What is the mechanism of acetazolamide (diamox)? What are the indications for its use?

Carbonic anhydrase is an enzyme that catalyzes the rapid conversion of carbon dioxide to bicarbonate and a hydrogen ion. In the nephron it helps acidify the urine and alkinalize the blood. See diagram below (CA = carbonic anhydrase).



Acetazolamide is a carbonic anhydrase inhibitor.

When carbonic anhydrase is inhibited there is a reduction in hydrogen ion secretion (ie causes metabolic acidosis) and an increased renal excretion of sodium, potassium, bicarbonate and water.

Indications for acetazolamide use include: edema, metabolic alkalosis, respiratory stimulant in COPD, urine alkalinization, moutain sickness, glaucoma.

Potential complication of acetazolimide use: hypokalemia!

Source

"Acetazolamide: Drug information." Up to Date v16.2. <http://www.uptodate.com>