Douglas J. Rhee, MD

58C. CARBONIC ANHYDRASE INHIBITORS 1 (ORANGE TOP)Mechanism of Action: Inhibition of carbonic anhydrase decreases aqueous production in ciliary body; when given parentally, willalso dehydrate the vitreous.Side Effects: Local (with Topical Therapy): Bitter taste.Systemic (with Topical Therapy): Diuresis, fatigue, GI upset, Stevens-Johnson syndrome, theoretical risk of aplasticanemia.(with Systemic Therapy): Hypokalemic/acidosis, renal stones, paresthesias, nausea, cramps, diarrhea, malaise, lethargy,depression, impotence, unpleasant taste, aplastic anemia, Stevens-Johnson syndrome.Contraindications: Sulfa allergy, hyponatremia/kalemia, recent renal stones, thiazide diuretics, digitalis useDrug Trade Concentration Usual Dose Notesacetazolamide Diamox 125, 250 mg tabs QD-QID Onset within 2 hr, lasts 4–6 hrDiamox Sequels 500 mg caps QD-BID lasts 12–24 hr500 mg IV one dose Immediate onset, duration 4 hr for temporary5–10 mg/kg/dose PO TID-QID IOP control Infantile glaucoma;definitive treatment is surgical. Forpreparation Instructions, see Appendix 2.brinzolamide Azopt Soln, 1% BID-TID TID for single therapydorzolamide Trusopt Soln, 2% BID-TID TID for single therapyBID when used in combination with betablockers