Formulary
Acetazolamide: Indications, Dosing, Side Effects and Interactions
Acetazolamide clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Acetazolamide: Indications, Dosing, Side Effects and Interactions
Acetazolamide clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Reduction of intra-ocular pressure in open-angle glaucoma,Reduction of intra-ocular pressure in secondary glaucoma,Reduction of intra-ocular pressure perioperatively in angle-closure glaucoma**
- **Adult** (By Mouth Using Immediate-Release Medicines, Or By Intravenous Injection, Or By Intramuscular Injection): 0.25-1 g daily in divided doses, intramuscular injection preferably avoided because of alkalinity.
**Glaucoma**
- **Adult** (By Mouth Using Modified-Release Medicines): 250-500 mg daily.
**Epilepsy**
- **Adult** (By Mouth Using Immediate-Release Medicines, Or By Intravenous Injection, Or By Intramuscular Injection): 0.25-1 g daily in divided doses, intramuscular injection preferably avoided because of alkalinity.
**Glaucoma for acetazolamide**
- **Child 12-17 years** (By mouth using modified-release medicines): 250-500 mg daily.
**Epilepsy for acetazolamide**
- **Neonate** (By mouth using immediate-release medicines, or by slow intravenous injection): Initially 2.5 mg/kg 2-3 times a day, followed by maintenance 5-7 mg/kg 2-3 times a day.
- **Child 1 month-11 years** (By mouth using immediate-release medicines, or by slow intravenous injection): Initially 2.5 mg/kg 2-3 times a day, followed by maintenance 5-7 mg/kg 2-3 times a day; maximum 750 mg per day.
- **Child 12-17 years** (By mouth using immediate-release medicines, or by slow intravenous injection): 250 mg 2-4 times a day.
**Reduction of intra-ocular pressure in primary and secondary glaucoma (specialist use only) for acetazolamide**
- **Child 1 month-11 years** (By mouth using immediate-release medicines, or by intravenous injection): 5 mg/kg 2-4 times a day, adjusted according to response; maximum 750 mg per day.
- **Child 12-17 years** (By mouth using immediate-release medicines, or by intravenous injection): 250 mg 2-4 times a day.
**Raised intracranial pressure for acetazolamide**
- **Child 1 month-11 years** (By mouth using immediate-release medicines, or by slow intravenous injection): Initially 8 mg/kg 3 times a day, then increased if necessary up to 100 mg/kg daily.
Cautions
Avoid extravasation at injection site (risk of necrosis); diabetes mellitus; elderly; impaired alveolar ventilation (risk of acidosis); long-term use; pulmonary obstruction (risk of acidosis); renal calculi
Contraindications
Adrenocortical insufficiency; hyperchloraemic acidosis; hypokalaemia; hyponatraemia; long-term administration in chronic angle-closure glaucoma
Side effects
General side-effects: Common or very common Haemorrhage; metabolic acidosis; nephrolithiasis; sensation abnormal Uncommon Bone marrow disorders; depression; dizziness; electrolyte imbalance; hearing impairment; hepatic disorders; leucopenia; nausea; renal colic; renal impairment; renal lesions; severe cutaneous adverse reactions (SCARs); skin reactions; thrombocytopenia; tinnitus; urinary tract discomfort; urine abnormalities; vomiting Rare or very rare Anaphylactic reaction; appetite disorder; confusion; diarrhoea; fatigue; fever; flushing; headache; irritability; libido decreased; paralysis; photosensitivity reaction; seizure Frequency not known Agranulocytosis; drowsiness; myopia; polyuria; suicidal behaviours; taste altered; thirst Specific side-effects: Uncommon With oral use Osteomalacia Rare or very rare With oral use Ataxia; hyperglycaemia; hypoglycaemia; renal tubular necrosis Frequency not known With oral use Agitation Side-effects, further information Acetazolamide is a sulfonamide derivative; blood disorders, rashes, and other sulfonamide-related side-effects occur occasionally - patients should be told to report any unusual skin rash. If electrolyte disturbances and metabolic acidosis occur, these can be corrected by administering bicarbonate.
Interactions
**Severe interactions:**
- Concurrent administration of acetazolamide and aspirin may result in severe acidosis and increase central nervous system toxicity.
- Severe osteomalacia has been noted in a few patients taking acetazolamide in combination with other anticonvulsants.
**Other interactions (9):**
- Acetazolamide is a sulfonamide derivative.
- Adjustment of dose may be required when Acetazolamide Tablets are given with cardiac glycosides or hypertensive agents.
- When given concomitantly, acetazolamide modifies the metabolism of phenytoin, leading to increased serum levels of phenytoin.
- There have been isolated reports of reduced primidone and increased carbamazepine serum levels with concurrent administration of acetazolamide.
- By increasing the pH of renal tubular urine, acetazolamide reduces the urinary excretion of amphetamine and quinidine and so may enhance the magnitude and the duration of effect of amphetamines and...
- Ciclosporin: Acetazolamide may elevate ciclosporin levels.
Pregnancy
Important safety information For acetazolamide MHRA/CHM advice: Antiepileptics: risk of suicidal thoughts and behaviour (August 2008) See Epilepsy . MHRA/CHM advice: Antiepileptic drugs: updated advice on switching between different manufacturers' products (November 2017) See Epilepsy . MHRA/CHM advice: Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review (January 2021) See Epilepsy .
Breast feeding
Amount too small to be harmful.
Hepatic impairment
Manufacturer advises avoid.
Renal impairment
Avoid-risk of metabolic acidosis.
Medicinal forms
Solution,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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