Thursday, January 16, 2020

Dose of Acetazolamide in Hemodialysis (HD) Patient


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