Diamox (acetazolamide) is a carbonic anhydrase inhibitor, which suppresses activity of carbonic anhydrase in the body. It does so by acting on the kidneys, preventing reabsorption of various substances---including potassium and sodium---thus causing them to be excreted in urine, along with excess fluid.

In relatively simple terms, by excreting the substances and producing more urine, blood pressure, brain pressure, and eye pressure are all lowered. The medication also causes the blood to become acidic, which in turn causes increased inhalation, which increases oxygen and lowers carbon dioxide found in the blood.

Diamox is useful in a range of conditions:

• Open-angle glaucoma
• Closed-angle glaucoma
• Medication-induced edema
• Heart failure-induced edema
• Altitude sickness
• Petit mal seizures
• Grand mal seizures
• Absence seizures
• Other epilepsy
• Other conditions

Because this medication works on the kidneys, it's not suitable for those with kidney impairment, nor is it suitable for those who have low blood potassium or low blood sodium. Additionally, patients tend to develop tolerance to Diamox, so it's generally not suitable for long-term use. However, by dosing every other day, every two days with a break on the third, or similar dosing schedules many patients can get around that to some extent.

Glaucoma

In treating glaucoma, Diamox is usually used along with other medications. Because so many patients develop tolerance to the medication, Diamox is typically used to lower eye pressure prior to surgery and immediately following surgery, though there may be some variation depending on individual circumstance.

Treatment is similar in both cases. Keep in mind the following are only rough guidelines; doctor instructions will likely vary and should be followed:

• Take 250 mg to 1000 mg (1 g) of Diamox per day.
• Doses of 250 mg can be taken once per day; higher doses should be divided and taken throughout the day.
• Do not exceed 1000 mg (1 g) per day.

Duration of treatment will depend on the end goal as well as patient response. While doses higher than 1000 mg have been used, there's no evidence that any benefit is provided that isn't found at 1000 mg.

Edema

Diamox is just one of several medications that may be given to treat edema, whether heart failure-induced or medication-induced. In both cases treatment tends to be longer-term, which can give rise to difficulties with tolerance. Treatment is very similar in both cases:

• Start with 250 mg to 375 mg of Diamox taken in the morning.
• This may work for some patients if taken every day.
• Other patients will fail to lose edema fluid; rather than increase dosage, these patients should take the medication every other day, or for two days and then a break for a day.
• Treatment with Diamox does not eliminate the need for other medications and other treatment, such as bed rest or salt restriction.

Treatment should continue for as long as a doctor recommends, provided no serious adverse effects develop.

Seizures

Why Diamox is effective at treating seizures isn't clear, but it does produce good results in both children and adults. In children dosage is determined by weight. In otherwise healthy adults, treatment is typically:

• Take 250 mg to 1000 mg of Diamox per day.
• Doses over 250 mg should be divided into several smaller doses.
• If taking other anticonvulsants, dosage should start at 250 mg per day.

In this use, since edema is probably not an issue, tolerance is not as much of a concern as it is with other medications. Assuming no serious side effects develop, treatment may continue long term. Other medications are often given along with Diamox, which can cause dosing and administration guidelines to deviate.

High-Altitude Sickness

Diamox is particularly helpful in treating high-altitude sickness in rapid ascents, such as rescue operations. The medication doesn't directly cure high-altitude sickness, but rather helps the body acclimatize faster. Treatment typically consists of:

• Take 500 mg to 1000 mg of Diamox 24 to 28 hours prior to ascent.
• Continue treatment for at least the next 48 hours.
• Treatment may continue an additional few days if needed.

If using Diamox to prevent sickness in rapid ascent scenarios, higher doses of 1000 mg are recommended. For slower ascents, particularly those where patients can stop and let the body acclimatize naturally, lower doses around 500 mg are ideal.