What are the uses of Diamox (acetazolamide)?

Uses of Diamox (Acetazolamide)

Diamox (acetazolamide) is primarily indicated for glaucoma, altitude sickness prevention and treatment, epilepsy, idiopathic intracranial hypertension, and as a diuretic for certain types of edema. 1, 2

FDA-Approved Indications

Acetazolamide is approved for several key medical conditions:

1. Glaucoma: Decreases intraocular pressure by reducing aqueous humor secretion 2
2. Epilepsy: Acts on the central nervous system to inhibit abnormal neuronal discharge 2
3. Edema: Promotes diuresis in cases of abnormal fluid retention (e.g., cardiac edema) 2
4. Altitude Sickness: Prevention and treatment of acute mountain sickness (AMS) 1

Mechanism of Action

Acetazolamide works through carbonic anhydrase inhibition, which leads to:

• Decreased secretion of aqueous humor in the eye
• Reduced abnormal neuronal discharge in the CNS
• Increased renal excretion of bicarbonate, sodium, water, and potassium
• Urinary alkalinization
• Decreased production of cerebrospinal fluid 2, 3

Altitude Sickness Prevention and Treatment

• Dosing for Prevention: 125-250 mg twice daily starting 24 hours before ascent 1, 4
• Treatment of Mild AMS: 250 mg twice daily 1
• For Rapid Ascents >3,500m: Higher doses (500-750 mg/day) may be more effective, particularly for military or emergency personnel 5
• Efficacy: Reduces risk of AMS symptoms by approximately 48% compared to placebo 4

Off-Label Uses

Acetazolamide is commonly used off-label for:

1. Idiopathic Intracranial Hypertension (IIH): Reduces intracranial pressure by decreasing CSF production 3
2. CSF Leaks: Helps manage elevated intracranial pressure 3
3. Respiratory Stimulation: Aids in ventilator weaning for COPD patients 3
4. Metabolic Alkalosis: Corrects metabolic alkalosis through its acidifying effect
5. Prevention of High-Dose Methotrexate Toxicity: Helps prevent toxicity by alkalinizing urine 3
6. Prevention of Contrast-Induced Nephropathy: May reduce risk of kidney damage from contrast agents 3

Contraindications

Acetazolamide should not be used in patients with:

• Kidney stones
• Sulfa allergy
• Severe hepatic or renal disease
• Adrenocortical insufficiency
• Hyperchloremic acidosis
• Aplastic anemia
• Sickle cell disease 1

Important Cautions and Side Effects

• Common Side Effects: Paresthesias, altered taste, vertigo, and allergic reactions 1
• Serious Side Effects: Kidney stones, metabolic acidosis, blood dyscrasias, Stevens-Johnson syndrome, electrolyte imbalances 1
• Drug Interactions: Limit caffeine intake due to potential interactions 1
• Renal Dosing: Adjust dosing in renal impairment; administration should not be more frequent than every 12 hours if creatinine clearance is <50 mL/min 3

Special Considerations

• Monitoring: Regular assessment of electrolytes, renal function, and acid-base status is recommended 1
• Avoid Combination: Do not combine with other diuretics due to increased risk of dehydration and electrolyte imbalances 1
• Cryptococcal Meningitis: Oral acetazolamide should NOT be used for reduction of elevated intracranial pressure in cryptococcal meningitis due to risk of severe acidosis and hypokalemia 6

Dosing Guidelines

• Glaucoma: 250-1000 mg daily in divided doses
• Epilepsy: 8-30 mg/kg daily in divided doses
• Altitude Sickness Prevention: 125-250 mg twice daily
• Idiopathic Intracranial Hypertension: 250-4000 mg daily in divided doses 3