From the Guidelines
Acetazolamide is associated with a range of side effects, including increased risk of diarrhea, dysgeusia, fatigue, nausea, paresthesia, tinnitus, vomiting, depression, and rarely renal stones, as reported in the most recent study 1.
Common Side Effects
- Diarrhea
- Dysgeusia (altered taste)
- Fatigue
- Nausea
- Paresthesia (tingling in hands and feet)
- Tinnitus (hearing dysfunction)
- Vomiting
Less Common but Serious Side Effects
- Depression
- Renal stones (kidney stones)
- Blood disorders (such as aplastic anemia)
- Severe skin reactions
- Electrolyte imbalances (particularly potassium depletion) According to the study 1, patients should be warned of these adverse side effects, and the medication should be prescribed with caution, especially in patients with a history of sulfa allergies due to potential cross-reactivity. Another study 1 also highlights the importance of monitoring for side effects, including Stevens-Johnson syndrome, malaise, anorexia, depression, serum electrolyte imbalance, renal calculi, blood dyscrasias, metallic taste, enuresis, paresthesia, diarrhea, and abdominal cramps.
Patient Management
- Patients should stay well-hydrated to reduce the risk of kidney stones.
- Regular monitoring of electrolytes and kidney function is recommended during long-term therapy.
- Patients should report any unusual bleeding, bruising, severe rash, or significant mood changes to their healthcare provider immediately.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Common Side Effects of Acetazolamide
- Paraesthesias: increased risk with a numbers needed to harm (95% CI) of 2.3 (2 to 2.7) 2
- Taste disturbances (dysgeusia): increased risk with a numbers needed to harm (95% CI) of 18 (10 to 38) 2
- Polyuria: increased risk with a numbers needed to harm (95% CI) of 17 (9 to 49) 2
- Fatigue: increased risk with a numbers needed to harm (95% CI) of 11 (6 to 24) 2
Rare but Serious Side Effects
- Stevens-Johnson syndrome (SJS): associated with acetazolamide treatment, particularly in Japanese, Japanese-American, and Indian patients 3, 4
- Toxic epidermal necrolysis (TEN): associated with acetazolamide treatment, with a possible relationship between genetic background and SJS-TEN 4
Dose Dependence of Side Effects
- Paraesthesias: risk increases with higher acetazolamide doses (beta=1.8,95% CI 1.1 to 2.9) 2
- Dysgeusia: risk increases with higher acetazolamide doses (beta=3.1,95% CI 1.2 to 8.2) 2
- Fatigue: risk may increase with higher acetazolamide doses, but not significantly (beta=2.6,95% CI 0.7 to 9.4) 2
Allergic Cross-Reactions
- No significant evidence of allergic cross-reactions between acetazolamide or furosemide and sulfa allergy 5