Adult Dosing
Glaucoma
- 250 mg-1 g IV q24 hrs, dose over 250 mg to be given in divided doses
- Max: 1 g/day
- Adjust dose carefully with individual attention to both symptomatology and ocular tension
Secondary glaucoma/ preoperatively in acute congestive (closed-angle) glaucoma
- 250 mg IV q4 hrs or q12 hrs
- Alt: 500 mg IV x 1, followed by 125-250 mg IV q4 hrs
Epilepsy
- 8-30 mg/kg or 375-1000 mg IV in divided doses; Max: 1 g/day
- In combination with other anticonvulsants: 250 mg q24 hrs
Edema due to Congestive Heart Failure
- 250-375 mg IV qam
- For best diuretic results: 250-375 mg IV every other day or for two days alternating
Drug-Induced Edema
- 250-375 mg IV qd x 1-2 days, alternating with a day of rest
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
Renal Dose Adjustment (Based on CrCl)
- 10-50 mL/min: Reduce dose to 250 mg bid
- <10 mL/min: Contraindicated
Hepatic Dose Adjustment
- Marked liver diseases/cirrhosis: Contraindicated
See Supplemental Patient Information
- Fatalities like Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias have occurred due to severe reactions to sulfonamides, discontinue the drug if such serious reactions occurs
- Anorexia, tachypnea, lethargy, coma and death have been reported with concomitant use of high-dose aspirin and acetazolamide, use cautiously in these patients
- Large dose results in a decrease in diuresis and can increase the incidence of drowsiness and/or paresthesia, give large doses in conjunction with other diuretics in order to secure diuresis in complete refractory failure
- Monitor CBC and platelet count at baseline prior to initiating acetazolamide therapy and at regular intervals during therapy, discontinue the treatment and institute appropriate therapy if significant changes occur
- Use cautiously in patients with pulmonary obstruction or emphysema where alveolar ventilation may be impaired, as acetazolamid therapy precipitate or aggravate acidosis
- Acetazolamide causes both increase and decrease in blood glucose, use cautiously in patients with impaired glucose tolerance or diabetes mellitus
- Monitor serum electrolytes periodically as acetazolamide causes electrolyte imbalances, including hyponatremia and hypokalemia, as well as metabolic acidosis
Cautions: Use cautiously in
- Renal diseases
- Concomitant high dose of aspirin
- Pulmonary obstruction or emphysema
- Diabetes mellitus
- Gout
Supplemental Patient Information
- Advise patients to avoid driving, operating machinery, or performing other hazardous activities as acetazolamide therapy may cause dizziness or drowsiness
Pregnancy Category:C
Breastfeeding: As per limited data low levels of acetazolamide is excreted in milk, following the maternal dosage of 1000 mg/day and would not be expected to cause any adverse effects in breastfed infants. This information is based upon LactMed database. (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 24 February 2011). As per manufacturer's data, because of the potential for serious adverse reaction in nursing infants from acetazolamide, a decision should be made whether to discontinue nursing or to discontinue the drug taking into account the importance of the drug to the mother.
