Skip to content

Acetazolamide

    Brands

    DEA Class; Rx

    Common Brand Names; Diamox Sequels (DSC)

    • Anticonvulsants, Other; 
    • Antiglaucoma, Carbonic Anhydrase Inhibitors
    Carbonic anhydrase inhibitor; acetazolamide is used for high-altitude sickness, and as an adjunct treatment for glaucoma and epilepsy.

    Indicated for the treatment of glaucoma.

    For use as an adjunctive agent in the treatment of seizures including absence seizures, tonic-clonic seizures, and partial seizures.
    For the treatment of acute altitude sickness.
    For altitude sickness prophylaxis, including prevention of high altitude cerebral edema.
    For the treatment of edema due to heart failure or drug therapy.
    For use as an adjunctive agent to reverse metabolic alkalosis.
    For use in urinary alkalinization.

    Hypokalemia

    Hyponatremia

    Hyperchloremic acidosis

    Hypersensitivity to acetazolamide or sulfa

    Liver disease

    Severe renal disease or dysfunction

    Long term use in noncongestive angle-closure glaucoma

    Cirrhosis

    Long-term administration in patients with chronic, noncongestive angle-closure glaucoma

    • Confusion
    • Convulsions
    • Drowsiness
    • Flaccid paralysis
    • Malaise
    • Paresthesias
    • Photosensitivity
    • Urticaria
    • Anorexia
    • Diarrhea
    • Metallic taste
    • Nausea
    • Vomiting
    • Hepatic disease
    • Aplastic anemia
    • Agranulocytosis
    • Leukopenia
    • Thrombocytopenia
    • Thrombocytopenic purpura
    • Melena
    • Acidosis
    • Electrolyte imbalance
    • Muscle weakness
    • Hematuria
    • Polyuria
    • Glycosuria
    • Hearing dysfunction or tinnitus
    • Sulfonamide type reactions

    Use caution in COPD, emphysema, and concomitant high-dose aspirin

    Use caution in diabetes, respiratory acidosis, and hepatic impairment

    Adverse drug reactions common to sulfonamide derivatives; Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN) may occur

    May impair alertness and/or physical coordination

    FDA-approved product labeling for many medications have included a broad contraindication in patients with a prior allregic reaction to sulfonamides; however, recent studies have suggested that crossreactivity between antibiotic sulfonamides and nonantibiotic sulfonamides is unlikely to occur

    May impair alertness and/or physical coordination

    Severe adverse effects including tachypnea, anorexia, coma, lethargy, and death reported with high-dose aspirin; use caution or avoid administration

    Increasing dose does not increase diuresis; may instead increase the incidence of paresthesia and/or drowsiness

    IM administration not recommended due to alkaline pH, which may cause pain

    Pregnancy category: C

    Lactation: Enters breast milk; not recommended

    Adults

    1,000 mg/day PO/IV is the FDA-approved max; up to 4,000 mg/day PO has been used off-label.

    Geriatric

    1,000 mg/day PO/IV is the FDA-approved max; up to 4,000 mg/day PO has been used off-label.

    Adolescents

    Safety and efficacy have not been established for the regular-release tablets or injection; maximum dose recommendations vary depending on the indication. 1,000 mg/day PO is the FDA-approved max dose for the extended-release capsule. The following max doses have been used off-label for the regular-release tablet and/or injection: for the management of glaucoma and seizures, up to 30 mg/kg/day PO (Max: 1,000 mg/day); for the reversal of metabolic alkalosis, up to 20 mg/kg/day IV/PO (Max: 1000 mg/day); for the prevention and treatment of altitude sickness, up to 5 mg/kg/day PO (Max: 250 mg/day) and 7.5 mg/kg/day PO (Max: 750 mg/day), respectively; for the treatment of pseudotumor cerebri, up to 100 mg/kg/day PO (Max: 2,000 mg/day).

    Children

    Children 12 years: Safety and efficacy have not been established for the regular-release tablets or injection; maximum dose recommendations vary depending on the indication. 1,000 mg/day PO is the FDA-approved max dose for the extended-release capsule. The following max doses have been used off-label for the regular-release tablet and/or injection: for the management of glaucoma and seizures, up to 30 mg/kg/day PO (Max: 1,000 mg/day); for the reversal of metabolic alkalosis, up to 20 mg/kg/day IV/PO; for the prevention and treatment of altitude sickness, up to 5 mg/kg/day PO (Max: 250 mg/day) and 7.5 mg/kg/day PO (Max: 750 mg/day), respectively; for the treatment of pseudotumor cerebri, up to 100 mg/kg/day PO (Max: 2,000 mg/day).
    Children 1 to 11 years: Safety and efficacy have not been established; maximum dose recommendations vary depending on the indication. For the management of glaucoma and seizures, doses up to 30 mg/kg/day PO (Max: 1,000 mg/day) have been used. For the reversal of metabolic alkalosis, doses up to 20 mg/kg/day IV/PO have been used. For the prevention and treatment of altitude sickness, doses up to 5 mg/kg/day PO (Max: 250 mg/day) and 7.5 mg/kg/day PO (Max: 750 mg/day), respectively, have been recommended. For the treatment of pseudotumor cerebri, doses up to 100 mg/kg/day PO (Max: 2,000 mg/day) have been used.

    Infants

    Safety and efficacy have not been established; maximum dose recommendations vary depending on the indication. For the management of glaucoma, doses up to 30 mg/kg/day PO have been used. For the reversal of metabolic alkalosis, doses up to 20 mg/kg/day IV/PO have been used. For the prevention and treatment of altitude sickness doses up to 5 mg/kg/day PO and 7.5 mg/kg/day PO, respectively, have been recommended. For the treatment of pseudotumor cerebri, doses up to 100 mg/kg/day PO have been used.

    Neonates

    Safety and efficacy have not been established; however, doses up to 20 mg/kg/day IV/PO have been used off-label for the reversal of metabolic alkalosis.

    Acetazolamide

    tablet

    • 125mg
    • 250mg

    powder for injection

    • 500mg

    capsule, extended-release

    • 500mg