Acetazolamide

Acetazolamide is a prescription medication used to treat the symptoms of Glaucoma, Acute Altitude Sickness, Congestive Heart Failure, Seizure, Drug-induced Edema, and Epilepsy. 

• Acetazolamide is available under the following different brand names: Diamox Sequels (DSC) 

Adult and Pediatric dosage

Tablet

• 125mg
• 250mg

Powder for injection

• 500mg

Capsule, extended-release

• 500mg

Glaucoma

Adult dosage

Closed-angle (acute congestive) glaucoma

• 500 mg orally/IV, followed by 125-250 mg orally every 4 hours
• Sustained-release: 500 mg orally every 12 hours

Open-angle (chronic simple) glaucoma

• 250 mg-1g orally/IV once daily or divided every 6-12 hours
• Sustained-release: 500 mg orally every 12 hours

Secondary Glaucoma

• 500 mg orally/IV, followed by 125-250 mg orally every 4 hours
• Sustained-release: 500 mg orally every 12 hours

Acute Altitude Sickness

Adult dosage:

• Immediate-released: 500-1000 mg/day orally divided every 8-12 hours
• Extended-release: 500-1000 mg orally every 12-24 hours
• Start 24-48 hours before ascent and continue for 48 hours at a high altitude or longer, to control symptoms if necessary

Children younger than 12 years of age: safety and efficacy not established

Children older than 12 years of age: 

• Immediate-release: 500-1000 mg/day orally divided every 8-12 hours
• Extended-release: 500-1000 mg orally every 12-24 hours

Congestive Heart Failure

Edema associated with CHF

• 250-375 mg (5 mg/kg) orally every morning

Seizure

• 8-30 mg/kg/day orally once daily or divided every 12 hours

Drug-induced Edema

• 250-375 mg orally/IV once daily

Epilepsy

Adult dosage

• 8-30 mg/kg/day orally once daily or divided every 6-12 hours; not to exceed 30 mg/kg/day or 1 g/day
• Children younger than 12 years of age: safety and efficacy not established
• Children older than 12 years of age: 8-30 mg/kg/day orally each day or divided every 6-12 hours; not to exceed 30 mg/kg/day or 1 g/day
• Extended-release capsules: Not recommended

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Acetazolamide include:

• dizziness, 
• lightheadedness, 
• an increased amount of urine, 
• blurred vision, 
• dry mouth, 
• drowsiness, 
• loss of appetite, 
• stomach upset, 
• headache, and
• tiredness

Serious side effects of Acetazolamide include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• increased body hair, 
• hearing loss, 
• ringing in the ears, 
• unusual tiredness, 
• persistent nausea or vomiting, 
• severe stomach pain, 
• easy bruising, 
• unusual bleeding, 
• fast or irregular heartbeat, 
• fever, 
• persistent sore throat, 
• mental or mood changes, 
• confusion, 
• difficulty concentrating, 
• severe muscle cramps or pain, 
• tingling in the hands and feet, 
• blood in the urine, 
• dark urine, 
• painful urination, 
• yellowing of the eyes or skin (jaundice), 
• blisters or sores in the mouth, 
• rash, and
• itching

Rare side effects of Acetazolamide include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Acetazolamide has severe interactions with no other drugs.
• Acetazolamide has serious interactions with the following drugs:
  • lonafarnib
  • methenamine
• Acetazolamide has moderate interactions with at least 49 other drugs.
• Acetazolamide has minor interactions with at least 30 other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use.  Keep a list of all your medications with you, and share this information with your doctor and pharmacist.  Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypokalemia
• Hyponatremia
• Hyperchloremic acidosis
• Hypersensitivity to acetazolamide or sulfa
• Liver disease
• Severe renal disease or dysfunction
• Long term use in non-congestive angle-closure glaucoma
• Cirrhosis
• Long-term administration in patients with chronic, non-congestive angle-closure glaucoma

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Acetazolamide?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Acetazolamide?”

Cautions

• Use caution in COPD, emphysema, and concomitant high-dose aspirin
• Use caution in diabetes, respiratory acidosis, and hepatic impairment
• Adverse drug reactions common to sulfonamide derivatives; Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN) may occur
• May impair alertness and/or physical coordination
• FDA-approved product labeling for many medications have included a broad contraindication in patients with a prior allergic reaction to sulfonamides; however, recent studies have suggested that cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides is unlikely to occur
• May impair alertness and/or physical coordination
• Severe adverse effects including tachypnea, anorexia, coma, lethargy, and death reported with high-dose aspirin; use caution or avoid administration
• Increasing dose does not increase diuresis; may instead increase the incidence of paresthesia and/or drowsiness
• IM administration is not recommended due to alkaline pH, which may cause pain

Pregnancy and Lactation

• Use with caution in pregnancy if benefits outweigh risks
• Enters breast milk; not recommended