英文药名: Diamox (Acetazolamide Tablets)

中文药名: 醋氮酰胺（乙酰唑胺片）

药品名称
别名: 醋氮酰胺;醋唑磺胺;代马克司;乙酰唑胺;丹木斯;代冒克斯; 醋氮酰胺
外文名: Acetazolamide,Acetamide, Albox,Diluran, Diurramide, DIAMOX,Edemox
通用名: 乙酰唑胺片
曾用名: 醋氮酰胺片、醋唑磺胺片
商品名: Diamox
主要成分: 乙酰唑胺
化学名称: N-[5-(氨磺酰基) -1,3,4-噻二唑-2-基]乙酰胺
分子式: C4H6N4O3S2
分子量: 222.25
性状: 本品为白色片

药理毒理
本品为碳酸酐酶抑制剂,能抑制房水生成,降低眼压.房水流出易度则不改变.乙酰唑胺能抑制睫状体上皮碳酸酐酶的活性,从而减少房水生成(50％～60％),使眼压下降.

药代动力学
口服容易吸收.与蛋白结合率高.口服乙酰唑胺500mg后1～1.5小时降低眼压作用开始；2～4小时血药浓度达峰值；可维持4～6小时,血清最高浓度为12～27mg/ml,T1/2为2.4～5.8小时.乙酰唑胺口服,在24小时内给药量的90％～100％以原形由肾脏排泄.

适应症
用于心脏性水肿，但对肾脏性及肝性水肿无效。亦用于治疗脑水肿和消化性溃疡病和青光眼。
适用于治疗各种类型的青光眼,对各种类型青光眼急性发作时的短期控制是一种有效的降低眼压的辅助药物。 开角型(慢性单纯性)青光眼,如用药物不能控制眼压,并用本品治疗可使其中大部分病例的眼压得到控制,做为术前短期辅助药物。
闭角型青光眼急性期应用本品降压后,原则上应根据房角及眼压描记情况选择适宜的抗青光眼手术。
本品也用于抗青光眼及某些内眼手术前降低眼压.抗青光眼术后眼压控制不满意者,仍可应用本品控制眼压。
继发性青光眼也可用本品降低眼压。

用法用量
成人常用量:
(1)开角型青光眼,口服首量250mg(1片),每日l～3次,维持量应根据病人对药物的反应决定,尽量使用较小的剂量使眼压得到控制；一般每日2次,每次 250mg(1片)就可使眼压控制在正常范围.
(2)继发性青光眼和手术前降眼压,口服250mg(1片),每4～8小时 1次,一般每日2～3次.
(3)急性病例,首次药量加倍给500mg(2片),以后用125～250mg(0.5～1片)维持量,每日2～3次.
任何疑问，请遵医嘱！

不良反应
一般用药后常见的不良反应有:
(1)四肢麻木及刺痛感；
(2)全身不适症候群:疲劳、体重减轻、困倦抑郁、嗜睡、性欲减低等；
(3)胃肠道反应:金属样味觉、恶心、食欲不振、消化不良、腹泻；
(4)肾脏反应:多尿、夜尿、肾及泌尿道结石等
(6)可出现暂时性近视,也可发生磺胺样皮疹,剥脱性皮炎.
少见的副作用:
(1)电解质紊乱:代谢性酸中毒、低钾血症,补充碳酸氢钠及钾盐有可能减轻症状；
(2)听力减退；
(3)最严重的不良反应是造血系统障碍:急性溶血性贫血、粒细胞减少症、血小板减少症、嗜伊红细胞增多症、再生障碍性贫血,和肾功能衰竭. 长期用药可加重低钾血症、低钠血症、电解质紊乱及代谢性酸中毒等症状.由于血钾下降可减弱本品的降眼压作用.对肾结石病人,本品可诱发或加重病情,如出现肾绞痛和血尿应立即停药.

禁忌症
肝、肾功能不全致低钠血症、低钾血症、高氯性酸中毒,肾上腺衰竭及肾上腺皮质机能减退(阿狄森病),肝昏迷.

注意事项
(1) 询问病人有否磺胺过敏史,不能耐受磺胺类药物或其他磺胺衍生物利尿药的患者,也不能耐受本品;
(2)与食物同服可减少胃肠道反应;
(3)下列情况应慎用:
①因本品可增高血糖及尿糖浓度,故糖尿病患者应慎用；
②酸中毒及肝、肾功能不全者慎用.
(4)对诊断的干扰:
①尿17-羟类固醇测定,因干扰Glenn-Nelson法的吸收,可产生假阳性结果；
②尿蛋白测定,由于尿碱化,可造成如溴酚蓝试验等一些假阳性结果；
③血氨浓度、血清胆红素、尿胆素元浓度都可以增高；
④血糖浓度、尿糖浓度均可增高,非糖尿病者不受影响；
⑤血浆氯化物的浓度可以增高,血清钾的浓度可以降低.
(5)随访检查:急性青光眼及青光眼急性发作时,每日应测眼压,慢性期应定期测量眼压,并定期检查视力、视野.眼压控制后应根据青光眼类型、前房角改变及眼压描记情况,调整用药剂量及选择适宜的抗青光眼手术.需延期施行抗青光眼手术的病人,较长期使用本品,除应加服钾盐外,在治疗前还需有24小时有眼压、视力、视野、血压、血象及尿常规等记录,以便在治疗过程中评价疗效及发现可能产生的不良反应,根据病情调整药量;
(6)某些不能耐受乙酰唑胺不良反应或久服无效者,可改用其他碳酸酐酶抑制剂,如双氯非那胺.

孕妇及哺乳期用药
动物试验证实应用高于成人剂量10倍的乙酰唑胺对啮齿类动物胎仔有较高的致畸发病率,因此必需考虑其利弊.已有报告指出将要分娩的和妊娠期的妇女不宜使用,尤其是妊娠的前3个月内.
哺乳妇女确需使用本品应暂停哺乳.

儿童用药
小儿常用量:抗青光眼,每日2～3次,每次按体重口服5～10mg／kg,或每日按体表面积口服300～900mg/m2,分2～3次服用.

药物相互作用
(1)与促肾上腺皮质激素、糖皮质激素尤其与盐皮质激素联合使用,可以导致严重的低血钾,在联合用药时应注意监护血清钾的浓度及心脏功能.亦应估计到长期同时使用有增加低血钙的危险,可以造成骨质疏松,因为这些药都能增加钙的排泄;
(2)与苯丙胺、抗M?胆碱药、尤其是和阿托品、奎尼丁联合应用时,由于形成碱性尿,本品排泄减少,会使不良反应加重或延长;
(3)与抗糖尿病药(如胰岛素)联合应用时,可以减少低血糖反应,因为本品可以造成高血糖和尿糖,故应调整剂量;
(4)与苯巴比妥、卡马西平或苯妥英等联合应用,可引起骨软化发病率上升;
(5)洋地黄苷类与本品合用,可提高洋地黄的毒性,并可发生低钾血症;
(6)与甘露醇或尿素联合应用,在增强降低眼内压作用的同时,可增加尿量.

药物过量
尚未有患者服用过量致急性毒性反应的报道.

Diamox

Generic Name: acetazolamide (a SEET a ZOLE a mide)
Brand Names: Diamox, Diamox Sequels

What is Diamox (acetazolamide)?
Acetazolamide is a carbonic anhydrase inhibitor. Carbonic anhydrase is a protein in your body. Acetazolamide reduces the activity of this protein.

Acetazolamide is used to treat glaucoma and to treat and to prevent acute mountain sickness (altitude sickness). It is also used as a part of some treatment plans for congestive heart failure and seizure disorders.

Acetazolamide may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Diamox (acetazolamide)?
Call your doctor immediately if you experience a sore throat, fever, unusual bleeding or bruising, tingling or tremors in your hands or feet, pain in your side or groin, or a rash. These symptoms could be early signs of a serious side effect.

Use caution when driving, operating machinery, or performing other hazardous activities. Acetazolamide may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Avoid prolonged exposure to sunlight. Acetazolamide may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.

Who should not take Diamox (acetazolamide)?
Tell your doctor if you have ever had an allergic reaction to a sulfa-based drug such as sulfamethoxazole (e.g., Bactrim, Septra, Gantanol). Acetazolamide is also a sulfa-based drug, and you may have a similar reaction to it.

Before taking acetazolamide, tell your doctor if you
are on aspirin therapy,
have liver disease,
have kidney disease,
have heart disease,
have lung disease, or
have a hormonal disease.

You may not be able to take acetazolamide, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.

Acetazolamide is in the FDA pregnancy category C. This means that it is not known whether acetazolamide will harm an unborn baby. Do not take acetazolamide without first talking to your doctor if you are pregnant. Acetazolamide passes into breast milk. It is not known whether acetazolamide will affect a nursing infant. Do not take acetazolamide without first talking to your doctor if you are breast-feeding a baby.

How should I take Diamox (acetazolamide)?
Take acetazolamide exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Take acetazolamide with food if it upsets your stomach. Store acetazolamide at room temperature away from moisture and heat.

What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?
Seek emergency medical attention.
Symptoms of an acetazolamide overdose are not well known, but the following symptoms might be expected: drowsiness, decreased appetite, nausea, vomiting, dizziness, numbness or tingling, shaking, and ringing in the ears.

What should I avoid while taking Diamox (acetazolamide)?
Use caution when driving, operating machinery, or performing other hazardous activities. Acetazolamide may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Avoid prolonged exposure to sunlight. Acetazolamide may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.

Diamox (acetazolamide) side effects
If you experience any of the following serious side effects, stop taking acetazolamide and seek emergency medical attention:
an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
a sore throat or a fever;
unusual bleeding or bruising;
side or groin pain;
tingling or tremors in your hands or feet; or
a rash.

Other, less serious side effects may be more likely to occur. Continue to take acetazolamide and talk to your doctor if you experience
decreased appetite, nausea, vomiting, constipation, diarrhea, or changes in taste;
drowsiness, dizziness, fatigue, or weakness;
nervousness or mild tremor;
headache or confusion;
increased sensitivity of the skin to sunlight;
worsening gout;
loss of blood sugar control (if you are diabetic);
ringing in your ears or hearing problems; or
changes in your vision.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Diamox (acetazolamide)?
Before taking this medication, tell your doctor if you are taking any of the following medicines:
cyclosporine (Sandimmune). Cyclosporine may have more side effects if it is taken with acetazolamide.
primidone (Mysoline). Primidone may not be as effective if it is taken with acetazolamide, and seizure control may be reduced.
diflunisal (Dolobid). Diflunisal may increase both the activity and the side effects of acetazolamide.
aspirin, salsalate (Disalcid, Salflex, Salsitab, others), choline salicylate (Arthropan), magnesium salicylate (Doan's, Magan, Mobidin), and other aspirin-like products (salicylates). These medicines may also interact with acetazolamide, and special monitoring of your therapy may be necessary.
lithium (Lithobid, Eskalith, others). Acetazolamide may decrease the level of lithium in your blood. Special monitoring or a dosage adjustment may be necessary.

Drugs other than those listed here may also interact with acetazolamide. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

Where can I get more information?
Your pharmacist can provide more information about acetazolamide.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed

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