ACETAZOLAMIDE TILLOMED

Posology i) Glaucoma (simple acute congestive and secondary):

Adults: 250 - 1000mg per 24 hours, usually in divided doses for amounts over 250mg daily. ii) Abnormal retention of fluid: Congestive heart-failure, drug-induced oedema.

Adults:

For diuresis, the starting dose is usually 250 - 375mg once daily in the morning. If, after an initial response, the patient fails to continue to lose oedema fluid do not increase the dose but allow for kidney recovery by omitting a day.

Best results are often obtained on a regime of 250 - 375mg daily for two days, rest a day and repeat or merely giving Acetazolamide injection every other day. g. digitalis, bed rest and salt restriction in congestive heart failure and proper supplementation with elements such as potassium in drug-induced oedema.

For cases of fluid retention associated with pre-menstrual tension, a daily dose (single) of 125 - 375mg is suggested. iii) Epilepsy Adults: 250 - 1000mg daily in divided doses. Children: 8 - 30mg/kg in daily divided doses and not to exceed 750mg/day.

The change from other medication to Acetazolamide injection should be gradual.

Elderly:

Acetazolamide injection should only be used with particular caution in elderly patients or those with potential obstruction in the urinary tract or with disorders rendering their electrolyte balance precarious or with liver dysfunction.

6 below. Method of Administration Intravenous or intramuscular injection. The direct intravenous route is preferred as intramuscular use is limited by the alkaline pH of the solution.

The following adverse reactions are classified by system organ class and ranked under heading of frequency using the following convention: Not known (cannot be estimated from the available data). 2 Decreased appetite, hyponatraemia, hyperglycaemia, hypoglycaemia .

3 Flaccid paralysis and seizures. 1 1 Acetazolamide is a sulphonamide derivative and therefore some side effects similar to those caused by sulphonamides have occasionally been reported. 2 During long-term therapy, metabolic acidosis and electrolyte imbalance may occasionally occur.

This can usually be corrected by the administration of bicarbonate. 3 Adverse reactions during short-term therapy are usually non-serious. 4 The condition invariably subsides upon diminution or discontinuation of the medication. Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.

It allows continued monitoring of the benefit/risk balance of the medicinal product. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Suicidal ideation and behaviour have been reported in patients treated with antiepileptic agents in several indications. A meta-analysis of randomised placebo controlled trials of anti-epileptic drugs has also shown a small increased risk of suicidal ideation and behaviour.

The mechanism of this risk is not known and the available data do not exclude the possibility of an increased risk for Acetazolamide injection. Therefore, patients should be monitored for signs of suicidal ideation and behaviours and appropriate treatment should be considered.

Patients (and caregivers of patients) should be advised to seek medical advice should signs of suicidal ideation or behaviour emerge. Increasing the dose does not increase the diuresis and may increase the incidence of drowsiness and/or paraesthesia.

Increasing the dose often results in a decrease in diuresis. Under certain circumstances, however, very large doses have been given in conjunction with other diuretics in order to secure diuresis in complete refractory failure. When Acetazolamide injection is prescribed for long-term therapy, special precautions are advisable.

The patient should be cautioned to report any unusual skin rash. Periodic blood cell counts, and electrolyte levels are recommended. Fatalities have occurred, although rarely, due to severe reactions to sulphonamides including acetazolamide, such as Steven-Johnson syndrome and toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anaemia and other blood dyscrasias and anaphylaxis.

A precipitous drop in formed blood cell elements or the appearance of toxic skin manifestations should call for immediate cessation of Acetazolamide injection therapy. Acetazolamide treatment may cause electrolyte imbalances, including hyponatraemia and transient hypokalaemia, as well as metabolic acidosis.

Therefore, periodic monitoring of serum electrolytes is recommended. Particular caution is recommended in patients with conditions that are associated with, or predispose to, electrolyte and acid/base imbalances, such as patients with impaired renal function (including elderly patients), pulmonary obstruction or emphysema patients with diabetes mellitus and patients with impaired alveolar ventilation may be impaired.

Severe metabolic acidosis has been reported in patients with normal renal function during treatment with acetazolamide and salicylates. Both increases and decreases in blood glucose levels have been described in patients treated with acetazolamide.

This should be taken into consideration in patients with impaired glucose tolerance or diabetes mellitus. In patients with a past history of renal calculi, benefit should be balanced against the risks of precipitating further calculi.

1. Care should be taken during intravenous administration of alkaline preparations to avoid extravasation and possible development of skin necrosis. 8). In case of AGEP diagnosis, acetazolamide should be discontinued and any subsequent administration of acetazolamide contraindicated.

8). Non-cardiogenic pulmonary oedema typically developed within minutes to hours after acetazolamide intake. Symptoms included dyspnoea, hypoxia, and respiratory insufficiency. If non- cardiogenic pulmonary oedema is suspected, acetazolamide should be withdrawn, and supportive treatment should be given.

Acetazolamide should not be administered to patients who previously experienced non-cardiogenic pulmonary oedema following acetazolamide intake. Cases of choroidal effusion/detachment have been reported after the use of acetazolamide.

Symptoms include acute onset of decreased visual acuity or ocular pain and can occur within hours after initiation of acetazolamide treatment. If choroidal effusion/detachment is suspected, acetazolamide should be discontinued as rapidly as possible.

1. Acetazolamide injection should not be used in patients hypersensitive to sulphonamides. Acetazolamide injection is contraindicated in situations in which sodium and/or potassium blood levels are depressed, in cases of marked kidney and liver dysfunction, suprarenal gland failure and hyper-chloremic acidosis.

Acetazolamide injection should not be used in patients with hepatic cirrhosis as this may increase the risk of hepatic encephalopathy. Long-term administration of Acetazolamide injection is contra-indicated in patients with chronic non-congestive angle-closure glaucoma since it may permit organic closure of the angle to occur while the worsening glaucoma is masked by lower intraocular pressure.