Acetozolamide

Acetazolamide is a carbonic anhydrase inhibitor medication primarily used to treat conditions such as glaucoma, epilepsy, and altitude sickness. It works by reducing the production of aqueous humor in the eye, lowering intraocular pressure, and altering the body’s acid-base balance. Originally developed as a diuretic, it is also prescribed off-label for metabolic alkalosis and certain types of seizures.

Chemically, acetazolamide is a sulfonamide derivative with the molecular formula C4H6N4O2S2. It acts by inhibiting the enzyme carbonic anhydrase, which plays a key role in bicarbonate ion exchange across cell membranes. This inhibition disrupts fluid and electrolyte balance, leading to increased urine output and reduced fluid retention.

Common side effects include tingling in the hands and feet (paresthesia), frequent urination, and stomach upset. More serious adverse effects may include electrolyte imbalances, kidney stones, or allergic reactions. Acetazolamide is contraindicated in individuals with severe kidney disease, adrenal gland insufficiency, or a history of sulfonamide allergies.

The drug is available in oral tablet and intravenous forms, with typical dosages varying depending on the condition being treated. For glaucoma, it is often used in combination with other medications to manage intraocular pressure. In altitude sickness prevention, it helps by promoting respiratory alkalosis, which reduces symptoms of hypoxia.

Acetazolamide is generally well-tolerated, but long-term use may lead to metabolic acidosis due to excessive bicarbonate loss. Regular monitoring of blood pH and electrolyte levels is recommended during prolonged therapy. It is classified as a Schedule IV controlled substance in some countries due to its potential for abuse, though this is rare.