|
American Academy of
Opthalmology
|
Oral acetazolamide
is 100 percent excreted unchanged, which means that the drug is eliminated
through the kidneys and does not depend on metabolism for inactivation of the
drug. Therefore, creatinine clearance (CrCl) directly influences the duration
of action.
Dosage adjustments
in CKD. The following dosages are recommended for patients with renal
compromise:
If CrCl > 50
mL/min: Use full dose (250 mg four times a day or 500 mg extended-release
capsule [e.g., Diamox Sequels] twice daily).
If CrCl 10 to 50
mL/min: Use a half dose (250 mg twice daily).
If CrCl < 10
mL/min: Do not give acetazolamide.
If the patient is on hemodialysis: Use a half dose (250 mg
twice daily).
If the patient is on
peritoneal dialysis: Use 125 mg daily.3-5
In patients with
end-stage renal disease, oral acetazolamide has been found to reduce IOP only
50 percent as much as it does in healthy patients.
|
|
Micromedex
|
62.5 to 125 mg daily
after dialysis; titrate to effect and toxicity
|
|
Medscape
|
20-50% Dialysable
|
|
Acetazolamide in
Hemodialysis Patients: A Rational Use After Ocular Surgery [Roy et al. 1992]
|
250 mg STAT (loading
dose), then 125 mg daily
If prescribed for
more than 4 days, plasma levels of acetazolamide
should be measured
|
|
Acetazolamide
Toxicity and Pharmacokinetics in Patients Receiving Hemodialysis
[Schwennk et al.
1995]
|
62.5-125 mg/day
would be approximate,
titrated to effect,
toxicity, and therapeutic drug monitoring (if available)
The desired serum acetazolamide concentration range
is 5-10 mcg/ml (total drug), which has been associated with maximum lowering
of intraocular pressure," although some clinicians proposed a range of
15-20 mcg/ml for optimum long-term control of ocular hypertension
|
|
The Renal Drug
Handbook (Third Edition, 2009)
|
Dose for CrCl <
10 mL/min: 250 mg daily
HD: Unlike
dialysability – 250 mg daily
HDF (high flux):
Unknown dialysability – 250 mg daily
|
Monitor for central nervous system toxicity, included fatigue, lethargy,
and confusion
All information was
accessed on 16.01.2020