Acetazolamide: Brands, Price & Uses in Bangladesh

Acetazolamide is a carbonic anhydrase inhibitor used as adjunctive (add-on) therapy for several conditions, with the strength of evidence varying by indication:

FDA-approved / established uses

• Glaucoma: Adjunctive treatment of chronic open-angle glaucoma, secondary glaucoma, and short-term preoperative management of acute angle-closure glaucoma, by lowering intraocular pressure.
• Epilepsy: Adjunctive therapy (used together with other anticonvulsants) for centrencephalic epilepsies, including certain generalized (petit mal/absence) and mixed seizure patterns.
• Edema: Adjunctive treatment of edema due to congestive heart failure and drug-induced edema.
• Acute mountain sickness (altitude sickness): Prevention and reduction in severity of symptoms of acute mountain sickness in individuals undertaking rapid ascent to high altitude.

Commonly used off-label (not FDA-approved but supported by clinical practice/literature)

• Idiopathic intracranial hypertension (pseudotumor cerebri) to reduce cerebrospinal fluid production.
• Periodic paralysis syndromes (hypokalemic/hyperkalemic) in selected patients.
• Metabolic alkalosis in critically ill patients, as an adjunct.

Note: Acetazolamide is always used as an adjunct in epilepsy and edema; it is not intended as sole/first-line therapy for these conditions.

Glaucoma

Epilepsy (adjunctive)

Total daily dose of 8 to 30 mg/kg in divided doses; optimum range is usually 375-1000 mg daily. When added to existing anticonvulsant therapy, start at 250 mg once daily and titrate as needed.

Edema (congestive heart failure / drug-induced)

250-375 mg once daily in the morning (approximately 5 mg/kg); best results are often obtained with intermittent dosing (alternate days, or two days on/one day off) to avoid reduced diuretic response.

Acute mountain sickness

500-1000 mg daily in divided doses; the higher dose is preferred for rapid ascent. Start dosing 24-48 hours before ascent and continue for at least 48 hours after arrival at high altitude (or longer if symptoms persist).

Administration

Tablets may be taken with or without food; taking with food may reduce stomach upset. Tablets can be crushed and mixed with soft food (e.g., applesauce) or a flavored syrup for patients who have difficulty swallowing. See Renal/Hepatic notes under Precautions and Special Populations.

Side effects of Acetazolamide range from common and generally mild to rare but serious:

Common

• Paresthesias (tingling/numbness), particularly of the fingers, toes, and around the mouth - usually mild and dose-related.
• Fatigue, drowsiness, malaise, headache.
• Loss of appetite, nausea, vomiting, altered taste, diarrhea.
• Increased urination (mild diuretic effect).

Less common / serious

• Metabolic acidosis and electrolyte disturbances (hypokalemia, hyponatremia) - see Contraindications/Precautions.
• Kidney stone (renal calculus) formation.
• Blood disorders: aplastic anemia, agranulocytosis, leukopenia, thrombocytopenia (rare but require monitoring with prolonged use).
• Liver dysfunction, including rare cholestatic jaundice or fulminant hepatic necrosis.
• Hypersensitivity/skin reactions: urticaria, photosensitivity, and rarely Stevens-Johnson syndrome or toxic epidermal necrolysis.
• Hearing disturbances, tinnitus.
• Transient myopia; rarely, choroidal effusion/detachment after ocular surgery.