acetazolamide--(Diamox丹木斯)- 乙酰唑胺 -乙醯胺基硫唑嘧錠-乙醯偶氮胺的歷史

2023-10-26 12:25PM 
前幾天去四季溯溪上課. 準備資料時發現 WMS 居然出了 2024 年的高海拔指引更新(2023-10-11發表). 關於兒童使用丹木斯劑量的筆記重新整理在這裡
野外與登山醫學-丹木斯的兒童(指含16歲以下)劑量每次最大250mg(2024WMS指引)

2023-09-11 15:10 
前天去北搜教課, 提到丹木斯的兒童劑量. 我的記憶與筆記不同. 所以重新查詢一下相關資料. 
uptodate 網站關於 acetazolamide 的建議, 兒童每次最大劑量是 250mg.
2014年WMS指引更新. 兒童AMS治療最大劑量是每次 250mg
2010年WMS指引. 兒童AMS的最大治療劑量是每次 250mg
但CDC yellow book 的最大治療劑量是 125mg. 且 2019 WMS 指引的最大劑量也是每次 125mg. 
若是要以WMS的指引為主. 作為主要參考, 應該以 2019年那一篇為主. 則兒童發生AMS每次最大治療劑量 125mg 是合理的. 

另外. 2010- 2014- 2019- 這三篇高海拔疾病指引都有同一個通訊作者. Andrew M. Luks

Corresponding author: Andrew Luks, MD, Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359762, Seattle, WA 98104

Altitude illness, acute:
 預防AMS劑量

Prevention: Limited data available: Infants, Children, and Adolescents: Oral: Immediate release: 2.5 mg/kg/dose every 12 hours started either the day before (preferred) or on the day of ascent and may be discontinued after staying at the same elevation for 2 to 3 days or if descent initiated; maximum dose: 125 mg/dose (Ref). Note: The International Society for Mountain Medicine does not recommend prophylaxis in children except in the rare circumstance of unavoidable rapid ascent or in children with known previous susceptibility to acute mountain sickness (Ref). Higher doses are effective up to 500 mg, but are also associated with increased adverse effects and not recommended (Ref).

治療AMS劑量
Treatment: Acute mountain sickness (AMS); moderate: Limited data available: 

Infants, Children, and Adolescents: Oral: Immediate release: 2.5 mg/kg/dose every 8 to 12 hours; maximum dose: 250 mg/dose. 

Note: With high altitude cerebral edema, dexamethasone is the primary treatment; however, acetazolamide may be used adjunctively with the same treatment dose (Ref).

下面是uptodate網頁截圖

而uptodate引用的參考資料是這一篇回顧性文章(可點擊標題看原文)
REVIEW ARTICLE
Wilderness Medical Society Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness Wilderness Environ Med, 2010
這一篇的筆記在這裡

(ymmcc)2010 WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude illness
這篇研究報告關於兒童使用丹木斯的最大治療劑量是 250mg. 

2023-08-11  15:25

acetazolamide 一般民眾不容易記(醫療人員亦同). 底下以丹木斯來代替. 方便大家閱讀.
一開始是想找 diamox(專門指這個商品) 生產上市的時間, 結果沒找到(等等繼續找)., 但找的過程看到一些有趣的相關文章, 先做筆記. 不然過幾天就忘了. 又要重新找.

In 1940, Mann and Kellin discovered Acetazolamide and recognized its anticonvulsant property against focal and generalized seizures. 註1

還有另一篇介紹丹木斯的回顧性文章也可以參考

Review Article: The history and rationale of using carbonic anhydrase inhibitors in the treatment of peptic ulcers. In memoriam Ioan Puşcaş (1932–2015)

丹木斯屬於非抗生素類磺胺藥物. 對於抗生素磺胺類過敏的人. 吃丹木斯不一定會過敏(大部分不會). 所以如果因為擔心藥物過敏而將丹木斯從預防高海拔疾病的名單剔除. 有點可惜. (之前我有整理過相關筆記)
丹木斯是一種碳酸酐酶(carbonic anhydrases)抑制劑.
碳酸酐酶(下面以CA代替)廣泛存在於細菌(bacteria), 古菌(archaea) 真核生物(eukaryotes,). 它的作用是將二氧化碳與水結合, 產生出碳酸,

註1:
Acetazolamide: Old drug, new evidence? Published online 2022 Jun 14. d
Arif Ali Shukralla,corresponding author 1 Emma Dolan, 1 and Norman Delanty