to symptomatology and ocular tension. continuous supervision by a physician is advisable. in treatment of secondary glaucoma and in the preoperative treatment of some cases of acute congestive (closed-angle) glaucoma , the preferred dosage is 250 mg every four hours, although some cases have responded to 250 mg twice daily on short-term therapy. in some acute cases, it may be more satisfactory to administer an initial dose of 500 mg followed by 125 or 250 mg every four hours depending on the individual case. intravenous therapy may be used for rapid relief of ocular tension in acute cases. a complementary effect has been noted when acetazolamide has been used in conjunction with miotics or mydriatics as the case demanded. epilepsy: it is not clearly known whether the beneficial effects observed in epilepsy are due to direct inhibition of carbonic anhydrase in the central nervous system or whether they are due to the slight degree of acidosis produced by the divided dosage. the best results to date have been seen in petit mal in pediatric patients. good results, however, have been seen in patients, both pediatric patients and adult, in other types of seizures such as grand mal, mixed seizure patterns, myoclonic jerk patterns, etc. the suggested total daily dose is 8 to 30 mg per kg in divided doses. although some patients respond to a low dose, the optimum range appears to be from 375 to 1,000 mg daily. however, some investigators feel that daily doses in excess of 1 g do not produce any better results than a 1 g dose. when acetazolamide is given in combination with other anticonvulsants, it is suggested that the starting dose should be 250 mg once daily in addition to the existing medications. this can be increased to levels as indicated above. the change from other medications to acetazolamide should be gradual and in accordance with usual practice in epilepsy therapy. congestive heart failure: for diuresis in congestive heart failure, the starting dose is usually 250 to 375 mg once daily in the morning (5 mg/kg). if, after an initial response, the patient fails to continue to lose edema fluid, do not increase the dose but allow for kidney recovery by skipping medication for a day. acetazolamide yields best diuretic results when given on alternate days, or for two days alternating with a day of rest. failures in therapy may be due to overdosage or too frequent dosage. the use of acetazolamide does not eliminate the need for other therapy such as digitalis, bed rest, and salt restriction. drug-induced edema: recommended dosage is 250 to 375 mg of acetazolamide once a day for one or two days, alternating with a day of rest. note: the dosage recommendations for glaucoma and epilepsy differ considerably from those for congestive heart failure, since the first two conditions are not dependent upon carbonic anhydrase inhibition in the kidney which requires intermittent dosage if it is to recover from the inhibitory effect of the therapeutic agent. interference with laboratory tests sulfonamides may give false negative or decreased values for urinary phenolsulfonphthalein and phenol red elimination values for urinary protein, serum non-protein and for serum uric acid. acetazolamide may produce an increased level of crystals in the urine. acetazolamide interferes with the hplc method of assay for theophylline. interference with the theophylline assay by acetazolamide depends on the solvent used in the extraction; acetazolamide may not interfere with other assay methods for theophylline.

pecial senses: hearing disturbances, tinnitus, transient myopia. transient myopia is the result of forward movement of the ciliary body leading to a narrowing of the angle. urogenital: crystalluria, increased risk of nephrolithiasis with long-term therapy, hematuria, glycosuria, renal failure, polyuria to report suspected adverse reactions, contact avet pharmaceuticals inc. at 1-866-901-drug (3784) or fda at 1-800-fda-1088 or www.fda.gov/medwatch.

dicate that acetazolamide has utility as an adjuvant in the treatment of certain dysfunctions of the central nervous system (e.g., epilepsy). inhibition of carbonic anhydrase in this area appears to retard abnormal, paroxysmal, excessive discharge from central nervous system neurons. the diuretic effect of acetazolamide is due to its action in the kidney on the reversible reaction involving hydration of carbon dioxide and dehydration of carbonic acid. the result is renal loss of hco 3 ion, which carries out sodium, water, and potassium. alkalinization of the urine and promotion of diuresis are thus affected. alteration in ammonia metabolism occurs due to increased reabsorption of ammonia by the renal tubules as a result of urinary alkalinization.

s advised for patients receiving concomitant high-dose aspirin and acetazolamide, as anorexia, tachypnea, lethargy, metabolic acidosis, coma, and death have been reported (see warnings ). both increases and decreases in blood glucose levels have been described in patients treated with acetazolamide. this should be taken into consideration in patients with impaired glucose tolerance or diabetes mellitus. acetazolamide treatment may cause electrolyte imbalances, including hyponatremia and hypokalemia, as well as metabolic acidosis. therefore, periodic monitoring of serum electrolytes is recommended. particular caution is recommended in patients with conditions that are associated with, or predispose a patient to, electrolyte and acid/base imbalances, such as patients with impaired renal function (including elderly patients; see precautions, geriatric use ), patients with diabetes mellitus, and patients with impaired alveolar ventilation. some adverse reactions to acetazolamide, such as drowsiness, fatigue, and myopia, may impair the ability to drive and operate machinery.