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Acetazolamide is a diuretic and carbonic anhydrase inhibitor medication used to treat several illnesses. It works to cause an accumulation of carbonic acid by preventing its breakdown. FDA-approved indications include glaucoma, idiopathic intracranial hypertension, congestive heart failure, altitude sickness, periodic paralysis, and epilepsy. In addition, it is used off-label for central sleep apnea, Marfan syndrome, prevention of high-dose methotrexate nephrotoxicity, and prevention of contrast-induced nephropathy. This activity outlines the indications, contraindications, interactions, monitoring, and other therapeutic information pertinent to members of an interprofessional team in the care of patients with conditions requiring the use of acetazolamide. Objectives: Identify the indications for acetazolamide, both FDA-approved and off-label. Describe the mechanism of action of acetazolamide. Summarize the adverse event profile of acetazolamide. Explain the importance of collaboration and coordination among the interprofessional team and how it can enhance patient care with acetazolamide therapy to improve patient outcomes for patients with indicated conditions. Access free multiple choice questions on this topic.

There have been reports of central nervous system (CNS) toxicity with coma.[27] In addition, hyperchloremic metabolic acidosis and electrolyte disturbances are usually seen in acetazolamide overdose. Therefore, clinicians should rapidly obtain serum electrolyte levels (especially serum potassium) and arterial blood gas analysis. According to product labeling, there is no specific antidote to acetazolamide; hence treatment is usually supportive. Bicarbonate administration can usually correct metabolic acidosis. Despite its plasma protein binding and high RBC distribution, acetazolamide may be dialyzable. Dialysis may be especially valuable in managing acetazolamide overdosage complicated with acute kidney injury.

Acetazolamide is not frequently used in clinical medicine, but clinicians need to know the drug's adverse effects and contraindications. Patients require education from the team, including the clinician, nurse, and pharmacist, on the dose and indications of the drug and to report any side effects. Because there is no antidote to acetazolamide, it is essential to emphasize to the patient to seek immediate care if there is an overdose. The prescriber should work with the pharmacist on medication reconciliation to ensure no drug-drug interactions. The prescriber should also use Tall Man (mixed case) lettering for the prescription of acetazolamide which is included in look-alike-sound-alike drugs.[11] Pharmacists should also verify that the prescription as acetazolamide is included in the ISMP (Institute for Safe Medication Practices) medication list to avoid confusion.[28] The nurse should be able to monitor the patient on subsequent visits, counsel on medication administration, and verify patient adherence. Nursing is often a bridge between the prescriber, pharmacist, and other clinicians. All interprofessional team members must document their findings in the patient's record whenever they interact with them. They are also responsible for communicating to the appropriate team members if any changes in the patient's status may merit attention. The interprofessional healthcare team can optimize therapy with acetazolamide while minimizing adverse events, resulting in better therapeutic outcomes for the patient. [Level 5]