A carbonic anhydrase inhibitor used primarily to lower intracranial pressure in idiopathic intracranial hypertension.
Drug Class: diuretic
Acetazolamide (brand name Diamox) is a medication that reduces the production of cerebrospinal fluid, making it particularly useful for treating idiopathic intracranial hypertension (IIH). It also has uses for glaucoma and altitude sickness.
Key Takeaways
- Reduces cerebrospinal fluid production
- Primary treatment for IIH
- Causes tingling sensations—a common, harmless side effect
- Makes carbonated drinks taste strange
- Avoid if allergic to sulfa drugs
How It Works
Acetazolamide inhibits carbonic anhydrase, an enzyme involved in fluid production. By blocking this enzyme in the brain's choroid plexus, it reduces cerebrospinal fluid production, lowering intracranial pressure.
Common Uses
- Idiopathic intracranial hypertension—first-line medical treatment
- Glaucoma (reduces eye pressure)
- Altitude sickness prevention
- Certain seizure disorders
Dosing
- Usually 500mg to 2000mg daily
- Often divided into 2-4 doses
- Start lower and increase gradually
- Sustained-release formulation available
Side Effects
Common (Usually Tolerable)
- Tingling in hands, feet, face—very common, usually harmless
- Altered taste—carbonated drinks taste flat or metallic
- Increased urination
- Fatigue initially
- Loss of appetite
Less Common
- Kidney stones
- Low potassium
- Metabolic acidosis
- Blood count changes (rare)
Monitoring
- Electrolytes (especially potassium, bicarbonate)
- Kidney function
- Blood count periodically
- Symptoms of kidney stones
Important Precautions
Sulfa allergy: Acetazolamide is a sulfonamide. Tell your doctor if you have a sulfa drug allergy—alternatives may be needed.
Tips for Taking Acetazolamide
- Stay well hydrated (reduces kidney stone risk)
- Take with food to reduce stomach upset
- The tingling usually improves with time
- Potassium supplements may be needed
Frequently Asked Questions
Is the tingling normal?
Yes, tingling (paresthesias) is a very common side effect and is harmless. It often improves with continued use. If severe or bothersome, discuss with your doctor.
Why do sodas taste weird?
Acetazolamide alters how you taste carbon dioxide. Carbonated beverages may taste flat or metallic. This is harmless but can be unpleasant.
How long do I need to take this?
Duration depends on your condition. For IIH, it may be needed for months to years, often alongside weight loss efforts. Some patients can eventually stop the medication.
Medical Disclaimer: This information is for educational purposes only and does not replace professional medical advice.
Medically Reviewed Content
This article meets our editorial standards
- Written by:
- Hashemi Eye Care Medical Team
- Medically reviewed by:
- Board-Certified Neuro-Ophthalmologist (MD, Neuro-Ophthalmology)
- Last reviewed:
- January 30, 2025