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Starting Acetazolamide (Diamox)

Submitted by deb on Fri, 02/01/2013 - 21:45

Because this is a frequently asked question from patients we post here a reply:

Question:

My doctor wants to prescribe a medication called acetazolamide. Is that okay for someone with Hypokalemic periodic paralysis. When I
look on the web it says this medication causes you to excrete potassium. How can that be good for me?

Answer:

The "starter pak" is Diamox (acetazolamide) plus a potassium supplement. While Diamox reduces (or stops) the number of attacks, it also
causes you to excrete potassium in your urine, so you need to take some potassium to make up for what you lose.

Diamox can cause uncomfortable (but not dangerous) side e�ects if you begin with too large of a dose. The side e�ects are:

1) tingling in �ngers, toes, cheeks, lips and end of the nose, especially if you go out in the cold,

2) headache

3) visual weirdness. Diamox was used originally to treat people with glaucoma, which causes too much pressure inside the eyeball. It
reduces the pressure inside your eyeballs and changes the shape of your eyes slightly.

4) Diamox also can cause some stomach pain, nausea and loss of appetite. People often lose 10 pounds when they �rst go on it. It's best to
take it with a meal. The weight-loss e�ect doesn't last or it would be sold as a weight-loss drug.

5) it makes carbonated beverages like coke, pepsi, etc. taste weird for about six months. This e�ect fades after a while.

Talk to your doctor about starting Diamox slowly. Most have no objections to a slow start to reduce chances of side e�ects. If at
any point side e�ects are bothersome you can stay at that level until you adjust and then begin moving up again. After reports from
hundreds of patients it seems the best way to start Diamox is to take 1/2 of a 250 mg tablet (that is 125 mg) with your breakfast, and no
more, for an entire week. If you have no uncomfortable side e�ects, then in the second week you take 1/2 pill at breakfast and 1/2 pill
with dinner. In the third week you take 1/2 pill with breakfast, lunch and dinner. In the fourth week you take 1/2 pill with each meal and
1/2 pill with a substantial snack before bed. By this point you may �nd you are taking enough to make you feel much much better. But
you continue with this incremental regime until you reach the lowest dose which controls your symptoms.

If 1/2 of a pill (or 125 mg) causes very unpleasant side e�ects, drop back to 1/4 of a pill and follow the regime above, increasing only in
1/4 increments.

>What kind of potassium will he give me? I thought potassium was dangerous.

As far as potassium is concerned, individuals vary, there are dozens of di�erent kinds on the market and your doctor may have a
preference for the one he wants you to try. I �nd that one called "K-Lyte" is easiest on my stomach. It's a big tablet like an alka-selzter. You
drop it in water and it �zzes up to produce an orange-�avoured drink which doesn't taste too bad. We vary as which kind of potassium
works best for us and which bothers our stomach the least. But K-Lyte is a good place to start. You usually take one or two a day to replace
the potassium Diamox makes you pee out.

Potassium is required by the body to function, and in your case the abnormal movement of potassium into your muscles is causing an
imbalance between the level inside and outside the muscle cell. Taking some potassium helps to correct that imbalance and makes the
muscle cells function more normally.

The weakness in your legs you describe is almost certainly what is called an "abortive attack". That's an attack where you are more or less
weak for long periods of time. The amount of weakness may vary from day to day, or even hour to hour, but this is the kind of weakness
which eventually becomes permanent. We think that taking Diamox and potassium (K+) can help reduce or even avoid the development
of permanent weakness. The mantra is "Time is Muscle".

Tags:
Medications

Section:
Doctor Patient

Classification:
Andersen-Tawil Hyperkalemic Hypokalemic Normokalemic