What are the indications for Diamox (acetazolamide)?

From the Guidelines

Diamox (acetazolamide) is indicated for several medical conditions, including glaucoma, acute mountain sickness, epilepsy, idiopathic intracranial hypertension, and as a diuretic in heart failure, due to its action as a carbonic anhydrase inhibitor. The medication is used for the treatment of glaucoma, both open-angle and secondary glaucoma, typically at doses of 250-1000 mg daily in divided doses. Acetazolamide is also prescribed for the prevention and treatment of acute mountain sickness in individuals ascending to high altitudes, usually at 125-250 mg twice daily starting 1-2 days before ascent and continuing for 2-3 days at high altitude, as supported by studies such as 1 and 1.

Indications and Dosage

• Glaucoma: 250-1000 mg daily in divided doses
• Acute mountain sickness: 125-250 mg twice daily starting 1-2 days before ascent and continuing for 2-3 days at high altitude
• Epilepsy: as an adjunctive treatment, particularly in absence (petit mal), generalized tonic-clonic (grand mal), and mixed seizure types
• Idiopathic intracranial hypertension: 250-1000 mg daily, with a popular starting dose of 250–500 mg twice a day, as noted in 1
• Heart failure: as a diuretic when other diuretics have failed
• Metabolic alkalosis: for the treatment of certain types of metabolic alkalosis

Mechanism of Action

The drug works by inhibiting carbonic anhydrase, which reduces hydrogen ion secretion in the renal tubule, increases sodium, potassium, bicarbonate, and water excretion, and decreases aqueous humor production in the eye, thereby reducing intraocular pressure.

Side Effects and Considerations

Patients should be warned of the adverse side effects of acetazolamide, including increased risk of diarrhoea, dysgeusia, fatigue, nausea, paraesthesia, tinnitus, vomiting, depression, and rarely renal stones, as mentioned in 1. The dosage and administration of acetazolamide should be carefully considered, with a starting dose of 250–500 mg twice a day and titration of the daily dose up, as noted in 1.

From the Research

Diamox (Acetazolamide) Indications

• Acetazolamide is used for various conditions, including:
  • Altitude sickness: used to prevent and treat acute mountain sickness (AMS) 2, 3, 4, 5, 6
  • Glaucoma: used to reduce intraocular pressure 2
  • Sleep apnea: used to treat sleep apnea 2
  • Other conditions: such as epilepsy, edema, and certain types of glaucoma 2

Specific Indications

• Altitude sickness:
  • Preventive treatment with acetazolamide reduced the incidence of adverse altitude effects requiring an intervention in patients with COPD and the incidence of AMS in healthy lowlanders 40 years of age or older during a high-altitude sojourn 6
  • Acetazolamide is effective in decreasing the incidence and/or severity of AMS during rapid ascents, with evidence of enhanced effectiveness with higher doses 3
• Glaucoma:
  • Acetazolamide is used to reduce intraocular pressure in patients with glaucoma 2
• Sleep apnea:
  • Acetazolamide is used to treat sleep apnea, although the exact mechanism of action is not fully understood 2

Dosage and Administration

• The dosage of acetazolamide varies depending on the condition being treated:
  • Altitude sickness: 125-750 mg daily, with higher doses showing enhanced effectiveness 3
  • Glaucoma: typically 250-500 mg daily 2
  • Sleep apnea: typically 250-500 mg daily 2