Diamox: Effective Acetazolamide for Glaucoma & Altitude Sickness
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Synonyms | |||
Diamox, known generically as acetazolamide, is a carbonic anhydrase inhibitor prescription medication with established efficacy in managing elevated intraocular pressure and preventing or ameliorating symptoms of acute mountain sickness. Its mechanism of action reduces aqueous humor production in the eye and facilitates acclimatization to high altitude by inducing a metabolic acidosis, promoting ventilation. This expert-oriented guide details its pharmacological profile, appropriate use, and essential safety information for healthcare professionals and informed patients.
Features
- Active ingredient: Acetazolamide
- Drug class: Carbonic anhydrase inhibitor
- Available formulations: Oral tablets (125 mg, 250 mg) and extended-release capsules (500 mg)
- Prescription status: Rx-only medication
- Mechanism: Reversible inhibition of carbonic anhydrase enzymes
Benefits
- Effectively lowers intraocular pressure in open-angle glaucoma and secondary glaucomas
- Prevents and treats symptoms of acute mountain sickness including headache, nausea, and dizziness
- Adjunctive therapy in certain types of epilepsy, particularly absence seizures
- Reduces fluid retention in heart failure patients when other diuretics are insufficient
- Off-label utility in treating periodic paralysis syndromes and central sleep apnea
- Facilitates faster acclimatization to high-altitude environments
Common use
Diamox is primarily indicated for the management of various forms of glaucoma, including chronic simple (open-angle) glaucoma and secondary glaucomas. It is equally recognized for its effectiveness in preventing and treating the symptoms of acute mountain sickness (AMS) in individuals ascending to high altitudes. Additionally, it serves as an adjunctive therapy for certain seizure disorders and is used in the management of edema due to congestive heart failure. Off-label applications include treatment for periodic paralysis and metabolic alkalosis.
Dosage and direction
For glaucoma management: Adults typically receive 250 mg to 1 g daily in divided doses, usually every 6-8 hours. The extended-release formulation (500 mg) may be administered twice daily. For acute mountain sickness: 125 mg to 250 mg twice daily, starting 24-48 hours before ascent and continuing for 48 hours after reaching the target altitude. For epilepsy: 8-30 mg/kg/day in divided doses. Pediatric dosing must be carefully calculated based on weight and indication. Always administer with plenty of water to minimize renal calculi risk.
Precautions
Patients should maintain adequate hydration to reduce the risk of kidney stone formation. Regular monitoring of electrolyte levels, particularly potassium, is recommended during prolonged therapy. Use with caution in patients with respiratory acidosis or significant pulmonary obstruction. Hepatic and renal function should be assessed periodically during long-term treatment. May cause drowsiness or blurred vision - patients should avoid driving or operating machinery until response is known. Sulfonamide cross-sensitivity reactions may occur.
Contraindications
Absolute contraindications include hypersensitivity to acetazolamide or sulfonamides, significant renal or hepatic dysfunction, adrenal gland failure, and hypokalemia or hyponatremia. Should not be used in patients with severe pulmonary obstruction leading to CO2 retention, or in those with chronic non-congestive angle-closure glaucoma. Contraindicated in patients with metabolic acidosis and in those with long-term use of high-dose aspirin.
Possible side effect
Common adverse effects include paresthesia (tingling sensations), particularly in extremities and perioral region; gastrointestinal disturbances (nausea, vomiting, diarrhea); altered taste perception (especially carbonated beverages); polyuria; and drowsiness. Less frequently, patients may experience metabolic acidosis, electrolyte imbalances, renal calculi, transient myopia, or blood dyscrasias. Serious but rare side effects include Stevens-Johnson syndrome, toxic epidermal necrolysis, and fulminant hepatic necrosis.
Drug interaction
Significant interactions occur with other diuretics (potentiating hypokalemia), salicylates (increased risk of toxicity), amphetamines (prolonged effect), methenamine (reduced efficacy), and lithium (increased lithium levels). May enhance effects of folic acid antagonists and hypoglycemic agents. Concurrent use with other carbonic anhydrase inhibitors should be avoided. Caution with CYP3A4 substrates due to potential metabolic interactions.
Missed dose
If a dose is missed, administer it as soon as remembered unless it is nearly time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration. Consistent dosing is important for maintaining therapeutic effects, particularly in glaucoma management.
Overdose
Symptoms of overdose may include electrolyte imbalance, metabolic acidosis, drowsiness, confusion, and polyuria. Severe overdose can lead to convulsions, coma, and cardiovascular collapse. Treatment is supportive and symptomatic, including electrolyte correction and respiratory support. Hemodialysis may be effective in removing acetazolamide. There is no specific antidote.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in a tightly closed container. Protect from light and moisture. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Properly discard any unused medication through take-back programs or following FDA-recommended disposal methods.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting, changing, or stopping any medication. The prescribing physician should make dosage determinations based on individual patient factors. This document does not replace the official prescribing information provided by the manufacturer.
Reviews
Clinical studies demonstrate Diamox’s efficacy in reducing intraocular pressure by 40-60% in glaucoma patients. For altitude sickness prevention, research shows a 75% reduction in symptom incidence compared to placebo. Many mountaineering expeditions include Diamox as standard prophylaxis above 3,000 meters. Ophthalmologists report reliable pressure reduction, though many prefer it as adjunctive rather than primary therapy due to side effect profile. Patient experiences frequently note the characteristic tingling sensations as a expected but manageable side effect.