| Summary: | So I'm gonna be talking to you about some of the problems that we see with acetazolamide, known as Diamox, and the main issues that we face when we're using acetazolamide is usually from papilledema and usually it's idiopathic intracranial hypertension that we are giving. Normally our starting dose is 500 milligrams and then we ramp up relatively rapidly to 500 milligrams twice a day, but you can go as high as four grams. Most of my patients can't tolerate more than 2 to 3 grams of Diamox and the known adverse reactions that people complain about, which are the known side effects of the drug, paresthesias and tingling in the hands and feet and a metallic taste in their mouth. They might have some fatigue, we don't stop the drug for these because that normally equilibrates relatively quickly in the kidney, probably within the first two or three days. The main things that we have to worry about are the metabolic acidosis that occurs from the Diamox, fortunately this is rare and so we don't actually have to test patients on a routine basis with chemistries, rarely people have had hematologic abnormalities, aplastic anemia, but we don't do the CBC's on these people because that's an idiosyncratic reaction from acetazolamide, there's no way to predict it and it just happens randomly. And then the kidney stone and finally the patients who are "sulfa allergic". So these are the main things that we have to worry about: the kidney stone the sulfa and the metabolic acidosis. As you know, Diamox is a carbonic anhydrase inhibitor and what that means is it removes the water, anhydrase, from carbonic acid and that means its major role is the transition state between H2CO3 and water, which is the anhydrous, and the CO2. However, if we block this reaction then we're going to be forced to deal with the HCO3-and the H+, and in the kidney what that means is we have moving through the proximal renal tubule down to the loop and then around to the distal system. And mostly carbonic anhydrase inhibition is occurring in the proximal ...
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