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Diamox Sequels (acetazolamide)


Carbonic anhydrase inhibitor




Adjunctive treatment of chronic simple (open-angle) glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma where delay of surgery is desired in order to lower IOP. Prevention or amelioration of symptoms associated with acute mountain sickness despite gradual ascent.



Chronic Simple (Open-Angle) Glaucoma, Secondary Glaucoma, and Preoperatively in Acute Angle-Closure Glaucoma (Where Delay of Surgery is Desired in Order to Lower IOP):
Adjunctive Treatment:
500mg bid (usually in am and in pm)

If adequate control is not obtained by bid administration, the desired control may be established by means of acetazolamide tabs or inj

Acute Mountain Sickness

Prevention/Amelioration of Symptoms Associated w/ Acute Mountain Sickness Despite Gradual Ascent:
Usual: 500-1000mg/day in divided doses; higher dose level of 1000mg is recommended in circumstances of rapid ascent

Initiate dosing 24-48 hrs before ascent and continue for 48 hrs while at high altitude, or longer as necessary


Start at lower end of dosing range


Oral route


Cap, Extended-Release: 500mg


Depressed Na+ and/or K+ blood serum levels, marked kidney and liver disease/dysfunction, suprarenal gland failure, hyperchloremic acidosis, cirrhosis. (Long-term administration) Chronic noncongestive angle-closure glaucoma.


Fatalities reported, although rarely, due to severe reactions to sulfonamides (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, anaphylaxis, agranulocytosis, aplastic anemia, other blood dyscrasias); d/c if signs of hypersensitivity or other serious reactions occur. Sensitizations may recur when a sulfonamide is readministered irrespective of the route of administration. Increasing the dose does not increase the diuresis and may increase the incidence of drowsiness and/or paresthesia, and often results in a decrease in diuresis; under certain circumstances, very large doses have been given in conjunction with other diuretics to secure diuresis in complete refractory failure. Increase and decrease in blood glucose may occur; caution with impaired glucose tolerance or diabetes mellitus (DM). May cause electrolyte imbalances (eg, hyponatremia, hypokalemia) and metabolic acidosis; caution with conditions associated with, or that predispose a patient to, electrolyte and acid/base imbalances (eg, renal impairment, DM, impaired alveolar ventilation). Caution in elderly. May impair mental/physical abilities. Lab test interactions may occur. Growth retardation reported in children receiving long-term therapy.


Headache, malaise, fatigue, fever, GI disturbances, abnormal LFTs, drowsiness, paresthesia, depression, excitement, hearing disturbances, tinnitus, transient myopia, crystalluria, hematuria.


Caution with high-dose aspirin (ASA); anorexia, tachypnea, lethargy, metabolic acidosis, coma, and death reported. May increase phenytoin levels, which may increase/enhance occurrence of osteomalacia in some patients receiving chronic phenytoin therapy; caution during chronic concomitant therapy. May decrease concentrations of primidone and its metabolites, with a consequent possible decrease in anticonvulsant effect; caution when beginning, discontinuing, or changing the dose of acetazolamide. Possible additive effects with other carbonic anhydrase inhibitors; concomitant use is not advisable. May increase effects of other folic acid antagonists. Decreases urinary excretion of amphetamine and may enhance the magnitude and duration of their effect. Reduces urinary excretion of quinidine and may enhance its effect. May prevent urinary antiseptic effect of methenamine. May decrease lithium levels. Increased risk of renal calculus formation with sodium bicarbonate. May elevate cyclosporine levels.


Category C, not for use in nursing.


Carbonic anhydrase inhibitor; in the eye, decreases the secretion of aqueous humor and results in a drop in IOP. Diuretic effect is due to its action in the kidney on the reversible reaction involving hydration of carbon dioxide and dehydration of carbonic acid.


Absorption: Tmax= 3-6 hrs.


Assess for hypersensitivity to drug, sulfonamides, or other sulfonamide derivatives; renal/hepatic impairment; suprarenal gland failure; hyperchloremic acidosis; electrolyte imbalance; any other conditions where treatment is contraindicated or cautioned; pregnancy/nursing status; and possible drug interactions. Obtain baseline CBC and platelet count.


Monitor for signs/symptoms of hypersensitivity or other serious reactions, changes in blood glucose, electrolyte imbalance, and other adverse reactions. Perform periodic monitoring of CBC, platelet count, and serum electrolytes.


Inform of the adverse reactions associated with therapy; instruct to promptly report to physician if any signs/symptoms develop. Advise that in order to try to avoid acute mountain sickness, gradual ascent is desirable, but 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. Instruct to notify physician of all drugs concurrently being taken (eg, ASA), and if pregnant/breastfeeding. Inform that some adverse reactions, such as drowsiness, fatigue, and myopia, may impair the ability to drive and operate machinery.


20-25°C (68-77°F).


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