Diamox: Effective Management of Glaucoma & Altitude Sickness
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Synonyms | |||
Diamox (acetazolamide) is a carbonic anhydrase inhibitor prescription medication primarily indicated for the management of open-angle glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma. It is also a well-established prophylactic and therapeutic agent for acute mountain sickness (AMS), central sleep apnea, and certain types of epilepsy, particularly in children. Its mechanism of action involves reducing the production of aqueous humor in the eye and inducing a mild metabolic acidosis, which stimulates ventilation—key to its diverse therapeutic applications. This expert medical overview details its proper use, pharmacological profile, and essential safety information.
Features
- Active Ingredient: Acetazolamide
- Drug Class: Carbonic anhydrase inhibitor
- Available Forms: Oral tablets (125 mg, 250 mg), extended-release capsules (500 mg), and injectable solution (500 mg vial)
- Mechanism of Action: Reversible inhibition of the enzyme carbonic anhydrase, predominantly in the ciliary body of the eye and the renal tubules.
- Onset of Action: Diuretic effect begins within 60-90 minutes; intraocular pressure reduction occurs within 60 minutes, peaking at 2-5 hours.
- Duration: Effects of immediate-release tablets last 8-12 hours.
Benefits
- Lowers Intraocular Pressure: Effectively reduces elevated pressure within the eye, helping to prevent optic nerve damage and preserve vision in glaucoma patients.
- Prevents and Treats Altitude Sickness: Facilitates acclimatization to high altitudes by stimulating respiration and mitigating symptoms like headache, nausea, and dizziness.
- Adjuvant Therapy for Seizures: Particularly useful as an add-on treatment for specific seizure types, such as absence and myoclonic seizures.
- Promotes Diuresis: Induces a bicarbonate diuresis, useful in managing conditions like heart failure (although not a primary diuretic) and metabolic alkalosis.
- Reduces CSF Production: Can lower intracranial pressure in conditions like idiopathic intracranial hypertension (pseudotumor cerebri).
Common use
Diamox is commonly prescribed for the long-term management of chronic open-angle glaucoma and secondary glaucomas. It is a standard prophylactic medication for individuals rapidly ascending to altitudes above 3,000 meters (10,000 feet) to prevent acute mountain sickness. It is also used as adjunctive therapy for certain forms of epilepsy, most effectively in combination with other anticonvulsants. In clinical settings, it may be administered to correct metabolic alkalosis that is unresponsive to other treatments and to reduce elevated intracranial pressure.
Dosage and direction
Dosage is highly indication-specific and must be individualized under strict medical supervision.
- Glaucoma (Chronic): 250 mg to 1 g per day in divided doses (e.g., 125 mg to 250 mg every 6-12 hours).
- Acute Mountain Sickness (Prophylaxis): 125 mg twice daily, starting 24-48 hours before ascent and continuing for 48 hours after reaching the target altitude. For treatment, 250 mg twice daily.
- Epilepsy: 8-30 mg/kg per day in divided doses, typically not to exceed 1 g daily. The extended-release capsule (500 mg) is often administered once or twice daily.
- Diuresis in Heart Failure: 250-375 mg once daily in the morning.
- Administration: Immediate-release tablets can be crushed. The extended-release capsules must be swallowed whole. To minimize GI upset, take with food or milk.
Precautions
Patients should be closely monitored for electrolyte imbalances (particularly hypokalemia and hyponatremia), development of metabolic acidosis, and blood dyscrasias. Regular complete blood counts and electrolyte panels are recommended during prolonged therapy. Use with extreme caution in patients with:
- Impaired hepatic function or liver disease (risk of hepatic coma).
- Impaired renal function (contraindicated in severe renal failure).
- Respiratory acidosis (e.g., in COPD or severe pulmonary obstruction).
- Diabetes mellitus, as it may alter blood glucose levels.
- A history of sulfa allergy (cross-sensitivity is possible).
Contraindications
Diamox is absolutely contraindicated in patients with:
- Hypersensitivity to acetazolamide, other sulfonamides, or any component of the formulation.
- Significant renal disease, renal failure, hyperchloremic acidosis, or adrenocortical insufficiency.
- Low levels of sodium or potassium (hypokalemia, hyponatremia).
- Severe hepatic disease or cirrhosis.
- Long-term use in chronic non-congestive angle-closure glaucoma.
Possible side effect
Common side effects are often dose-related and may include:
- Metabolic: Metabolic acidosis, hypokalemia, hyperglycemia, loss of appetite, taste alteration (particularly a metallic taste for carbonated beverages).
- Neurological: Fatigue, dizziness, confusion, drowsiness, paresthesia (tingling in extremities and face).
- Gastrointestinal: Nausea, vomiting, diarrhea.
- Genitourinary: Polyuria, renal calculi (kidney stones), crystalluria.
- Hematologic (Rare but Serious): Aplastic anemia, agranulocytosis, leukopenia, thrombocytopenia.
- Dermatologic: Stevens-Johnson syndrome, toxic epidermal necrolysis (rare).
Drug interaction
Diamox has several significant drug interactions:
- Amphétamines & Quinidine: Acetazolamide alkalinizes urine, reducing the excretion and potentially increasing the toxicity of these drugs.
- Salicylates (e.g., Aspirin): High doses can lead to anorexia, tachypnea, lethargy, coma, and death due to additive metabolic acidosis and increased central nervous system penetration of salicylates.
- Other Diuretics: May potentiate the effects and risk of hypokalemia.
- Methenamine: Acetazolamide’s alkalinization of urine renders methenamine ineffective.
- Cyclosporine: May increase the risk of cyclosporine-induced nephrotoxicity.
- Primidone & Phenobarbital: May decrease serum levels of these anticonvulsants.
Missed dose
If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. Do not double the dose to make up for a missed one.
Overdose
Symptoms of overdose are primarily an extension of its side effects, including severe electrolyte imbalances (acidosis, hypokalemia), drowsiness, dizziness, confusion, nausea, and tinnitus. Severe overdose can lead to CNS depression, coma, and convulsions. Treatment is supportive and symptomatic, focusing on correcting electrolyte and acid-base imbalances. Hemodialysis may be effective due to the drug’s low protein binding.
Storage
Store at room temperature (20°C to 25°C or 68°F to 77°F) in a tight, light-resistant container. Keep away from excess moisture and heat. Keep all medications out of the reach of children and pets.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
- Ophthalmologist, 15 years experience: “An indispensable, though second-line, tool for managing glaucoma. Its predictable IOP-lowering effect is valuable, but we must vigilantly monitor for metabolic side effects and electrolyte depletion in long-term users.”
- Mountaineering Expedition Doctor: “The gold standard for AMS prophylaxis. Properly dosed, it drastically reduces the incidence and severity of symptoms, allowing for safer ascents. The common paresthesia is a small price to pay for efficacy.”
- Neurologist, specializing in epilepsy: “Its utility in specific pediatric epilepsy syndromes remains. It’s not a first-line monotherapy but serves as an effective adjunct, particularly when other agents have failed or caused intolerable side effects.”
- Patient with IIH: “The side effects were challenging initially (tingling, fatigue), but the reduction in my debilitating headaches and vision issues has been life-changing. It requires careful management with my neurologist.”