Hemodialyzability of Acetazolamide

Acetazolamide Intoxication in an Elderly Patient with Diabetes and Chronic Renal Failure after Cataract Surgery

“…Despite its high intraerythrocytic distribution and plasma binding properties (about 94%), acetazolamide can be effectively removed by dialysis, especially if renal impairment coexists. It is estimated that the rate of acetazolamide clearance in hemodialysis is about 150 mg in 4 hours and the acetazolamide-to-urea nitrogen excretion ratio is 0.16, which allows the prediction of the acetazolamide dialysance in several dialyzing conditions [4]. As expected, the drug was rapidly eliminated in our patient, with rapid and full neurologic recovery.…”

“…Unfortunately, ammonia levels and toxicological screen tests were not measured in our patient. However, a classic feature of acetazolamide intoxication, in contrast to uremic symptoms, is the rapid recovery and resolution of the symptoms soon after the start of renal replacement therapy, as the medication is easily dialyzable [4,9].…”

“…is mechanism of action is based on the reduction of cerebrospinal fluid (CSF) secretion by the choroid plexus, where acetazolamide affects both ion transport and protein expression [3]. erefore, acetazolamide is commonly used to treat elevated intraocular pressure, fluid retention, and epilepsy, as well as other rare diseases such as high altitude sickness, hypokalemic periodic paralysis, hydrocephalus, and Meniere's disease [4].…”

Systemic Side Effects of Glaucoma Medications

“…Thus, patients at known risk for renal insufficiency, such as diabetics and hypertensives, should have baseline measurement of blood urea nitrogen (BUN) and creatinine levels at the time of initiation of acetazolamide. Because the efficiency of dialysis in removing acetazolamide is only 30% of the efficiency of eliminating urea nitrogen, the dose frequency may need to be spaced at intervals greater than 24 h. 83 Though, not validated without measuring plasma levels, one possible maintenance dose regimen of acetazolamide is 125-250 mg after each dialysis session. However, in the presence of renal insufficiency, dose adjustment guided by determination of plasma levels is mandated to prevent unwanted toxicity.…”

Acetazolamide toxicity and dosing in dialysis patients

“…It is moderately dialyzable by HD, with 30% of administered dose cleared after a 4-h session using a dialysate flow rate of 500 mL/min and a blood flow rate of 200 mL/min. 3 Its removal is limited via peritoneal dialysis (PD), with only 6.8% cleared over 24 h despite a rigorous regimen of four 2.5 L 4-h exchanges and one 2.5 L 8-h exchange. 4 Its half-life of 1.7-5.8 h lengthens significantly to 26-60.8 h in HD patients 1,2 and 20.6-28.5 h in PD patients.…”