ACETAZOLAMIDE

A Drug Study Presented to the

Faculty of the Nursing Department
San Pedro College, Davao City
MRS. EREIN THERESE ACERO, RN, MN

In Partial Fulfillment of
The Requirements in NCM 216-RLE
SURGERY/PERCEPTION & COORDINATION NURSING ROTATION

BY:
KHESLER BERNIE N. BACALLA, ST.N.

May 3, 2021
Brand Name: DIAMOX

Generic Name: ACETAZOLAMIDE

Drug Classification: Diuretic, antiglaucoma drug, anticonvulsant,

altitude agent, urinary alkalinizer, Carbonic anhydrase inhibitor. Pregnancy risk category C

Mode of Action: Inhibits carbonic anhydrase in kidney, decreasing water reabsorption and
increasing excretion of sodium, potassium, and bicarbonate. Lowers intraocular pressure by
decreasing aqueous humor production. May raise seizure threshold by reducing carbonic
anhydrase in CNS, thereby decreasing neuronal conduction.

Dose and Route:

➣ Open-angle (chronic simple) glaucoma (given with miotics)

Adults: 250 mg P.O. one to four times daily, or 500-mg sustained-release capsule P.O. once or
twice daily. Don’t exceed total daily dosage of 1 g.

➣ Preoperative treatment of closed angle (secondary) glaucoma

Adults: 250 mg P.O. q 4 hours or 250 mg P.O. b.i.d.; in acute cases only, 500 mg P.O.
followed by 125 to 250 mg P.O. q 4 hours. For rapid relief of

increased intraocular pressure, 500 mg I.V., repeated in 2 to 4 hours; then 125 to 250 mg P.O.
q 4 to 6 hours. Children: 10 to 15 mg/kg/day P.O. in divided doses q 6 to 8 hours, or 5 to 10
mg/kg I.V. q 6 hours

➣ Seizure disorder (given with other anticonvulsants)

Adults and children: 250 mg P.O. daily when given with another anticonvulsant, or 8 to 30
mg/kg daily P.O. in one to four divided doses. Usual dosage range is 375 mg to 1 g daily.
➣ Drug-induced edema or edema secondary to heart failure

Adults: Initially, 250 to 375 mg P.O. daily. If diuresis fails, give dose on alternate days, or give
for 2 days alternating with day of rest. Children: 5 mg/kg P.O. daily, or 150 mg/ m2 P.O. or I.V.
once daily in morning

➣ Acute high-altitude (mountain) sickness

Adults: 500 mg to 1 g P.O. daily in divided doses, or sustained-release capsule q 12 to 24

hours. Dosing should begin 24 to 48 hours before ascent and continue during ascent and for
48 hours after reaching desired altitude. For rapid ascent, 1-g P.O. dose is recommended

Indication: For adjunctive treatment of: edema due to congestive heart failure; drug-induced
edema; centrencephalic epilepsies (petit mal, unlocalized seizures); chronic simple (open-
angle) glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma
where delay of surgery is desired in order to lower intraocular pressure. Acetazolamide is also
indicated for the prevention or amelioration of symptoms associated with acute mountain
sickness in climbers attempting rapid ascent and in those who are very susceptible to acute
mountain sickness despite gradual ascent.

Contraindication:

Acetazolamide therapy is contraindicated in situations in which sodium and/or potassium blood

serum levels are depressed, in cases of marked kidney and liver disease or dysfunction, in
suprarenal gland failure, and in hyperchloremia acidosis. It is contraindicated in patients with
cirrhosis because of the risk of development of hepatic encephalopathy.

Long-term administration of acetazolamide is contraindicated in patients with chronic non-

congestive angle-closure glaucoma since it may permit organic closure of the angle to occur
while the worsening glaucoma is masked by lowered intraocular pressure.
Side Effects:

The common side effects of acetazolamide include: dizziness, lightheadedness and increased
amount of urine, especially during the first few days as your body adjusts to the medication.

Other side effects of acetazolamide include blurred vision, dry mouth, drowsiness, loss of
appetite, changes in the sense of taste, stomach upset, nausea and vomiting, diarrhea,
headache, tingling feeling, ringing in the ears, confusion and tiredness.

Adverse Effects:

CNS: weakness, nervousness, irritability, drowsiness, confusion, dizziness, depression,

tremor, headache, paresthesia, flaccid paralysis, seizures

EENT: transient myopia, tinnitus, hearing dysfunction, sensation of lump in throat

GI: nausea, vomiting, diarrhea, constipation, melena, abdominal distention, dry mouth,
anorexia

GU: dysuria, hematuria, glycosuria, polyuria, crystalluria, renal colic, renal calculi, uremia,
sulfonamide-like renal lesions, renal failure

Hematologic: thrombocytopenia, leukopenia, agranulocytosis, hemolytic anemia,

thrombocytopenic purpura, pancytopenia, bone marrow depression with aplastic anemia

Hepatic: hepatic insufficiency

Metabolic: hypokalemia, hyperglycemia and glycosuria, hyperuricemia and gout, metabolic

acidosis, hyperchloremic acidosis

Respiratory: hyperpnea

Skin: rash, pruritus, urticaria, photosensitivity, hirsutism, cyanosis

Other: altered taste and smell, weight loss, fever, excessive thirst, pain at I.M. injection site,
hypersensitivity reaction, Stevens-Johnson syndrome

Drug Interactions:

Drug-drug.

• Amphetamines, procainamide, quinidine, tricyclic antidepressants: decreased

excretion and enhanced or prolonged effect of these drugs, leading to toxicity
• Amphotericin B, corticosteroids, corticotrophin, other diuretics: increased risk of
hypokalemia
• Lithium, phenobarbital, salicylates: increased excretion of these drugs, possibly
reducing their efficacy
• Methenamine compounds: inactivation of these drugs
• Phenytoin, primidone: severe osteomalacia
 • Salicylates: increased risk of salicylate toxicity

Drug-diagnostic tests.

• Ammonia, bilirubin, calcium, chloride, glucose, uric acid: increased levels

• Thyroid iodine uptake: decreased in patients with hyperthyroidism or normal thyroid
function
• Urinary protein (with some reagents): false-positive result

Drug-behaviors.

• Sun exposure: increased risk of photosensitivity

Nursing Responsibilities:

• Advise patient to take drug with food if GI upset occurs.

 R: To reduce side effects of stomach irritation, including indigestion, stomach
inflammation or ulcers. This medicine can irritate the stomach, and taking them with
food will reduce this effect.
• Caution patient to avoid driving and other hazardous activities until he knows how drug
affects concentration and alertness.
this drug may cause drowsiness that causes the driver may have slow reaction times,
reduced vigilance and impaired thinking. In the worst case the driver may fall asleep
behind the wheel.
• Tell patient to eat potassium-rich foods (such as seafood, bananas, and oranges) if
taking drug long term or receiving other potassium-depleting drugs.
R: This drug may reduce the potassium levels in your blood.
• Advise patient to avoid activities that can cause injury. Advise him to use soft toothbrush
and electric razor to avoid gum and skin injury.
 R: One of the Sid effect of acetazolamide is bleeding so it is important to advice the
patient to avoid activities that can cause injury.
• Tell patient to report significant numbness or tingling
R: Tingling or pins and needles feelings around the mouth and in the hands and feet is
a common side effect of Diamox and suggests the medicine is working.
• Inform patient that he’ll undergo regular blood testing during therapy.
R: regular blood tests to monitor the levels of electrolytes (e.g. sodium and potassium)
and the levels of blood cells in your blood
• Evaluate for signs and symptoms of sulfonamide sensitivity
R: this drug can cause fatal hypersensitivity
• Monitor laboratory test results for hematologic changes; blood glucose, potassium,
bicarbonate, and chloride levels; and liver and kidney function changes
 R: To monitor for hematologic reactions common to all sulfonamides, it is recommended
that baseline CBC and platelet Count be obtained on patients prior to initiating
Acetazolamide therapy and at regular intervals during therapy
• Observe for signs and symptoms of bleeding tendency.
R: since one of the side effects of this drug is bleeding.
• Monitor fluid intake and output
R: monitoring intake and output is a must to avoid dehydration since this drug is diuretic

References:

• RxList (2020). Acetazolamide. Retrieved May 3, 2021 from

https://www.rxlist.com/acetazolamide-drug.htm#description
• Medscape (n.d). Acetazolamide (Rx). Retrieved May 3, 2021 form
https://reference.medscape.com/drug/acetazolamide-342809#4
• Schull, P. (2013). Acetazolamide. McGraw-Hill Nurse’s Drug Handbook Seventh
Edition. McGraw- Hill education. Pages 15-17.