INDICATIONS
For adjunctive treatment of: edema due to congestive heart
failure; drug- induced edema; centencephalic 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.
DOSAGE AND ADMINISTRATION
Glaucoma
Acetazolamide should be used as an adjunct to the usual
therapy. The dosage employed in the treatment of chronic
simple (open- angle) glaucoma ranges from 250 mg to 1
g of acetazolamide per 24 hours, usually in divided doses
for amounts over 250 mg. It has usually been found that
a dosage in excess of 1 g per 24 hours does not produce
an increased effect. In all cases, the dosage should be
adjusted with careful individual attention both 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 children. Good results, however, have
been seen in patients, both children 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 1000 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- lnduced Edema
Recommended dosage is 250 to 375 mg of acetazolamide
once a day for one or two days, alternating with a day
of rest.
Acute Mountain Sickness
Dosage is 500 mg to 1000 mg daily, in divided doses using
tablets or sustained-release capsules as appropriate.
In circumstances of rapid ascent, such as in rescue or
military operations, the higher dose level of 1000 mg
is recommended. It is preferable to initiate dosing 24
to 48 hours before ascent and to continue for 48 hours
while at high altitude, or longer as necessary to control
symptoms.
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.
HOW SUPPLIED
Acetazolamide Tablets, USP 250 mg are scored, round, white
tablets imprinted “DAN DAN” and “5430”
supplied in bottles of 100, 500 and 1000.
Dispense in a well- closed container, as defined in the
USP, with a child- resistant closure.
Store at controlled room temperature
15°- 30° C (59°- 86° F). Rx Only
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