Carbonic anhydrase inhibitors contraindications

The carbonic anhydrase inhibitors are contraindicated in patients with known hypersensitivity to the dru , electrolyte imbalances, severe kidney or liver dysfunction, or anuria, and for long-term use in chronic non-congestive angle-closure glaucoma (may mask worsening glaucoma). 

Local side effects include burning, stinging, itching, foreign body sensation, dry eyes, and conjunctivitis. Brinzolamide may have a lower incidence of these side effects since the drug is in a neutral pH solution. Dorzolamide has been reported to cause irreversible corneal decompensation. Taste abnormalities have been reported with each agent. Both topical carbonic anhydrase inhibitors are sulfonamides and are contraindicated in patients with history of sulfonamide hypersensitivity.10,13... 

Sulfasalazine is contraindicated in individuals with hypersensitivity to salicylates, sulfonamides, sulfonylureas, and certain diuretics (furosemide, thiazides, and carbonic anhydrase inhibitors). Because it can cause kernicterus, sulfasalazine is contraindicated in infants and children under 2 years of age. Sulfasalazine passes into breast milk and is therefore contraindicated for nursing mothers. Similarly, pregnant women near term should not use this drug, although it appears to be the safest of the DMARDs during early pregnancy. 

Q10 Beta-adrenoceptor antagonists are contraindicated in patients with asthma or respiratory obstructive diseases, bradycardia, heart block or heart failure. Adrenergic agonists are contraindicated in patients with closed-angle glaucoma and should be used cautiously in patients with hypertension or heart disease. Parasympathomimetics cause poor night vision and dimming of vision, because of development of miosis, headache and brow ache. Carbonic anhydrase inhibitors have a weak diuretic action and can induce depression, drowsiness, paraesthesia, electrolyte disturbance such as hypokalaemia, acidosis and lack of appetite. 

Other Medical Conditions. Other systemic disorders can be affected by or contraindicate the use of topically applied medications. Examples include myasthenia gravis, which can be worsened with topical timolol, and erythema multiforme (Stevens-Johnson syndrome), which can be caused or exacerbated by topical ocular sulfonamides and related antiglaucoma drugs such as carbonic anhydrase inhibitors. 

Carbonic anhydrase inhibitors should be used with caution in patients with respiratory acidosis or those with severe loss of respiratory capacity, and in patients with diabetes mellitus. They are contraindicated in patients with hepatic disease or insufficiency, reduced serum concentrations of sodium or potassium, adrenocortical insufficiency, hyperchloremic acidosis, or severe renal disease or dysfunction. They should also be avoided in patients taking salicylates. 

Carbonic anhydrase inhibitors increase excretion of sodium, potassium, and bicarbonate by blocking carbonic anhydrase, which is an enzyme that maintains acid-base balance. Carbonic anhydrase inhibitors are contraindicated in the first trimester of pregnancy. 

A list of drugs for carbonic anhydrase inhibitors is provided in the Appendix. Detailed tables show doses, recommendations, expectations, side effects, contraindications, and more available on the book s Web site (see URL in Appendix). 

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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