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Drug - Drug Interactions Acetazolamide Drug Interactions

Acetazolamide Drug Interactions

Note that although hypokalaemia may occur with Acetazolamide it is said to be transient
and rarely clinically significant.

Acetazolamide + Aspirin

Metabolic acidosis can occur in those taking high-dose salicylates if they are given
carbonic anhydrase inhibitors (e.g. acetazolamide).

Carbonic anhydrase inhibitors should probably be avoided in those taking highdose


salicylates. If they are used, the patient should be well monitored for any evidence of
toxicity (confusion, lethargy, hyperventilation, tinnitus). In this context NSAIDs or
paracetamol (acetaminophen) may be safer alternatives. It is not known whether eye
drops interact similarly; there appear to be no reports of an interaction.

Acetazolamide + Carbamazepine

In a very small number of patients rises in serum carbamazepine levels resulting in


toxicity have occurred when acetazolamide was also given.

The general importance of this interaction is unknown, but it may be prudent to monitor
for indicators of carbamazepine toxicity (nausea, vomiting, ataxia, drowsiness) and take
levels if necessary.

Acetazolamide + Ciclosporin (Cyclosporine)

There is some limited evidence that acetazolamide can cause a marked and rapid rise
in ciclosporin serum levels (up to 6-fold in 72 hours), possibly accompanied by renal
toxicity.

Ciclosporin levels and/or effects (e.g. on renal function) should be monitored as a matter
of routine, but it may be prudent to increase monitoring if acetazolamide is started or
stopped. Adjust the dose of ciclosporin as necessary.

Acetazolamide + Lithium

There is some evidence to suggest that the excretion of lithium can be increased by
acetazolamide, but lithium toxicity has been seen in one patient given the combination.

The general importance of this interaction is unclear. Bear it in mind in case of an

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Drug - Drug Interactions Acetazolamide Drug Interactions

unexpected response to treatment.

Acetazolamide + Mexiletine

Large changes in urinary pH caused by the concurrent use of alkalinising drugs such
as acetazolamide can, in some patients, have a marked effect on the plasma levels of
mexiletine.

The effect does not appear to be predictable. The manufacturer of mexiletine


recommends that concurrent use should be avoided.

Acetazolamide + Opioids

Theoretically, urinary alkalinisers such as acetazolamide may increase the effects of


methadone.

The clinical significance of this interaction is unclear, but bear it in mind in case of an
unexpected response to methadone.

Acetazolamide + Phenobarbital

Severe osteomalacia and rickets have been seen in a few patients taking Phenobarbital or
primidone with acetazolamide. A marked reduction in serum primidone levels with a loss
in seizure control has also been described in a very small number of patients.

The general importance of this interaction is unknown. Concurrent use should be


monitored for signs or symptoms of low levels of vitamin D or osteomalacia. Stop
acetazolamide if possible should osteomalacia occur.

Acetazolamide + Phenytoin

Severe osteomalacia and rickets have been seen in a few patients taking phenytoin with
acetazolamide. Rises in phenytoin levels have also been described in a very small number
of patients. Fosphenytoin, a prodrug of phenytoin, may interact similarly.

The clinical importance of this interaction is unknown. Concurrent use should be


monitored for signs or symptoms of low levels of vitamin D, osteomalacia or phenytoin
toxicity. Stop acetazolamide if possible should osteomalacia occur. Indicators of
phenytoin toxicity include blurred vision, nystagmus, ataxia or drowsiness.

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Drug - Drug Interactions Acetazolamide Drug Interactions

Acetazolamide + Quinidine

Large rises in urinary pH due to the concurrent use of acetazolamide could cause
the retention of quinidine, which could lead to quinidine toxicity. Also note that
hypokalaemia, which may rarely be caused by acetazolamide, can increase the toxicity of
QT-prolonging drugs such as quinidine.

Monitor the effects if acetazolamide is started or stopped and adjust the quinidine dosage
as necessary. Also consider monitoring potassium to ensure it is within the accepted
range.

Refer: Stockley’s Drug Interactions

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