Side Effects of acetazolamide: A Synthesis of Findings from 24 Studies

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Original Abstract of the Article

Main Research Findings

Acetazolamide (AZM) is used for various conditions (e.g. altitude sickness, sleep apnea, glaucoma), but therapy is often limited by its side effect profile. This paper aimed to estimate the risk of commonly reported side effects based on meta-analyses. It also hypothesized that these risks are dose-dependent. 1

Another study suggests that acetazolamide may potentiate the effect of all-trans retinoic acid (ATRA), potentially leading to idiopathic intracranial hypertension (IIH) during treatment of acute promyelocytic leukemia (APL). 17

Further research reported a case of IIH associated with inhaled corticosteroids. This case involved a child with asthma who developed IIH while using inhaled corticosteroids at a moderate dose. 21

Acetazolamide is also used to treat glaucoma, but when used for managing post-surgical eye pressure, it can cause strong side effects requiring alternative treatments. 11

Acetazolamide is also used for the treatment and prevention of altitude sickness. This study reported a case of unilateral choroidal effusion after taking acetazolamide. This case is the first reported instance of choroidal effusion as a side effect of prophylactic use of acetazolamide against altitude sickness. 18

Niosomal gel formulations combining acetazolamide and carvedilol show potential for reducing side effects in glaucoma treatment. This study demonstrated that a formulation combining acetazolamide and carvedilol in niosomal gel reduced intraocular pressure and improved retinal atrophy in a rabbit model of glaucoma. 23

Research suggests that acetazolamide could be effective in treating pulmonary vascular disease. This study assessed the efficacy and safety of acetazolamide administered for 5 weeks to patients with pulmonary vascular disease, indicating that acetazolamide may increase respiratory rate in such patients. 14

Research also suggests that acetazolamide may be effective in treating acute heart failure. This study evaluated the effectiveness of acetazolamide in addition to loop diuretics in patients with acute heart failure, suggesting that combined use may lead to faster fluid retention improvement. 9

Moreover, acetazolamide is a potential natural medicine for the treatment of altitude sickness. This study highlights the potential of various natural medicines, including acetazolamide, for the prevention and treatment of altitude sickness, providing a detailed explanation of their mechanisms of action and side effects. 10

Reasons for Side Effects

The side effects of acetazolamide are attributed to its carbonic anhydrase inhibitory action. Carbonic anhydrase is present in various tissues and organs in the body and is involved in the production and breakdown of carbonic acid. Acetazolamide inhibits carbonic anhydrase, suppressing the breakdown of carbonic acid and reducing intracellular pH. This reduction in intracellular pH is believed to cause various side effects.

Common Side Effects

Gastrointestinal System

Common side effects of acetazolamide include gastrointestinal symptoms. These include reports of loss of appetite, nausea, vomiting, and abdominal pain. Taste disturbances, such as difficulty tasting, have also been reported. 24 8 7

Nervous System

Side effects related to the nervous system include dizziness, headache, fatigue, and tingling sensations. Severe side effects such as impaired consciousness and hallucinations have also been reported. These side effects are thought to occur due to acetazolamide inhibiting cerebrospinal fluid production and increasing intracranial pressure. 15 5 8

Metabolic and Endocrine System

Metabolic and endocrine side effects include electrolyte imbalances, particularly hypokalemia, and metabolic acidosis. Side effects such as kidney stones have also been reported. 6 5

Hematologic System

Hematologic side effects include thrombocytopenia and leukopenia. 24

Ophthalmic System

Ophthalmic side effects include increased intraocular pressure, myopia, and choroidal effusion. 18 3

Respiratory System

Respiratory side effects include dyspnea. 10

Urinary System

Urinary side effects include frequent urination and difficulty urinating. 14

Skin

Skin side effects include rash, itching, and hives. 24

Other

Other reported side effects include weakness, drowsiness, and fatigue. 8 20 19

Side Effect Management

Gastrointestinal System

Dietary and medication management can be effective for gastrointestinal side effects. Dietary interventions may involve consuming easily digestible foods or taking meals in smaller portions more frequently. Medication options include antiemetics and proton pump inhibitors. 8

Nervous System

Reducing or temporarily discontinuing acetazolamide dosage may be helpful for nervous system side effects. Analgesics and anti-anxiety medications can also be used depending on the symptoms. 20

Metabolic and Endocrine System

Electrolyte replenishment and addressing acidosis are effective management approaches for metabolic and endocrine side effects. Adequate hydration and dietary changes are crucial for preventing kidney stones. 6

Ophthalmic System

Eye drops to lower intraocular pressure can be used to manage ophthalmic side effects. If myopia or choroidal effusion occurs, consultation with an ophthalmologist is necessary. 18

Comparison between Studies

Similarities

These studies share a common focus on exploring various aspects of acetazolamide side effects. They also indicate that acetazolamide side effects may be dose-dependent. 1

Differences

Due to differences in target diseases and research methods, these studies exhibit varying outcomes. For instance, the incidence of acetazolamide side effects varies across studies. This can be attributed to differences in target diseases and research methods. Additionally, conclusions regarding the dose-dependence of acetazolamide side effects also differ among studies. This can be due to variations in research design and the number of patients involved. 1 17 21 11 10 9 18 23 14

Points to Note for Practical Application

Acetazolamide is used to treat various conditions, but it is important to remember that it carries the risk of side effects. When taking acetazolamide, it is crucial to consult a doctor and gain a comprehensive understanding of potential side effects before starting treatment. Additionally, if any adverse reactions occur during treatment, seeking immediate medical attention is essential. 1

Limitations of Current Research

While these studies commendably explore various aspects of acetazolamide side effects, they have some limitations. First, because these are observational studies, it is impossible to definitively conclude that acetazolamide is the cause of the side effects. Second, these studies involve small patient samples, hindering the generalizability of their findings. Finally, these studies focus on patients with specific conditions, making it difficult to extrapolate the results to patients with other diseases. 1

Future Research Directions

To further investigate acetazolamide side effects, larger-scale studies are needed. Research focusing on the dose-dependence of acetazolamide side effects is particularly important. Additionally, developing new treatment approaches to mitigate acetazolamide side effects is essential. 1

Conclusion

Acetazolamide is used to treat a variety of conditions, but it's crucial to remember the potential for side effects. Consulting a doctor before taking acetazolamide and fully understanding the potential side effects are essential. If any adverse reactions occur during treatment, seeking prompt medical attention is necessary. 1

Literature analysis of 24 papers
Positive Content
17
Neutral Content
1
Negative Content
6
Article Type
3
2
2
2
22
1.

Side effects of acetazolamide: a systematic review and meta-analysis assessing overall risk and dose dependence.

Author: SchmicklChristopher N, OwensRobert L, OrrJeremy E, EdwardsBradley A, MalhotraAtul

Side effects

The risk of commonly reported side effects of acetazolamide (AZM) was estimated through meta-analyses. The study found that the risk of these side effects is dose-dependent.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

2.

Side effects of acetazolamide: a systematic review and meta-analysis assessing overall risk and dose dependence.

Author: SchmicklChristopher N, OwensRobert L, OrrJeremy E, EdwardsBradley A, MalhotraAtul

Side effects

The risk of commonly reported side effects of acetazolamide (AZM) was estimated through meta-analyses. The study found that the risk of these side effects is dose-dependent.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

3.

Severe ocular side effects with acetazolamide: case report.

Author: Llovet-RausellA, Ruiz TolosaF, KudsiehB

Anterior chamber expansion
Reduced lens thickness
Reduced myopia
Decreased visual acuity

A 44-year-old woman with myopia, increased intraocular pressure, and a narrow anterior chamber experienced decreased visual acuity. Treatment with naproxen, acetazolamide, timolol, brimonidine, prednisolone, and ayclopentolate led to a gradual reduction of myopia, lens thickness, and anterior chamber expansion.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

5.

Long-term effectiveness and side effects of acetazolamide as an adjunct to other anticonvulsants in the treatment of refractory epilepsies.

Author: KatayamaFumihiko, MiuraHisao, TakanashiSakae

Useful for refractory epilepsies
Renal calculi

Acetazolamide is a useful adjunct drug for treating refractory epilepsies, but it can cause side effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

7.

Zinc therapy of acetazolamide-induced side-effects.

Author: DahlH, NørskovK, PeitersenE, HildenJ

Anorexia
Gustatory disorder
Paraesthesia

Zinc sulfate did not significantly reduce acetazolamide-induced side effects in 12 patients.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

8.

Gastrointestinal therapeutic system for acetazolamide. Efficacy and side effects.

Author: TheeuwesF, BayneW, McGuireJ

Lower intraocular pressure
Reduced side effects

The new gastrointestinal therapeutic system (GITS 15/125) formulation of acetazolamide was found to be as effective as conventional acetazolamide tablets in reducing intraocular pressure with fewer side effects such as drowsiness, tingling feet, tingling hands, and confusion.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

9.

[Acetazolamide in acute heart failure].

Author: JoltiMickaël, Darbellay FarhoumandPauline, CarballoDavid, CarballoSebastian

Faster decongestion
Treat heart failure

Acetazolamide, in addition to standard care loop diuretics, was shown to be effective in decongesting patients with acute heart failure. This approach was associated with fewer side effects and resulted in faster decongestion than standard care alone.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : French

10.

Promising Natural Medicines for the Treatment of High-Altitude Illness.

Author: LiLi, LinLin, WenBo, ZhaoPeng-Cheng, LiuDa-Sheng, PangGuo-Ming, WangZi-Rong, TanYong, LuCheng

High-altitude illness treatment

This review explores the use of natural medicines in the treatment of high-altitude illness (HAI). It summarizes the current evidence on the efficacy and safety of various natural medicines for different types of HAI and discusses their potential mechanisms of action.

ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

11.

Managing primary open-angle glaucoma in the setting of suboptimal surgical outcomes in the fellow eye.

Author: HuangMarshall J, SamuelsonThomas W, De FrancescoTiciana, LevinAriana, SieckErin, GazzardGus, PorterMatt, GallardoMark, ChangRobert T, LiuWendy W, ChayaCraig, GulatiShawn, ShahManjool

Elevated IOP
Glaucoma progression

This case report describes a patient with glaucoma who did not respond well to traditional medical management. The patient underwent left eye cataract surgery with viscocanaloplasty and Hydrus microstent insertion, but IOP remained high. Trabeculectomy was eventually performed, but the surgery was complicated by a thick Tenon layer.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

12.

[Combination diuretic therapy in heart failure].

Author: MassopKaren, KramersC Kees

Improved decongestion

This study investigated the use of acetazolamide (Diamox) in combination with loop diuretics for patients with decompensated heart failure. The study found that adding acetazolamide resulted in a higher rate of decongestion without seemingly more side effects.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Dutch

15.

Case report: Novel <i>SCN4A</i> variant associated with a severe congenital myasthenic syndrome/myopathy phenotype.

Author: BergholdVeronika M, KokoMahmoud, BeruttiRiccardo, PleckoBarbara

Side effects

This report describes a case of a patient with a severe congenital myopathy phenotype originally diagnosed as mitochondrial myopathy, but later revealed to be a SCN4A-related myopathy based on genetic testing. The study highlights the importance of genetic testing in severe myopathies, particularly in regard to treatment options.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

16.

Case report: Sodium and chloride muscle channelopathy coexistence: A complicated phenotype and a challenging diagnosis.

Author: PagliaraniSerena, MeolaGiovanni, FilaretiMelania, ComiGiacomo Pietro, LucchiariSabrina

Successful genetic diagnosis
Gastrointestinal side effects

This case study describes a woman with a complex phenotype caused by coexisting mutations in both the <i>CLCN1</i> and <i>SCN4A</i> genes, leading to myotonia congenita (MC) and paramyotonia congenita (PMC).

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

17.

Papilledema and idiopathic intracranial hypertension due to the possible potentiation of ATRA by posaconazole in a case of acute promyelocytic leukemia.

Author: AtasUnal, Aydin ErsoyMerve, IltarUtku, YucelOrhan Kemal, TurkogluElif Betul, SalimOzan

IIH

This case report discusses the diagnosis and treatment process of idiopathic intracranial hypertension (IIH) emerging in a young acute promyelocytic leukemia (APL) case.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

18.

Bilateral choroidal effusions after taking acetazolamide for altitude sickness.

Author: RothwellAlice, AndersonOwen

Blurred vision
Choroidal effusions

Acetazolamide is a medication commonly used to prevent altitude sickness. This case report describes a healthy woman who developed myopia and bilateral choroidal effusions after taking a single dose of acetazolamide for a hiking trip. This is the first reported case of choroidal effusions as a side effect of acetazolamide's prophylactic use for altitude sickness.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

20.

Safety of Memantine in Combination with Potentially Interactive Drugs in the Real World: A Pharmacovigilance Study Using the Japanese Adverse Drug Event Report (JADER) Database.

Author: SatoKenichiro, ManoTatsuo, IwataAtsushi, TodaTatsushi

Alzheimer's disease treatment
Memantine interactions

Memantine is an NMDA receptor antagonist used to treat Alzheimer's disease. It should be used with caution in combination with amantadine or dextromethorphan due to potential interactions that may increase adverse effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

21.

Benign intracranial hypertension associated with inhaled corticosteroids in a child with asthma.

Author: TrayerJames, O'RourkeDeclan, CassidyLorraine, ElnazirBasil

Asthma control
Benign intracranial hypertension
Steroid side effects

This case report highlights the possibility of benign intracranial hypertension (BIH) as a side effect of moderate doses of inhaled corticosteroids.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

22.

Oral acetazolamide for intraocular pressure lowering: balancing efficacy and safety in ophthalmic practice.

Author: GulatiShawn, ArefAhmad A

Lower IOP
Allergy
Side effects

Acetazolamide, a carbonic anhydrase inhibitor, is a valuable adjunct to topical therapy for lowering intraocular pressure in glaucoma. While not a first-line option, its benefits can outweigh risks in many circumstances, requiring careful monitoring for potential side effects and allergic reactions.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

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