Acetazolamide is used to treat glaucoma, epileptic seizures, altitude sickness, and cystinuria. It is sometimes used as a diuretic. Common brand names are Apo-Acetazolamide, Cetamid, Diamox, Optamide, and Zolmide. Acetazolamide is classified as a Carbonic anhydrase inhibitor, Anti-glaucoma, Anti-convulsant, Diuretic, and Urinary alkanizer.

Indication for Acetazolamide

Acetazolamide is used to decrease intraocular pressure in the treatment of glaucoma. It is also used as a diuretic. Acetazolamide can be used as an andjunct in the treatment of refractory seizure disorders and can also prevent altitude sickness.

Acetazolamide is sometimes used to treat for toxicity of wekly acidic medications and to rpevent uric acid or renal calculi by alkanizing the urine.

Routes and Dosage of Acetazolamide

Glaucoma

PO: ADULTS, ELDERLY: 250 mg 1-4 times a day. Extended-release: 500 mg 2 time a day. CHILDREN: 8-30 mg/kg/day in divided doses every 8 hours.

IV: ADULTS, ELDERLY: 250-500 mg; may repeat in 2-4 hours, then continue with oral therapy. CHILDREN: 5-10 mg/kg every 6 hours. Maximum: 1g per day.

Epilepsy

PO: ADULTS, ELDERLY, CHILDREN: 375-1,000 mg per day in up to 4 divided doses.

Edema

PO: ADULTS: 250-375 mg per day. CHILDREN: 5 mg/kg/dose once daily.

Altitude Sickness

PO: ADULTS, ELDERLY: 250 mg 2-4 times per day. If possible, begin 24-48 hours prior to ascent; continue for at least 48 hours at high altitude as needed to control symptoms.

Action of Acetazolamide

Acetazolamide reduces formation of hyrdrogren and bicarbonate ions by inhibiting the enzyme carbonic anhydrase. It increases excretion of sodium, potassium, bicarbonate, and water in kidneys. It decreases formation of aqueous humor in the eye and retards abnormal charge from the CNS neurons.

Side Effects and Adverse Reactions of Acetazolamide

Side Effects of Acetazolamide

  • Weakness
  • Diarrhea
  • Increased urinary frequency
  • Decreased appetite
  • Decreased weight
  • Metallic taste
  • Nausea and vomiting
  • Paresthesia
  • Headache
  • Photosensitivity
  • Confusion
  • Tinnitus

Adverse Reactions of Acetazolamide

  • Nephrotoxicity or Hepatotoxicity manifested as dark urine or stool, pain in lower back, jaundice, dysuria, crystalluria, or renal calculi.
  • Bone marrow depression manifested as aplastic anemia, thrombocyptopenic purpura, leukopenia, agranulocytosis, or hemolytic anemia.

Nursing Considerations for Clients Taking Acetazolamide

  • Assess pupil for dialtion and response to light.
  • Obtain history of seizure disorder.
  • Monitor for acidosis.
  • May increases digoxin levels.
  • May increase effects or toxicity of amphetamines.
  • May decrease effects of methenamine.
  • May increase ammonia, bilirubin, glucose, chloride, uric acid, calcium levels.

Patient Teaching for Clients Taking Acetazolamide

  • Report presence of tingling or tremors in the hands or feet.
  • Report for unusual bleeding or bruising.
  • Inform physician of Unexplained fever, sore throat, or flank pain.