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Published online by Cambridge University Press: 06 October 2020
THERAPEUTICS
Brands
• Diamox, Diamox-Sequels, Azomid, AZM,Dazamide, Novo-Zolamide
Generic?
• Yes
Class
• Antiepileptic drug (AED)
Commonly Prescribed for
(FDA approved in bold)
• Adjunctive treatment for centrencephalic epilepsies (petit mal, unlocalized)
• Acute mountain sickness
• Edema due to congestive heart failure or medication
• Glaucoma
• Adjunctive treatment for generalized tonicclonic and partial seizures
• Idiopathic intracranial hypertension (IIH) (pseudotumor cerebrii)
• Episodic ataxias type 1 and 2
• Hemiplegic migraine
• Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS)
• Marfan syndrome
• Sleep apnea
How the Drug Works
• Blocks the carbonic anhydrase enzyme, which is responsible for converting carbon dioxide and water to bicarbonate. This increases excretion of sodium, potassium, bicarbonate, and water, producing alkaline diuresis. In epilepsy, it decreases excessive neuronal discharge in CNS due to either slight degree of acidosis or perhaps reduction of extracellular calcium. It also reduces production of CSF and aqueous humor
How Long Until It Works
• Seizures: within a few days
• IIH: maximum benefit in 4–6 weeks
If It Works
• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated. Consider tapering and slowly stopping after 2 years seizure-free, depending on the type of epilepsy
• IIH: monitor visual fields and papilledema and symptoms such as visual obscurations and headache
If It Doesn't Work
• Increase to highest tolerated dose
• Seizures: consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind
• IIH: eliminate symptomatic causes such as drugs or toxins, encourage weight loss if patient is obese, consider loop diuretics or topiramate. Lumbar puncture often provides short-term relief of symptoms. For visual loss, optic nerve defenestration or CSF shunting (lumboperitoneal or ventriculoperitoneal) may be needed
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