IV Acetazolamide Infusion Duration
IV acetazolamide should be administered as a direct intravenous push or bolus injection, not as a prolonged infusion. 1
Administration Guidelines
Standard IV Administration
- The direct intravenous route is preferred over intramuscular administration 1
- Acetazolamide is given as a bolus injection, not infused over an extended period 1
- Each 500 mg vial must be reconstituted with at least 5 mL of Sterile Water for Injection before administration 1
Dosing by Indication
For Glaucoma:
- Typical dose: 250 mg to 1 g per 24 hours in divided doses 1
- Acute cases: Initial 500 mg bolus, followed by 125-250 mg every 4 hours 1
- IV therapy provides rapid relief of ocular tension in acute situations 1
For Metabolic Alkalosis (Critical Care):
- Single dose of 500 mg IV is as effective as multiple 250 mg doses for reversing metabolic alkalosis 2
- Alternative regimen: 250 mg IV every 6 hours for four doses 2
- Onset of action occurs within 2 hours, with maximal effect at approximately 15.5 hours 3
- Effect sustained for 48-72 hours after a single dose 3, 4
For Pediatric CAR T Cell Complications (Cerebral Edema):
- Initial: 15 mg/kg (maximum 1,000 mg) IV 5
- Maintenance: 8-12 mg/kg (maximum 1,000 mg) IV every 12 hours 5
- This specific indication may involve slower administration given the context of cerebral edema management 5
Important Clinical Considerations
Reconstitution and Stability
- Reconstituted solutions remain stable for 3 days refrigerated (2-8°C) or 12 hours at room temperature 1
- Contains no preservative, so appropriate sterile technique is essential 1
Onset and Duration of Action
- Rapid onset within 2 hours of IV administration 3
- Prolonged duration of 48-72 hours after a single dose, which explains why single-dose therapy is effective 2, 3
- This extended duration allows for once-daily or every-other-day dosing in many conditions 1
Common Pitfall
The key misconception is treating acetazolamide like medications requiring prolonged infusion. Acetazolamide is administered as a direct IV push/bolus, not dripped over hours. The only exception is in the pediatric CAR T cell protocol where the context suggests more careful administration in the setting of severe cerebral edema 5, though even here specific infusion times are not detailed, suggesting bolus administration remains standard.