Acetazolamide (Diamox)

When is acetazolimide used?
Acetazolimide can be used in combination with other AEDs to treat absence and myoclonic seizures. However, it is most commonly used in women whose seizures worsen around the time of their period (catamenial epilepsy—LINK).

What are the most common side effects?
Most people who take acetazolamide have few or no side effects. Those that do most often complain of:

• Dizziness
• Lethargy
• Loss of appetite
• Tingling around the mouth, fingertips, and toes
• Increased frequency of urination

Most of these symptoms decrease and disappear over time. If they do not, or are particularly troublesome, you should call your doctor to decide whether or not to adjust the dosage, or even change the medication.

Also, some patients develop tolerance to acetazolamide, which means the drug becomes less effective over time.

What are the most serious side effects?
About 1% to 2% of patients taking acetazolamide develop kidney stones. Therefore, patients taking it should make sure to drink plenty of fluid, especially those patients living in warmer climates.

What are the symptoms of a kidney stone?
If a kidney stone causes a blockage, or moves down the ureter, it may cause some of the following symptoms:

• Pain or aching in the back on one or both sides
• Spasms of intense pain (anywhere between the bottom of the ribs and the groin)
• Bloody, cloudy or smelly urine
• Nausea and vomiting
• A frequent urge to urinate
• A burning sensation during urination
• Fever and chills

Anyone who has one or more of these symptoms should seek medical advice.

Is there anyone who should not take acetazolamide?
Patients with a history of kidney stones should probably avoid acetazolamide. Also, patients on the ketogenic diet or those taking topiramate or zonisamide should be especially cautious as these other therapies also increase the risk for kidney stones.