Carbonic anhydrase inhibitors may also alter blood sugar; both hyperglycemia and hypoglycemia have been described. Potassium-sparing diuretics: (Moderate) Carbonic anhydrase inhibitors promote electrolyte excretion including hydrogen ions, sodium, and potassium. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. 5 mg/kg/dose PO given 1 to 4 times per day has been recommended based on retrospective studies. Monitor patients on anticonvulsants carefully when amoxapine is used concurrently. produced by the divided dosage. No dosage guidelines are available for extended-release capsules.CrCl 10 to 50 mL/min: Dosing interval every 12 hours for IV or regular-release tablets. and institution of appropriate therapy are important. There have been case reports of neonatal sacrocoocygeal teratoma, metabolic acidosis, hypocalcemia, hypomagnesemia, renal tubular acidosis, and low birth weight following in utero exposure to acetazolamide. When combined, the effects on bone catabolism can be additive. The usual maintenance dosage is 375 to 1,000 mg/day. 12 hours (or a 500 mg controlled-release capsule once daily) before and during The intramuscular route of administration is not recommended due to the alkalinity of the injection, which causes pain. Amphetamine: (Moderate) Monitor for an increase in the incidence and severity of amphetamine-related adverse effects during concomitant use of urinary alkalinizing agents. This should be taken into consideration in patients with impaired glucose tolerance or diabetes mellitus who are receiving antidiabetic agents. humans as no cases of acute poisoning with this drug have been reported. For non-prescription products, read the label or package ingredients carefully. as indicated above. should be noted that such use does not obviate the need for prompt descent if See additional information. i.e., high altitude pulmonary Caution is advised for patients receiving concomitant 500 mg PO twice daily. Ethacrynic Acid: (Moderate) Carbonic anhydrase inhibitors promote electrolyte excretion including hydrogen ions, sodium, and potassium. Other reports did not identify any adverse fetal effects or increased risk to the infant. 15 to 25 mg/kg/day PO given in 2 to 3 divided doses has been recommended. RxList does not provide medical advice, diagnosis or treatment. Monitor blood glucose and for changes in glycemic control and be alert for evidence of an interaction. Avoid concomitant use in amphetamine overdose situations. Keep from freezing. Anticonvulsants may cause cause nausea/vomiting, dizziness, ataxia, somnolence/lethargy, incoordination, blurred or double vision, restlessness, toxic encephalopathy, anorexia, and headaches; these effects can increase the risk for falls. (Minor) Carbonic anhydrase inhibitors may alter blood sugar. Copyright: Merative US L.P. 1973, 2023. Monitor blood glucose and for changes in glycemic control and be alert for evidence of an interaction. levels (particularly potassium) and blood pH levels should be monitored. Use caution if acetazolamide or methazolamide is coadministered; monitor for excessive pseudoephedrine-related adverse effects. The change from other medications to acetaZOLAMIDE should Last updated on Oct 1, 2022. Monitor serum potassium to determine the need for potassium supplementation and alteration in drug therapy. Monitor blood glucose and for changes in glycemic control and be alert for evidence of an interaction. Vorinostat: (Moderate) Use vorinostat and carbonic anhydrase inhibitors together with caution; the risk of QT prolongation and arrhythmias may be increased if electrolyte abnormalities occur. Monitor serum potassium to determine the need for potassium supplementation and alteration in drug therapy. Hyperammonemia resulting from zonisamide resolves when zonisamide is discontinued and may resolve or decrease in severity with a decrease of the daily dose. Serum potassium concentrations should be checked and adjusted prior to the administration of nondepolarizing neuromuscular blockers. Corticosteroids: (Moderate) Corticosteroids may increase the risk of hypokalemia if used concurrently with acetazolamide. What Are the Best PsA Treatments for You? These maybe symptoms of serious blood problems (eg, agranulocytosis, aplastic anemia). The FDA-approved dose is 500 to 1,000 mg/day PO in divided doses starting 24 to 48 hours before ascent and continuing for 48 hours while at high altitude, or longer as necessary to control symptoms. Statistically significant decreases were seen in pre- and post-acetazolamide pH (7.51 vs. 7.37, p less than 0.001) and HCO3 (39.4 mEq/L vs 31.4 mEq/L, p less than 0.001). Approximately 47% of an extended-release dose is eliminated renally within 24 hours. Acetazolamide can also increase the rate of excretion of weakly acidic drugs, such as barbiturates. Acetazolamide is contraindicated in marked kidney disease or dysfunction. 1,000 mg/day PO is the FDA-approved max dose for the extended-release capsule. For the reversal of metabolic alkalosis, doses up to 20 mg/kg/day IV/PO have been used. The clearance of memantine is reduced by about 80% under alkaline urine conditions at pH 8. and preoperatively in acute angle-closure glaucoma where delay of surgery is This condition It is contraindicated in patients with Do not double doses. Urinary alkalinizers increase the proportion of non-ionized metabolites of the amphetamine molecule, resulting in decreased renal excretion of these compounds. For the treatment of pseudotumor cerebri, doses up to 100 mg/kg/day PO have been used. When combined, the effects on bone catabolism can be additive. Your doctor may adjust your dose as needed. These combinations can lead to symptomatic hypokalemia and associated ECG changes in some susceptible individuals. Placebo-controlled clinical trials have shown that Epoprostenol: (Moderate) Further reductions in blood pressure may occur when epoprostenol is administered with other antihypertensive agents. Acetazolamide is also used with other medications to treat a certain type of eye problem ( open-angle glaucoma ). Take this medicine exactly as directed by your doctor. Both hyperglycemia and hypoglycemia have been described in patients treated with acetazolamide. Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Minor) Acetazolamide can induce osteomalacia in patients treated chronically with barbiturates. PDR.net is to be used only as a reference aid. Inhibition of carbonic anhydrase in this area appears to Empagliflozin; Linagliptin: (Minor) Carbonic anhydrase inhibitors may alter blood sugar. Methamphetamine: (Moderate) Urinary alkalinizers, such as acetazolamide, result in decreased renal excretion of amphetamines. Bumetanide: (Moderate) Carbonic anhydrase inhibitors promote electrolyte excretion including hydrogen ions, sodium, and potassium. If rapid ascent is undertaken and acetazolamide is used, it should be noted that such use does not obviate the need for prompt descent if severe forms of high altitude sickness occur, i.e., high altitude pulmonary edema (HAPE) or high altitude cerebral edema. This medicine is available only with your doctor's prescription. Phenytoin: (Minor) Acetazolamide or methazolamide can induce osteomalacia in patients being concomitantly treated with hydantoin anticonvulsants. Published data on the risk of acetazolamide therapy during pregnancy are unclear. The successful treatment of altitude sickness involves production of respiratory and metabolic acidosis, which increases ventilation and binding of oxygen to hemoglobin. Digoxin: (Moderate) Carbonic anhydrase inhibitors can result in hypokalemia. It can enhance the sodium depleting effects of other diuretics when used concurrently. What are warnings and precautions for Acetazolamide? This should be taken into consideration in patients with impaired glucose tolerance or diabetes mellitus who are receiving antidiabetic agents. the kidney which requires intermittent dosage if it is to recover from the dehydration of carbonic acid. Monitor blood glucose and for changes in glycemic control and be alert for evidence of an interaction. The maximum dosage is 1 g/day. Significant differences compared to baseline were seen in serum HCO3 (36.2 mEq/L vs. 30.9 mEq/L, p less than 0.011), serum Cl (91.1 mEq/L vs. 95.4 mEq/L, p less than 0.03), acid-base excess (10.6 vs. 6.6, p less than 0.002), and pH (7.44 vs. 7.41, p less than 0.05). Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. Use caution if acetazolamide or methazolamide is coadministered; monitor for excessive pseudoephedrine-related adverse effects. However, the dose is usually not more than 1 gram (g) per day. A complementary effect has been noted when acetaZOLAMIDE has been used May make this condition worse. If unable to tolerate, gradually decrease dosage to minimum of 125 mg/day PO. effective in the control of fluid secretion (e.g., some types of glaucoma), in Both hyperglycemia and hypoglycemia have been described in patients treated with acetazolamide. Sensitizations may recur when a sulfonamide is readministered irrespective of the route of administration. Your doctor may adjust your dose as needed. Both hyperglycemia and hypoglycemia have been described in patients treated with acetazolamide. Concomitant use of acetazolamide with metformin may increase the risk for lactic acidosis; consider more frequent monitoring. Carbonic anhydrase inhibitors increase the alkalinity of the urine, thereby increasing the amount of nonionized pseudoephedrine available for renal tubular reabsorption. For seizures (in combination with other anticonvulsants): Adults250 milligrams (mg) once a day. Doses greater than 1,000 mg/day are not usually associated with an increased effect. AdultsAt first, 250 milligrams (mg) per day. conditions. Pre-existing hypokalemia and hyperuricemia can also be potentiated by carbonic anhydrase inhibitors. Sodium Bicarbonate: (Minor) Acetazolamide and sodium bicarbonate used concurrently increases the risk of renal calculus formation via calcium phosphate supersaturation. After 24 hours of acetazolamide, significant decreases were seen in mean serum HCO3 (29.5 mEq/L vs. 26.9 mEq/L, p less than 0.001) and base excess (10 mEq/L vs. 4 mEq/L, p less than 0.001). extremities, hearing dysfunction or tinnitus, loss of appetite, taste Acetazolamide is rapidly absorbed from the GI tract, and peak serum concentrations for the tablets and extended-release capsules are achieved in 24 hours and 812 hours, respectively. Alogliptin; Pioglitazone: (Minor) Carbonic anhydrase inhibitors may alter blood sugar. AcetaZOLAMIDE should be used as an adjunct to the usual Amphotericin B lipid complex (ABLC): (Moderate) Acetazolamide can potentiate hypokalemia and therefore can increase the risk of hypokalemia caused by amphotericin B. Amphotericin B liposomal (LAmB): (Moderate) Acetazolamide can potentiate hypokalemia and therefore can increase the risk of hypokalemia caused by amphotericin B. Amphotericin B: (Moderate) Acetazolamide can potentiate hypokalemia and therefore can increase the risk of hypokalemia caused by amphotericin B. Arsenic Trioxide: (Moderate) Caution is advisable during concurrent use of arsenic trioxide and acetazolamide as electrolyte imbalance caused by diuretics may increase the risk of QT prolongation with arsenic trioxide. anticonvulsants, it is suggested that the starting dose should be 250 mg once being able to get an erection, but not having it last long enough for sex. Alkaline urine will significantly increase the half-life of benzphetamine. Adult Dosing . Usual dose is 8 to 30 milligrams (mg) per kilogram (kg) of body weight, taken in divided doses. Acetazolamide is a carbonic anhydrase inhibitor used to treat edema from heart failure or medications, certain types of epilepsy, and glaucoma.. Generic Name Acetazolamide DrugBank Accession Number DB00819 Background. edema (HAPE) or highaltitude cerebral edema. Adverse reactions, occurring most often early in therapy, The carbonic anhydrase inhibitors increase the rate of urinary calcium excretion; phenytoin increases the metabolism of the D vitamins. Pre-existing hypokalemia and hyperuricemia can also be potentiated by carbonic anhydrase inhibitors. Brompheniramine; Pseudoephedrine: (Moderate) Acetazolamide and methazolamide can decrease excretion and enhance the effects of pseudoephedrine. Both hyperglycemia and hypoglycemia have been described in patients treated with acetazolamide. Butabarbital: (Minor) Acetazolamide can induce osteomalacia in patients treated chronically with barbiturates. Use caution if acetazolamide or methazolamide is coadministered; monitor for excessive pseudoephedrine-related adverse effects. Check with your doctor right away if you have blood in the urine, nausea and vomiting, pain in the groin or genitals, or sharp back pain just below the ribs. Treatment should be symptomatic and supportive. Additionally, a urine pH more than 8 has been observed to reduce the amount of amphetamine excreted in the urine over 16 hours to less than 3% of the original dose; a 5-fold reduction compared to controls. Periodic monitoring of Serum potassium concentrations should be checked and adjusted prior to the administration of nondepolarizing neuromuscular blockers. Use caution if acetazolamide or methazolamide is coadministered; monitor for excessive pseudoephedrine-related adverse effects. Aspirin, ASA; Butalbital; Caffeine: (Minor) Acetazolamide can induce osteomalacia in patients treated chronically with barbiturates. Extended-release capsules are not indicated for use in this condition. Ephedrine; Guaifenesin: (Major) Acetazolamide or methazolamide can decrease excretion and enhance the effects of ephedrine. Visit the RxList Drug Interaction Checker for any drugs interactions. of the urine and promotion of diuresis are thus affected. Increasing urine pH may increase amphetamine exposure by reducing urinary excretion of amphetamine. Monitor blood glucose and for changes in glycemic control and be alert for evidence of an interaction. AdultsAt first, 250 to 375 milligrams (mg) once a day in the morning. AcetaZOLAMIDE yields best diuretic results when given on advisable. Monitor blood glucose and for changes in glycemic control and be alert for evidence of an interaction. 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