Methazolamide dosing

Alprazolam may also relieve tremor at doses of 0.75 to 3 mg/day (357). Because chronic use can lead to habituation or dependence, alprazolam is best used episodically for patients who require only intermittent tremor reduction to prevent social embarrassment or occupational interference. Methazolamide, a carbonic anhydrase inhibitor, has been reported to reduce hand tremor (at doses of 50 to 300 mg/day) in several open studies ( 358, 359). A controlled trial, however, could not confirm the efficacy of this agent in the treatment of tremor but did report that side effects such as paresthesias, sedation, headache, and gastrointestinal symptoms were common (77, 356). 

Only 55% of methazolamide binds to plasma proteins, compared with 90% to 95% of acetazolamide. Becanse only the imboimd portion of the drug dose is pharmacologically active, methazolamide can be given at lower doses than acetazolamide to achieve comparable effects. 

Dose-response stndies of the ocnlar hypotensive effect of methazolamide have shown that lOP decreases in a dose-dependent manner for doses of 25,50, and 100 mg given every 8 honrs the mean decreases in lOP at these doses are 3 3,4.3, and 5.6 mm Hg, respectively. 

Methazolamide is one of the best-tolerated oral CAIs, especially at low doses. However, administration of this drug poses the same general risk as administration of acetazolamide, and the side effects associated with methazolamide use are essentially the same as those associated with acetazolamide. Compared with acetazolamide, methazolamide generally produces less acidosis and has less effect on urinary citrate levels.Thus, patients who are intolerant of acetazolamide may tolerate methazolamide therapy without difficulty. 

Skin eruptions can also occur. Methazolamide should be used cautiously in patients of Japanese or Korean descent. Reports of severe Stevens-Johnson syndrome have been documented, with one case occurring after a single dose. Although Stevens-Johnson syndrome has been reported after use of acetazolamide in patients with various ethnic backgrounds, methazolamide-induced Stevens-Johnson syndrome has been encountered only in the Japanese. 

Methazolamide is a derivative of acetazolamide in which one of the active hydrogens has been replaced by a methyl group. This decreases the polarity and permits a greater penetration into the ocular fluid, where it acts as a carbonic anhydrase inhibitor, reducing intraocular pressure. Its dose for glaucoma is 50 to 100 mg two to three... 

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