The efficacy and drug interactions of acetazolamide tablets
Acetazolamide tablets, as carbonic anhydrase inhibitors, mainly produce diuretic effects by inhibiting renal tubular carbonic anhydrase, while reducing intraocular pressure and regulating acid-base balance. Its drug interactions involve an increased risk of electrolyte imbalance, metabolic enzyme effects, and specific drug synergistic effects. Special attention should be paid to monitoring requirements when used in combination with potent diuretics, antiepileptic drugs, etc.
1. Main functions and effects
(1) Diuretic effect: selectively inhibits proximal tubular carbonic anhydrase, reduces Na+- H+exchange, promotes HCO3-, Na+, K+excretion, and produces weak diuretic effect.
(2) Mechanism of intraocular pressure reduction: By inhibiting ciliary carbonic anhydrase and reducing aqueous humor production, it is suitable for acute attacks of glaucoma.
(3) Metabolic acidosis: Long term use can cause loss of HCO3-, used to correct metabolic alkalosis and prevent altitude sickness.
2. Important drug interactions
(1) Strong diuretics: Combination with furosemide may worsen hypokalemia, and electrolyte and ECG changes need to be monitored.
(2) Antiepileptic drugs: reduce the excretion of phenytoin, increase the risk of central toxicity, and adjust the dosage when used in combination.
(3) Salicylic acid drugs: Compete with renal tubular secretion channels, which may cause toxic symptoms such as tinnitus and drowsiness.
3. Special interaction mechanism
(1) Lithium salt preparation: increases lithium kidney excretion, reduces blood lithium concentration, requires monitoring of efficacy and adjustment of dosage.
(2) Hypoglycemic drugs: may weaken the effect of sulfonylurea on blood glucose, and diabetes patients need to strengthen blood glucose monitoring.
(3) Quinidine: Alkalizing urine can reduce the excretion of quinidine, potentially increasing the risk of cardiac toxicity.
4. Metabolic related interactions
(1) CYP450 enzyme substrate: As a weak inhibitor of CYP3A4, it may affect the blood drug concentration of drugs metabolized by this enzyme.
(2) P-gp transporter: When used in combination with P-gp substrates such as digoxin, attention should be paid to changes in absorption rate, and it is recommended to take it in batches.
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