What are the indications and dosages for acetazolamide?

From the Guidelines

Acetazolamide is indicated for various medical conditions, including glaucoma, altitude sickness, idiopathic intracranial hypertension, epilepsy, metabolic alkalosis, and periodic paralysis, with dosages ranging from 250-1000 mg daily in divided doses, depending on the condition being treated. The medication works by inhibiting carbonic anhydrase, which reduces hydrogen ion secretion in the renal tubule and increases sodium, potassium, bicarbonate, and water excretion, thereby decreasing intraocular pressure, cerebrospinal fluid production, and altering the seizure threshold 1.

Indications and Dosages

• Glaucoma: 250-1000 mg daily in divided doses
• Altitude sickness prevention: 125-250 mg twice daily starting 24-48 hours before ascent and continuing for 48 hours at high altitude
• Altitude sickness treatment: 250 mg every 8-12 hours
• Idiopathic intracranial hypertension: 250-1000 mg daily in divided doses, with a popular starting dose of 250–500 mg twice a day, and titrating the daily dose up as needed 1
• Epilepsy: 8-30 mg/kg daily in divided doses
• Metabolic alkalosis: 250-375 mg every 6 hours
• Periodic paralysis: 250-1000 mg daily

Side Effects and Precautions

Common side effects of acetazolamide include paresthesias, fatigue, altered taste, and increased urination 1. The medication should be used cautiously in patients with sulfa allergies, renal impairment, liver disease, or electrolyte abnormalities, and requires periodic monitoring of electrolytes and renal function during long-term use. Patients should be warned of the adverse side effects of acetazolamide, which can include increased risk of diarrhoea, dysgeusia, fatigue, nausea, paraesthesia, tinnitus, vomiting, depression, and rarely renal stones 1.

Recent Studies

A recent study published in 2021 found that acetazolamide can reduce sleep apnea intensity by up to 45% in unselected groups of patients, and improve sleep efficiency and oxygenation 1. Another study published in 2009 found that acetazolamide can be used to treat pseudotumor cerebri in children with acute promyelocytic leukemia, with an initial dose of 25 mg/kg per day and titrating upward until clinical response is attained (maximum dose 100 mg/kg per day) 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION 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 for epilepsy. 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 for drug induced edema

The indications and dosages for 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, with an optimum range of 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

Indications for Acetazolamide

• Acetazolamide is used for various conditions, including altitude sickness, sleep apnoea, glaucoma, and epilepsy 3, 4, 5, 6, 7
• It is a useful prophylactic for acute mountain sickness, causing 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 6
• In glaucoma, acetazolamide is used to reduce intraocular pressure 7

Dosages for Acetazolamide

• For altitude sickness, a dosage of 250 mg daily is recommended when planning a rapid ascent to an altitude above 3000 metres 5
• In the treatment of glaucoma, dosages of 500 mg of sustained-release capsules once or twice a day, or 250 mg of tablets four times a day have been used 7
• For epilepsy, acetazolamide is primarily used in combination therapy with other antiepileptic medications, although the exact dosage is not specified 6
• The risk of side effects, such as paraesthesias, taste disturbances, polyuria, and fatigue, increases with higher doses of acetazolamide 3