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20-September-2008 09:55:46 - Acetazolamide Acetazolamide Systematic IUPAC name N-5-aminosulfonyl-1,3,4-thiadiazol-2-yl-acetamide Identifiers CAS number 59-66-5 ATC code S01EC01 PubChem 1986 DrugBank APRD00119 Chemical data Formula C4H6N4O3S2 Mol. mass 222.248 g/mol Pharmacokinetic data Bioavailability ? Metabolism None Half life 3 to 9 hours Excretion Renal Therapeutic considerations Pregnancy cat. B3AU CUS Legal status POMUK ℞-onlyUS Routes Oral, IV Acetazolamide, sold under the trade name Diamox, is a carbonic anhydrase inhibitor that is used to treat glaucoma, epileptic seizures, benign intracranial hypertension pseudotumor cerebri, altitude sickness, cystinuria, and dural ectasia. Acetazolamide is available as a generic drug and is also used as a diuretic. Contents 1 Mechanism of Action 1.1 Uses 1.2 Acute mountain sickness 2 Side-effects 3 Contraindications 4 References 5 Footnotes Mechanism of Action This drug will block the formation of H+ and H2CO3 from CO2 and H2O. The end result is that bicarbonate is excreted in the urine. Indirectly, it will block the Na/H exchanger in the renal proximal tubule by decreasing the conversion of intracellular CO2 and H2O into bicarbonate and a hydrogen ion that is needed for the Na/H exchanger to reabsorb sodium and water back from the tubule lumen. Therefore, there is a natriuretic/diuretic action in addition to the washing away of bicarbonate in the urine. The excess luminal water and sodium leads to an increased flow rate that can further disrupt other transporters in the tubule from functioning properly. Uses Acetazolamide is often used in the treatment of various diseases. For glaucoma sufferers, the drug decreases fluid formation in the eye resulting in lower intraocular pressure. In epilepsy, its main use is in absence seizures, with some benefit in other seizure syndromes. It is also used to decrease generation of cerebrospinal fluid in benign intracranial hypertension and has shown efficacy in autosomal dominant hyperkalemic periodic paralysis. It's been demonstrated in drug trials to relieve symptoms associated with dural ectasia in indivduals with Marfan Syndrome.1 Off-label uses include Acetazolamide as a conjunction drug to merely assist patients with sleep apnea by lowering blood pH and encourage respiration.2 Acute mountain sickness Acetazolamide is sometimes taken prophylactically, anywhere between 125 milligrams mg to 500 mg per day, starting a few days before going to the higher altitude. Such use is recommended for those ascending from sea level to 3000 meters 9800 feet in one day, or for those ascending more than 600 meters 2000 feet per day once above an altitude of 2500 meters 8200 feet. 3 Also, prophylactic use is recommended for those with a history significant for acute mountain sickness. The drug forces the kidneys to excrete bicarbonate, the conjugate base of carbonic acid. By increasing the amount of bicarbonate excreted in the urine, the blood becomes more acidic. Acidifying the blood stimulates ventilation, which is beneficial during acclimatization. Note that acetazolamide is not an immediate fix for acute mountain sickness; it speeds up acclimatization which in turn helps to relieve symptoms. This may take up to a day or two, and requires waiting without any further rapid ascent. It is often advisable to descend if even mild acute mountain sickness is experienced. If serious sickness is encountered, descent is considered mandatory unless other circumstances present greater danger. Side-effects Common side effects of using this drug include numbness and tingling in the fingers and toes, and taste alterations parageusia, especially for carbonated drinks; both are usually due to mild hypokalemia low potassium levels. Some may also experience blurred vision but this usually disappears shortly after stopping the medication. Acetazolamide also increases the risk of developing calcium oxalate and calcium phosphate kidney stones. Everyone will experience more frequent urination as a result of using acetazolamide. One should drink more fluids than usual to prevent dehydration and headaches. Acetazolamide prolongs the effects of amphetamines and related drugs. Contraindications Acetazolamide should not be taken by individuals if: They have sickle cell anemia They are allergic to sulfa medications They are allergic to any carbonic anhydrase inhibitor They have liver or kidney disease They have adrenal gland failure i.e. Addison's disease They have diabetes They are pregnant or nursing mothers References Houston, Charles S. 2005. Going Higher: Oxygen Man and Mountains. Seattle, WA: Mountaineers Books. ISBN 0 89886 631 6. Griffen, H. Winter 1989. Complete Guide to Prescription Non-Prescription Drugs. Putnam Adult. ISBN 0 89586 754 0. Dietz T.E. 2006-01-29. An Altitude Tutorial. International Society for Mountain Medicine. Retrieved on 2007-11-15. Diamox - Quoted from the Physician's Desk Reference 1993. Climber.org. Retrieved on 2007-11-15. Ferrer S, Borras J, Martin-Gil J, Martín-Gil FJ.1989. Thermal studies on sulfonamide derivative complexes .1. Thermal-behavior of Acetazolamide - Copper complexes. Thermochim Acta, 1472:321-330. Footnotes ^ Scoliosis Research Society 2006-11-27. Dural Ectasia in the Marfan Spine: Symptoms and Treatment.also it's been used in high-altitude mountain sickness. SpineUniverse. Retrieved on 2007-11-15. ^ Arch Intern Med - Abstract: Central sleep apnea. Improvement with acetazolamide therapy, October 1, 1982, White et al. 142 10: 1816 ^ Hackett, P.H. Roach, R.C. 2001. High-altitude illness. The New England Journal of Medicine 345 2: 107-114. doi:10.1056/NEJM200107123450206. PMID 11450659. v d e Anticonvulsants N03 GABAA receptor inhibitor Barbiturates Barbexaclone, Metharbital, Methylphenobarbital, Pentobarbital, Phenobarbital, Primidone Benzodiazepines Clobazam, Clonazepam, Clorazepate, Diazepam, Lorazepam, Midazolam, Nimetazepam, Nitrazepam, Temazepam Sodium channel blocker/ Calcium channel blocker Hydantoins Ethotoin, Fosphenytoin, Mephenytoin, Phenytoin Succinimides Ethosuximide, Mesuximide, Phensuximide Carboxamides Carbamazepine, Oxcarbazepine, Rufinamide Phenyltriazines Lamotrigine Unknown/multiple/ unsorted Oxazolidinediones Ethadione, Paramethadione, Trimethadione Fatty acid derivatives Valpromide, Valnoctamide Carboxylic acids Valproic acid Sodium valproate Valproate semisodium, Tiagabine Others GABA analogs: Gabapentin, Pregabalin, Progabide, Vigabatrin -- Monosaccharides: Topiramate -- Aromatic allylic alcohols: Stiripentol -- Ureas: Phenacemide, Pheneturide Carbamates: Emylcamate, Felbamate, Meprobamate -- Pyrrolidines: Brivaracetam, Levetiracetam, Nefiracetam, Seletracetam Sulfa drugs: Acetazolamide, Ethoxzolamide, Sultiame, Zonisamide -- Propionates: Beclamide -- Aldehydes: Paraldehyde -- Bromides: Potassium bromide, Sodium bromide v d e Ophthalmologicals: antiglaucoma preparations and miotics S01E Sympathomimetics Apraclonidine Brimonidine Clonidine Dipivefrine Epinephrine Parasympathomimetics M: Aceclidine Pilocarpine M/N: Acetylcholine Carbachol AI: Demecarium Echothiophate Stigmine Fluostigmine, Neostigmine, Physostigmine Paraoxon Carbonic anhydrase inhibitors Acetazolamide Brinzolamide Diclofenamide Dorzolamide Methazolamide Beta blocking agents Befunolol Betaxolol Carteolol Levobunolol Metipranolol Timolol Prostaglandin analogues Bimatoprost Latanoprost Travoprost Unoprostone Other agents Dapiprazole Guanethidine v d e Antihypertensives C02 and diuretics C03 Sympatholytic agents Centrally acting/antiadrenergics α2 agonist Clonidine, Guanfacine, Methyldopa imidazoline receptor agonist Moxonidine, Rilmenidine adrenergic uptake inhibitor Rescinnamine, Reserpine Ganglion-blocking/nicotinic antagonist Mecamylamine, Trimethaphan Peripherally acting/antiadrenergics α1 blockers: Prazosin Indoramin Trimazosin Doxazosin Urapidil Guanidine derivatives: Betanidine Guanethidine Guanoxan Debrisoquine Guanoclor Guanazodine Guanoxabenz Vasodilators Diazoxide hydrazinophthalazine Hydralazine, Dihydralazine, Endralazine, Cadralazine Minoxidil Nitroprusside Phentolamine Other antihypertensives serotonin antagonist Ketanserin endothelin receptor antagonist Bosentan, Ambrisentan, Sitaxsentan MAOI Pargyline THI Metirosine Diuretics Low ceiling Thiazides at DCT Bendroflumethiazide Hydroflumethiazide Hydrochlorothiazide Chlorothiazide Polythiazide Trichlormethiazide Cyclopenthiazide Methyclothiazide Cyclothiazide Mebutizide Sulfonamides Quinethazone Clopamide Chlortalidone Mefruside Clofenamide Metolazone Meticrane Xipamide Indapamide Clorexolone Fenquizone Other Mersalyl Theobromine Cicletanine osmotic Mannitol, Urea carbonic anhydrase inhibitor at PT Acetazolamide High ceiling Loop diuretic at AL Bumetanide, Furosemide, Torasemide, Ethacrynic acid Potassium-sparing at CD ESC blockers Amiloride, Triamterene aldosterone antagonists Spironolactone, Eplerenone, Potassium canrenoate, Canrenone Retrieved from http://en..org/wiki/Acetazolamide Categories: Carbonic anhydrase inhibitors | Mountaineering | Anticonvulsants | Sulfonamides Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Français 日本語 Polski Português Română This page was last modified on 18 July 2008, at 17:11
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