From the Guidelines
Acetazolamide is a carbonic anhydrase inhibitor used to treat several conditions, and its dosage varies depending on the condition being treated, with a typical starting dose of 250-500 mg twice a day for idiopathic intracranial hypertension, as recommended by the most recent guidelines 1.
Uses of Acetazolamide
- Glaucoma: 250-1000 mg daily, often divided into 2-4 doses
- Altitude sickness prevention: 125-250 mg twice daily, starting 24-48 hours before ascent and continuing for 48 hours after reaching the desired altitude
- Acute mountain sickness treatment: 250 mg twice daily
- Epilepsy: 8-30 mg/kg daily in divided doses, with maintenance doses typically 375-1000 mg daily
- Idiopathic intracranial hypertension: 250-1000 mg daily
- Diuretic: 250-375 mg once daily
Dosage and Administration
- The dosage of acetazolamide should be titrated up to achieve the desired therapeutic effect, with a maximal dose of 4 g daily, as used in the IIHTT study 1
- 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 1
- Acetazolamide can also be used to reduce sleep apnoea intensity, with a dose range of 36-1000 mg, as studied in the European Respiratory Review 1
Special Considerations
- In pediatric patients receiving chimeric antigen receptor T cell therapy, acetazolamide can be administered at a dose of 15 mg/kg (maximum 1,000 mg) intravenous (i.v.) followed by 8-12 mg/kg (maximum 1,000 mg) i.v. every 12 hours, with monitoring of renal function and acid-base balance once or twice daily 1
- Patients should maintain adequate hydration while taking acetazolamide and be aware that it may cause drowsiness or dizziness, particularly at the beginning of treatment.
From the FDA Drug Label
Reconstituted solutions retain their physical and chemical properties for 3 days under refrigeration at 2° to 8°C (36° to 46°F), or 12 hours at room temperature 20° to 25°C (68° to 77°F). The dosage employed in the treatment of chronic simple (open-angle) glaucoma ranges from 250 mg to 1 g of acetazolamide per 24 hours, usually in divided doses for amounts over 250 mg. In treatment of secondary glaucoma and in the preoperative treatment of some cases of acute congestive (closed-angle) glaucoma, the preferred dosage is 250 mg every four hours, although some cases have responded to 250 mg twice daily on short-term therapy The suggested total daily dose is 8 to 30 mg per kg in divided doses. Although some patients respond to a low dose, the optimum range appears to be from 375 to 1000 mg daily For diuresis in congestive heart failure, the starting dose is usually 250 to 375 mg once daily in the morning (5 mg/kg) Recommended dosage is 250 to 375 mg of acetazolamide once a day for one or two days, alternating with a day of rest
The uses of Acetazolamide include:
- Glaucoma: treatment of chronic simple (open-angle) glaucoma, secondary glaucoma, and acute congestive (closed-angle) glaucoma
- Epilepsy: treatment of petit mal in children and other types of seizures such as grand mal, mixed seizure patterns, myoclonic jerk patterns
- Congestive Heart Failure: diuresis
- Drug induced Edema: treatment of edema
The dosages of Acetazolamide are:
- Glaucoma: 250 mg to 1 g per 24 hours, usually in divided doses
- Epilepsy: 8 to 30 mg per kg in divided doses, optimum range 375 to 1000 mg daily
- Congestive Heart Failure: 250 to 375 mg once daily in the morning
- Drug induced Edema: 250 to 375 mg once a day for one or two days, alternating with a day of rest 2
From the Research
Uses of Acetazolamide
- Acetazolamide is used for various conditions, including altitude sickness, sleep apnea, glaucoma, and epilepsy 3, 4, 5, 6, 7
- It is used as a prophylactic for acute mountain sickness, causing a marked reduction in headache, nausea, vomiting, weakness, etc. 4
- Acetazolamide is also used in the treatment of seizures, particularly in combination therapy with other antiepileptic medications 5, 7
Dosages of Acetazolamide
- The typical dosage of acetazolamide for preventing acute mountain sickness is 250 mg daily 6
- For epilepsy, acetazolamide is primarily used in combination therapy with other antiepileptic medications, although it may be used as monotherapy 5
- Large doses of acetazolamide may be used to increase arterial oxygen levels and reduce symptoms of acute mountain sickness, but data is limited 4
Side Effects and Efficacy
- Acetazolamide increases the risk of side effects such as paraesthesias, taste disturbances, polyuria, and fatigue 3
- The risk of these side effects is dose-dependent, with higher doses increasing the risk of paraesthesias and dysgeusia 3
- Acetazolamide has been shown to be effective in reducing the risk of acute mountain sickness and improving symptoms of epilepsy, although its use has been limited due to perceived poor efficacy and adverse events 4, 5, 6, 7