Acetazolamide contraindications

Contraindications Severe renal disease, adrenal insufficiency, hypochloremic acidosis, hypersensitivityto acetazolamide, to any component of the formulation, orto sulfonamides. 

Metabolic alkalosis is generally treated by correction of abnormalities in total body K+, intravascular volume, or mineralocorticoid levels. However, when the alkalosis is due to excessive use of diuretics in patients with severe heart failure, replacement of intravascular volume may be contraindicated. In these cases, acetazolamide can be useful in correcting the alkalosis as well as producing a small additional diuresis for correction of volume overload. Acetazolamide can also be used to rapidly correct the metabolic alkalosis that may develop in the setting of respiratory acidosis. 

Contraindications to the use of methazolamide are the same as those associated with the use of acetazolamide. Methazolamide, however, can be used more safely in patients with a history of kidney stones or renal impairment. Patients with COPD may tolerate methazolamide better than acetazolamide, because the metabolic acidosis is less pronounced. 

Use of Oral CAIs in Clinical Practice. Use of oral CAIs is generally limited to the management of acute primary ACG or in cases where other efforts have been proven to be inadequate or contraindicated. In chronic use, methazolamide 25 or 50 mg three times a day generally carries a more favorable side effect profile than acetazolamide in any form. If acetazolamide must be used chronically, then 500 mg (at bedtime or twice daily) in a sustained-release form is preferred. This formulation may... 

Fatal anaphylactic shock with massive pulmonary edema has been reported in a 66-year-old woman who was taking acetazolamide for glaucoma (21). She had a history of sulfonamide allergy, and acetazolamide is a sulfonamide derivative. Sulfonamide allergy should be regarded as a contraindication to acetazolamide. 

Methenamine and methenamine mandelate are only effective as urinary antisepties if the pH is about 5.5 or lower, when formaldehyde is released. This is normally achieved by giving urinary acidifiers such as ammonium chloride, ascorbic acid, or sodium acid phosphate. In the case of methenamine hippurate, the acidification of the urine is achieved by the presence of hippuric acid. The concurrent use of substances that raise the urinary pH such as acetazolamide, sodium bicarbonate, potassium or sodium citrate is clearly contraindicated. Potassium citrate mixture BPC has been shown to raise the pH by more than 1 at normal therapeutic doses, thereby making the urine sufficiently alkaline to interfere with the activation of methenamine to formaldehyde. Some antacids (containing magnesium, aluminium or calcium as well as sodium bicarbonate mentioned above) can also cause a significant rise in the pH of the urine. ... 

It has been su ested, but not confirmed, that because increased levels of carbon dioxide in the tissues can increase the sensitivity to oxygen-induced convulsions, carbonic anhydrase inhibitors, such as acetazolamide, are contraindicated in those given hyperbaric oxygen, because they cause carbon dioxide to persist in the tissues. Nor should hyperbaric oxygen be given during opioid or barbiturate withdrawal because the convulsive threshold of such patients is already low. ... 

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