Carbonic anhydrase inhibitor combination agent

Glaucoma Management of open-angle (chronic simple) glaucoma may be used in combination with miotics, beta blockers, hyperosmotic agents, or carbonic anhydrase inhibitors. 

Concomitant therapy Cholinesterase inhibitors may be used in combination with adrenergic agents, -blockers, carbonic anhydrase inhibitors, or hyperosmotic agents. 

It may be necessary to combine these or add another agent such as oral acetazolamide and/or dorzolamide eye drops, which are both carbonic anhydrase inhibitors that reduce aqueous humour production. 

THERAPEUTIC USES The efficacy of carbonic anhydrase inhibitors as single agents for the treatment of edema is low. However, the combination of acetazolamide with diuretics that block Na+ reabsorption at more distal sites in the nephron causes a marked natriuretic response in patients with low basal fractional excretion of Na (<0.2%), who are resistant to diuretic monotherapy. Even so, the long-term usefulness of carbonic anhydrase inhibitors often is compromised by the development of metabohc acidosis. 

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