Diamox

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/08/01 13:49:22」(JST)

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Not to be confused with acetohexamide or methazolamide.

Acetazolamide

Systematic (IUPAC) name
N-(5-sulfamoyl-1,3,4-thiadiazol-2-yl)acetamide
Clinical data
Trade names	Diamox
AHFS/Drugs.com	monograph
Pregnancy cat.	B3 (AU) C (US)
Legal status	POM (UK) ℞-only (US)
Routes	Oral, IV
Pharmacokinetic data
Metabolism	None
Half-life	3 to 9 hours
Excretion	Renal
Identifiers
CAS number	59-66-5 Y
ATC code	S01EC01
PubChem	CID 1986
DrugBank	DB00819
ChemSpider	1909 Y
UNII	O3FX965V0I Y
KEGG	D00218 Y
ChEBI	CHEBI:27690 Y
ChEMBL	CHEMBL20 Y
Chemical data
Formula	C4H6N4O3S2
Mol. mass	222.245 g/mol
SMILES O=S(=O)(c1nnc(s1)NC(=O)C)N
InChI InChI=1S/C4H6N4O3S2/c1-2(9)6-3-7-8-4(12-3)13(5,10)11/h1H3,(H2,5,10,11)(H,6,7,9) Y Key:BZKPWHYZMXOIDC-UHFFFAOYSA-N Y
Y (what is this?)  (verify)

Acetazolamide, sold under the trade name Diamox, is a carbonic anhydrase inhibitor that is used to treat glaucoma, epileptic seizures, Idiopathic intracranial hypertension (pseudotumor cerebri), altitude sickness, cystinuria, periodic paralysis and dural ectasia. Acetazolamide is available as a generic drug and is also a diuretic.

Mechanism of action

Acetazolamide is a carbonic anhydrase inhibitor. Medically it may be used to treat conditions of moderate to severe metabolic or respiratory alkalosis. It does this by interfering with bicarbonate (HCO₃^-) reabsorption in the kidneys, thereby re-acidifying the blood (and thus alkalinizing the urine).

Carbonic anhydrase (CA) catalyzes the first part of the following reversible reaction (the second half happens spontaneously, favouring production of H⁺ + HCO₃^-), in which carbon dioxide (CO₂) and water (H₂O) are converted to carbonic acid (H₂CO₃) and vice-versa:

CO₂ + H₂O <--^CA--> H₂CO₃ <--> H⁺ + HCO₃^-

In the kidney tubules, locally secreted hydrogen ions normally combine with filtered bicarbonate (HCO₃^-) to form carbonic acid (H₂CO₃). Carbonic acid in turn is normally acted upon by carbonic anhydrase, leading to formation of CO₂. As CO₂ rapidly leaves the tubules by diffusing across cell membranes, the above reaction normally runs shifted strongly to the left (i.e. reversed), and more bicarbonate can be continuously reabsorbed from the serum. However, in the presence of acetazolamide, carbonic anhydrase is inhibited and carbonic acid levels build up. The inhibition of carbonic anhydrase in turn leads to a slowing of the reverse reaction and a decrease in the body's ability to reabsorb serum bicarbonate, resulting in urinary bicarbonate wasting. This leads to a decreased ability to exchange Na⁺ for H⁺ in the presence of acetazolamide (in proximal convoluted tubules of kidney) resulting in a mild diuresis. By contrast, the H⁺ that is also present in the lumen is reabsorbed via an alternative pathway along with Cl^-; it then passes into the bloodstream, leading to hyperchloremic metabolic acidosis. This effect can also be used for therapeutic correction of alkalosis seen in altitude sickness or other forms of respiratory alkalosis.

Uses

Acetazolamide is often used in the treatment of various diseases.

Glaucoma

Acetazolamide has been used for the treatment of sufferers of glaucoma. When used to treat glaucoma, acetazolamide inhibits production of HCO₃^-. In health, it is the production of HCO₃^- which draws Na⁺ into the eye; water follows by osmosis to form the aqueous humour. In glaucoma treatment, the goal is often to reduce the intraocular pressure and acetazolamide does this by reducing production of aqueous humour.

Neurologic

In epilepsy, its main use is in absence seizures and myoclonic seizures. It can be used in both episodic ataxia types 1 and 2 (although the mechanisms are presumed to be different between the two).

In catamential epilepsy, an increase in seizure frequency around menses, acetazolamide can be an adjunct to an anti-seizure medication regimen to aid in decreasing seizure frequency around menses.

Acetazolamide is also used to decrease the production of cerebrospinal fluid in idiopathic intracranial hypertension as well as hydrocephalus to delay surgical intervention and has shown efficacy in some forms of periodic paralysis.

It is administered in nuclear medicine prior to brain studies with 99m-Technetium labeled HMPAO to increase the specificity of the study for brain death.

Marfan's syndrome

It's been demonstrated in drug trials to relieve symptoms associated with dural ectasia in individuals with Marfan's Syndrome.

Central sleep apnea

Off-label uses include acetazolamide as a conjunction drug to merely assist patients with central sleep apnea by lowering blood pH and encouraging respiration.

Acute mountain sickness

To reduce the incidence of Acute Mountain Sickness acetazolamide is sometimes taken prophylactically, anywhere between 125 milligrams (mg) to 1000 mg per day, starting a few days before going to higher altitudes. Such use is recommended for those ascending from sea level to 3000 meters (9800 feet) in one day, or for those ascending more than 600 meters (2000 feet) per day once above an altitude of 2500 meters (8200 feet). Also, prophylactic use is recommended for those with a significant history of acute mountain sickness.

Acetazolamide forces the kidneys to excrete bicarbonate, the conjugate base of carbonic acid. By increasing the amount of bicarbonate excreted in the urine, the blood becomes more acidic. Acidifying the blood stimulates ventilation, which increases the amount of oxygen in the blood. At high altitudes, climbers hyperventilate in response to lower oxygen levels. The hyperventilation results in reduced carbon dioxide (an acid) and a respiratory alkalosis. The normal physiologic response to a respiratory alkalosis is for the kidneys to increase excretion of bicarbonate (a base) to compensate for the loss of carbon dioxide. This kidney response takes a few days, however acetazolamide in a sense accelerates this process by leading to a more rapid renal bicarbonate loss (metabolic acidosis).

Note that acetazolamide is not an immediate fix for acute mountain sickness; it speeds up part of the acclimatization process which in turn helps to relieve symptoms. This may take up to a day or two, and requires waiting without any further rapid ascent. It is often advisable to descend if even mild acute mountain sickness is experienced. If serious sickness is encountered, descent to a lower elevation is considered to be mandatory unless other circumstances present greater danger.

Congestive Heart Failure

For diuresis in congestive heart failure, the starting dose is usually 250 to 375 mg once daily in the morning (five mg per kg). If, after an initial response, the patient fails to continue to lose edema fluid, do not increase the dose but allow for kidney recovery by skipping medication for a day.

Acetazolamide yields best diuretic results when given on alternate days, or for two days alternating with a day of rest.

Failures in therapy may be due to overdosage or too frequent dosage. The use of Acetazolamide does not eliminate the need for other therapy such as digitalis, bed rest, and salt restriction.

Drug-Induced Edema

Recommended dosage is 250 to 375 mg of Acetazolamide once a day for one or two days, alternating with a day of rest.

Note: The dosage recommendations for glaucoma and epilepsy differ considerably from those for congestive heart failure, since the first two conditions are not dependent upon carbonic anhydrase inhibition in the kidney which requires intermittent dosage if it is to recover from inhibitory effect of the therapeutic agent.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

Side-effects

Common side effects of using this drug include numbness and tingling in the fingers and toes, and taste alterations (parageusia), especially for carbonated drinks. Also possible gastrointestinal disturbances such as nausea, vomiting and diarrhea; polyuria, and occasional instances of drowsiness and confusion. Some may also experience blurred vision but this usually disappears shortly after stopping the medication. Acetazolamide also increases the risk of developing calcium oxalate and calcium phosphate kidney stones. Everyone will experience more frequent urination as a result of using acetazolamide. One should drink more fluids than usual to prevent dehydration and headaches. Acetazolamide prolongs the effects of amphetamines and related drugs. Acetazolamide also causes metabolic acidosis.

Contraindications

Acetazolamide should not be taken by individuals if:

• They have sickle cell anemia
• They are allergic to sulfa medications
• They are allergic to any carbonic anhydrase inhibitor
• They have liver or kidney disease
• They have adrenal gland failure (i.e. Addison's disease)
• They are pregnant or are nursing mothers

Chemistry

Roblin, Richard O.; Clapp, James W. (1950). Journal of the American Chemical Society 72 (11): 4890. doi:10.1021/ja01167a011. 

External links

• Acetazolamide bound to proteins in the PDB

References

UpToDate Contents

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• 1. 急性高山病および高地脳浮腫 acute mountain sickness and high altitude cerebral edema
• 2. 利尿剤の作用機序 mechanism of action of diuretics
• 3. 換気調節障害 disorders of ventilatory control
• 4. 高山病：小児特有の懸念事項 high altitude disease unique pediatric considerations
• 5. 代謝性アルカローシスの治療 treatment of metabolic alkalosis

English Journal

• Changes in cerebral hemodynamic and cognitive parameters after external carotid-internal carotid bypass surgery in patients with severe steno-occlusive disease: A pilot study.

• Dong Y, Teoh HL, Chan BP, Ning C, Yeo TT, Sinha AK, Venketasubramanian N, Slavin MJ, Sachdev P, Collinson SL, Chen C, Sharma VK.SourceDepartment of Pharmacology, National University Health System, Singapore; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
• Journal of the neurological sciences.J Neurol Sci.2012 Nov 15;322(1-2):112-6. doi: 10.1016/j.jns.2012.07.034. Epub 2012 Jul 28.
• BACKGROUND: The direct impact of external carotid-internal carotid (EC-IC) bypass surgery on cognition of patients with severe steno-occlusive disease of internal carotid (ICA) or middle cerebral artery (MCA) is unknown. In this pilot study, we evaluated changes in cerebral hemodynamic and cognition
• PMID 22846792

• Structural, spectroscopic and voltammetric studies of bis(acetazolamido)bis(aquo)bis(nicotinamide)copper(II).

• Oztürk F, Bulut A, Paşaoğlu H, Bulut I, Büyükgüngör O.SourceOndokuz Mayıs University, Faculty of Arts and Sciences, Department of Physics, Samsun, Turkey. Electronic address: filiz.ozturk@omu.edu.tr.
• Spectrochimica acta. Part A, Molecular and biomolecular spectroscopy.Spectrochim Acta A Mol Biomol Spectrosc.2012 Nov;97:24-30. doi: 10.1016/j.saa.2012.05.036. Epub 2012 May 24.
• Polymeric copper(II) complex, [Cu(Hacm)(2)(na)(2)(H(2)O)(2)] [H(2)acm; acetazolamide, na; nicotinamide] was synthesized and characterized by spectroscopic (IR; infrared spectroscopy, EPR; electron paramagnetic resonance), structural (XRD) and voltammetric structural (CV) methods. The copper(II) comp
• PMID 22750334

Japanese Journal

• 高流量化した標準内シャントによって鎖骨下動脈スチール症候群を発症した1例

• 熊谷 文昭,櫛田 隆久,佐々木 路佳,近藤 正道,由良 茂貴,石崎 賢一,坂本 和也
• 日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 42(7), 529-534, 2009-07-28
• 透析に導入されてから13年を経過した63歳女性に，鎖骨下動脈スチール症候群（subclavian steal syndrome（SSS））の発症がみられた．患者は50歳のときに，糖尿病を合併するIgA腎症を原病とする腎不全に対して，左前腕定型的標準的内シャントを設置して血液透析を始めた．約10年を経過したころからめまいの散発をみるようになり，検索を受けた脳神経外科で，左椎骨動脈の逆流現象が認められ …
• NAID 10025192834

• SPECTを使った脳機能画像の定量化と標準化(<特集>脳虚血とSPECT/PET)

• 飯田 秀博,渡部 浩司,赤松 哲哉,中澤 真弓,松原 佳亮,竹内 朝子,岩田 倫明,林 拓也,横田 千晶,福島 和人,福本 真司
• 脳神経外科ジャーナル 16(10), 742-752, 2007-10-20
• SPECTの汎用性は高く,日常の臨床だけでなく多施設臨床評価試験での利用が期待される.しかし,現実にはSPECTの定量性は保障されておらず,施設を超えた再現性も確保できていない.当該研究グループでは,正確な吸収補正と散乱線補正を組み込んだSPECT画像再構成プログラム(QSPECT)の開発を行い,PETに匹敵する定量精度を確保した.施設誤差を最小にする試みに基づき,初回循環移行係数の高いIMP検査 …
• NAID 110006436934

Related Links

• Diamox (acetazolamide) medical facts from Drugs.com

Physician reviewed Diamox patient information - includes Diamox description, dosage and directions. ... Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines ...

• ダイアモックス/アセタゾラミド

Diamox HOME 広告 通販 病院ランキング 血液検査 副作用 漢方薬 「利尿薬」 「降圧利尿剤」 「血圧を下げる薬（降圧薬）」 「高血圧」 緑内障・テンカンなど アセタゾラミド（一般名 ） acetazolamide 商 品 名 作 用 機 序 腎臓に ...

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「アセタゾラミド」

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英

acetazolamide

同

アセタゾールアミド acetazol amide

商

ダイアモックス、Dazamide, Diamox

関

利尿薬

分類

• 利尿薬
• 抗てんかん薬

作用機序

利尿薬

• 近位尿細管で管腔側から炭酸脱水酵素(carbonic anhydrase, CA)を阻害

近位尿細管の上ににはCAは管腔側細胞膜と細胞質に存在。

• HCO₃^-は原尿としていったん排泄されるが、近位尿細管でH₂CO₃となり、これがCAによりCO₂とH₂Oに分解されてCO₂(膜透過性が高いので)が近位尿細管上皮に取り込まれる。細胞内でCO₂は細胞内に存在するCAによりH⁺とHCO₃^-となる。細胞内のH⁺は管腔側に存在するNa⁺/H⁺交換系によって分泌されると共にNa⁺が取り込まれる。ここでNa⁺とともにH₂Oが再吸収される。細胞内のNa⁺とHCO₃^-はNa⁺/HCO₃^-共輸送体により血管側に運ばれる。
• 管腔側のCAを阻害することでNa⁺、HCO₃^-、およびH₂Oは再吸収を受けることなく排泄される (SPC.263)。

適応

• 緑内障、てんかん、肺気腫における呼吸性アシドーシス、心性浮腫、肝性浮腫、月経前緊張症、メニエル病、メニエル症候群、睡眠時無呼吸症候群

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