From the Guidelines
Indication for Acetazolamide
Acetazolamide is primarily indicated for the treatment of idiopathic intracranial hypertension (IIH), glaucoma, epilepsy, and altitude sickness.
- The typical starting dose of acetazolamide for IIH is 250–500 mg twice a day [ 1 ], with the majority of clinicians titrating the daily dose up.
- For glaucoma, epilepsy, and altitude sickness, the dosages vary but generally fall within the range of 250-1000 mg orally daily in divided doses.
- It's also worth noting that acetazolamide has been studied for its potential use in obstructive sleep apnea (OSA), particularly at high altitudes, where it has shown to reduce sleep apnea intensity and improve oxygenation [ 1 ].
- However, its use in OSA is not widely approved and is recommended under research conditions due to limited data on long-term outcomes and potential side effects [ 1 ].
- Common side effects of acetazolamide include diarrhea, dysgeusia, fatigue, nausea, paresthesia, tinnitus, vomiting, depression, and rarely renal stones [ 1 ].
- Patients should be warned about these potential side effects and monitored accordingly.
From the Research
Indications for Acetazolamide
The indications for acetazolamide include:
- Epilepsy 2
- Glaucoma 2
- Edema 2
- Altitude sickness 2, 3, 4, 5
- Idiopathic intracranial hypertension 2
- Elevated intracranial pressure (ICP) due to cerebrospinal fluid (CSF) leaks 2
- Prevention of high-altitude pulmonary edema (HAPE) 6
- Treatment of acute mountain sickness (AMS) 3, 4, 5
Dosage and Administration
The dosage of acetazolamide ranges from 250 to 4,000 mg daily, divided every 6-12 hours 2. The optimal dosage for preventing AMS is still debated, with studies suggesting that 125 mg BD is not significantly different from 375 mg BD 5, while others recommend doses of 500-750 mg/day for rapid ascents to altitudes above 3,500 m 3.
Mechanism of Action
Acetazolamide works by inhibiting carbonic anhydrase, which leads to reduced hydrogen ion secretion in the proximal renal tubule, resulting in increased bicarbonate and cation excretion and causing urinary alkalization and diuresis 2. It also decreases the production of cerebrospinal fluid (CSF) and aqueous humor, reducing intracranial pressure (ICP) and intraocular pressure 2.