: 500 mg orally 2 times a day

Comments: Doses in excess of 1 g/24 hours generally do not produce increased effects.

Uses: For the adjunctive treatment of chronic simple (open-angle) glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma where a delay of surgery is desirable so as to decrease intraocular pressure.

What other drugs will affect acetazolamide?

Other drugs may interact with acetazolamide, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about acetazolamide.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.01.

Last reviewed: October 06, 2015
Date modified: December 03, 2017

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