Diamox: Effective Acetazolamide Therapy for Glaucoma & Altitude Sickness
Diamox
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Synonyms | |||
Diamox (acetazolamide) is a carbonic anhydrase inhibitor prescription medication primarily indicated for the management of open-angle glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma. It is also clinically proven for the prevention and amelioration of symptoms associated with acute mountain sickness. Its mechanism of action involves reducing the secretion of aqueous humor in the eye and inducing a mild metabolic acidosis, which can stimulate ventilation and aid acclimatization to high altitude. This makes it a versatile agent in both ophthalmological and high-altitude medical contexts.
Features
- Active Ingredient: Acetazolamide
- Drug Class: Carbonic anhydrase inhibitor
- Available Forms: Oral tablets (125 mg, 250 mg) and extended-release capsules (500 mg)
- Prescription Status: Requires a prescription in most jurisdictions
- Mechanism: Reversible inhibition of the enzyme carbonic anhydrase
Benefits
- Effectively lowers intraocular pressure, helping to preserve optic nerve function and prevent vision loss in glaucoma patients.
- Reduces the incidence and severity of symptoms of acute mountain sickness, including headache, nausea, and dizziness, when used prophylactically.
- Provides an adjunctive treatment option for certain types of epilepsy, particularly absence seizures.
- Can be used to correct metabolic alkalosis in specific clinical settings.
- Offers a non-surgical option for managing fluid retention due to congestive heart failure.
- The extended-release formulation allows for convenient once-daily dosing, improving patient adherence.
Common use
Diamox is most commonly prescribed for the management of various forms of glaucoma, including chronic open-angle glaucoma and secondary glaucomas. It is a well-established prophylactic and therapeutic agent for acute mountain sickness, particularly for individuals ascending to altitudes above 3000 meters. In neurology, it serves as an adjunctive treatment for certain seizure disorders. Off-label uses include the management of idiopathic intracranial hypertension (pseudotumor cerebri) and metabolic alkalosis that is unresponsive to other treatments.
Dosage and direction
Dosage is highly individualized based on the indication, patient response, and renal function. For glaucoma, the typical adult dose is 250 mg to 1 g per day, administered in divided doses (1 to 4 times daily). For acute mountain sickness prophylaxis, the recommended dose is 125 mg twice daily, starting 24 to 48 hours before ascent and continuing for 48 hours after reaching the target altitude. For epilepsy, doses can range from 8 to 30 mg/kg per day in divided doses. The extended-release capsules (500 mg) are typically administered once or twice daily. It is crucial to follow the specific dosing instructions provided by the prescribing physician, as deviations can affect efficacy and safety.
Precautions
Patients should be advised that Diamox may cause increased sensitivity to sunlight (photosensitivity); appropriate sun protection is recommended. Due to its diuretic effect, adequate hydration should be maintained, but excessive fluid intake is not advised. Caution is required in patients with respiratory acidosis or significant respiratory impairment, as the drug can exacerbate these conditions. Regular monitoring of electrolytes (particularly potassium and bicarbonate) and complete blood counts is recommended during prolonged therapy. Patients should be informed that the drug can cause paresthesia and taste alteration, which are generally transient.
Contraindications
Diamox is contraindicated in patients with known hypersensitivity to acetazolamide or any sulfonamide-derived drugs. It should not be used in situations of marked kidney and liver disease or dysfunction, suprarenal gland failure, or hyperchloremic acidosis. Its use is also contraindicated in patients with low levels of sodium or potassium, severe obstructive pulmonary disease, and in those with chronic non-congestive angle-closure glaucoma due to the potential for paradoxical increase in intraocular pressure.
Possible side effect
Common side effects include paresthesia (tingling sensation, especially in the extremities), loss of appetite, taste alteration (particularly a metallic taste), polyuria, and drowsiness. Gastrointestinal disturbances such as nausea, vomiting, and diarrhea may occur. Less frequently, patients may experience metabolic acidosis, electrolyte imbalances (hypokalemia), blood dyscrasias (including leukopenia, thrombocytopenia, agranulocytosis), crystalluria, renal calculi, and transient myopia. Allergic reactions, including skin rashes, Stevens-Johnson syndrome, and anaphylaxis, though rare, have been reported.
Drug interaction
Diamox can interact with several classes of medications. It may increase the levels and toxicity of primidone and phenobromide. Concurrent use with other diuretics can potentiate diuretic and hypokalemic effects. It may alter the excretion of aspirin (acetylsalicylic acid) and other salicylates, increasing the risk of salicylate toxicity. The hypokalemic effect can be exacerbated by corticosteroids or amphotericin B. It can also decrease the efficacy of methenamine compounds. Concomitant use with sodium bicarbonate may counteract its metabolic acidosis-inducing effect.
Missed dose
If a dose is missed, it should be taken as soon as remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed one is not recommended, as it may increase the risk of adverse effects.
Overdose
Symptoms of overdose may include electrolyte imbalance (especially hypokalemia and hyperchloremic acidosis), drowsiness, confusion, nausea, vomiting, dizziness, and paresthesia. Severe overdose can lead to convulsions, coma, and renal failure. Management is primarily supportive and symptomatic, focusing on correcting electrolyte and acid-base imbalances. Hemodialysis may be effective due to the drug’s low protein binding.
Storage
Store at room temperature (15°C to 30°C or 59°F to 86°F) in a tightly closed container, protected from light, moisture, and excessive heat. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The efficacy and safety profile described may not be applicable to all individuals.
Reviews
Clinical studies and meta-analyses consistently support the efficacy of acetazolamide for its primary indications. In ophthalmology, it is recognized as an effective agent for lowering intraocular pressure, though often used adjunctively due to side effects. For altitude sickness prophylaxis, systematic reviews confirm its superiority over placebo in reducing incidence and severity of symptoms, with a typical number needed to treat (NNT) of around 4 to 6. Patient-reported outcomes often note the effectiveness in preventing debilitating altitude illness but frequently mention side effects like paresthesia and diuresis. In neurological applications, evidence supports its use as an add-on therapy for certain refractory epilepsies.