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Carbonic anhydrase inhibitors are a medication used to manage and treat glaucoma, idiopathic intracranial hypertension, altitude sickness, congestive heart failure, and epilepsy, among other diseases. Carbonic anhydrase inhibitors are considered part of the diuretic class of medications. This article reviews the indications, action, and contraindications for carbonic anhydrase inhibitors as valuable agents in treating glaucoma, idiopathic intracranial hypertension, and other disorders. This activity will highlight the mechanism of action, adverse event profile, and other key factors, e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, and relevant interactions pertinent for members of the interprofessional healthcare team in the treatment of patients with glaucoma, idiopathic intracranial hypertension, and related conditions. Objectives: Identify the mechanism of action of carbonic anhydrase inhibitors. Describe the potential adverse effects of carbonic anhydrase inhibitors. Review the appropriate monitoring necessary for carbonic anhydrase inhibitors. Outline interprofessional team strategies for improving care coordination and communication to improve outcomes in patients receiving treatment with carbonic anhydrase inhibitors. Access free multiple choice questions on this topic.

There have been reports of toxicity in a few cases in chronically receiving aspirin therapy and patients undergoing hemodialysis. Symptoms of toxicity are lethargy, confusion, fatigue, and incontinence. Salicylate may compete with acetazolamide plasma protein binding and inhibit renal clearance.[14] Similarly, patients on dialysis should avoid this class of drugs due to inhibited renal function and the risk of elevated serum concentrations.[15] Symptoms of toxicity resolve a few days after discontinuing the medication. There is no reported antidote for carbonic anhydrase inhibitor toxicity.

Due to the risks of serious adverse effects such as toxicity, hepatic failure, and SJS/TEN, carbonic anhydrase inhibitors should be prescribed cautiously. It is essential for all interprofessional healthcare team members, including clinicians (MDs, DOs, NPs, and PAs), nurses, and pharmacists, to know the contraindications and recognize the side effects of these medications. Effective communication between the team and the patient is essential to reduce adverse effects. There is no antidote for carbonic anhydrase inhibitors; therefore, medication use in patients with impaired renal and liver function requires close monitoring. Nurses can participate in patient counseling and serve as a contact point for clinicians. Pharmacists should verify appropriate dosing based on indication, perform medication reconciliation to check for drug-drug interactions, and can also counsel the patient on dosing, administration, and potential adverse events. When prescribing carbonic anhydrase inhibitors, this interprofessional approach to care will drive improved outcomes and reduce potential adverse events. It is the job of the interprofessional healthcare team to ensure that the patient understands the difference in administration through oral or topical routes. In the setting of severe glaucoma, patients may be taking several topical and oral intraocular pressure-lowering drugs and should be careful to use the recommended dosages. Ophthalmic eye drop bottles with different cap colors may help avoid confusion and over administration. Many randomized-control trials and meta-analyses have confirmed the safety and efficacy of topical carbonic anhydrase inhibitors, such as dorzolamide and brinzolamide, combined with other glaucoma medications such as prostaglandin analogs or beta-blockers.[16] [Level 1]