底下內容來自兩個不同網站.上面的是 from uptodate . 下面是 from Drug.com
中文是google自動翻譯
** 乙醯唑胺=丹木斯. 丹木斯是曾經的商品名. 乙醯唑胺是中文成分學名
筆記:
1. 曾發生嚴重全身性磺胺過敏的人, 不建議使用丹木斯
1. 曾發生嚴重全身性磺胺過敏的人, 不建議使用丹木斯
2. 曾發生輕微磺胺過敏的人, 發生丹木斯過敏機率並不高, 可與醫師討論是否試用藥物. 評估過敏反應
3. 明顯腎功能異常的人, 可能發生電解質失調(主要是 鈉 Na 鉀K), 不建議使用丹木斯(丹木斯是一種較弱的利尿劑)
4. 某些肝硬化患者, 可能出現肝腦病變, 而丹木斯在少部分民眾身上可能發生嚴重肝毒性, 增加肝腦病變風險, 因此不建議使用丹木斯 (severe hepatotoxicity is uncommon)
最顯著的副作用是周圍感覺異常。
3. 明顯腎功能異常的人, 可能發生電解質失調(主要是 鈉 Na 鉀K), 不建議使用丹木斯(丹木斯是一種較弱的利尿劑)
4. 某些肝硬化患者, 可能出現肝腦病變, 而丹木斯在少部分民眾身上可能發生嚴重肝毒性, 增加肝腦病變風險, 因此不建議使用丹木斯 (severe hepatotoxicity is uncommon)
系統性回顧和多項隨機試驗發現,乙醯唑胺單藥使用時,可使急性高山症症狀減輕約 75%[ 30,66-75 ]。
臨床上有效的預防劑量,同時也能最大限度地減少副作用,是每 12 小時 125 毫克(每日 250 毫克)(表 5)。然而,乙醯唑胺預防AMS的理想劑量尚未確定,大多數臨床試驗均採用較高劑量[ 20,52,54,73,76,77 ]。一些專家認為,理想的劑量是抑制腎臟碳酸酐酶的劑量(5mg/kg/天),但尚無臨床試驗證明,在成人中採用基於體重的方案能取得更好的效果[ 20 ]。對於 AMS 預防,較高的劑量不太可能提供額外的益處,但會增加副作用的發生率。
預防性使用的時間取決於上升情況。上升到固定睡眠高度的個體(例如,休閒滑雪者)可以在上升前一天開始服用乙醯唑胺並持續 48 小時。如果計劃進一步上升,可以繼續使用乙醯唑胺直至達到最大海拔。也可以間歇性服用乙醯唑胺,以加速海拔升高時的適應過程或治療輕度急性高山症。停藥後症狀不會復發。儘管急性高山症 (AMS) 的危險在幾天的適應後就會消失,但乙醯唑胺仍然可能對治療睡眠障礙有用。 (參見上文 『症狀輕微的病人』 )乙醯唑胺
臨床上有效的預防劑量,同時也能最大限度地減少副作用,是每 12 小時 125 毫克(每日 250 毫克)(表 5)。然而,乙醯唑胺預防AMS的理想劑量尚未確定,大多數臨床試驗均採用較高劑量[ 20,52,54,73,76,77 ]。一些專家認為,理想的劑量是抑制腎臟碳酸酐酶的劑量(5mg/kg/天),但尚無臨床試驗證明,在成人中採用基於體重的方案能取得更好的效果[ 20 ]。對於 AMS 預防,較高的劑量不太可能提供額外的益處,但會增加副作用的發生率。
預防性使用的時間取決於上升情況。上升到固定睡眠高度的個體(例如,休閒滑雪者)可以在上升前一天開始服用乙醯唑胺並持續 48 小時。如果計劃進一步上升,可以繼續使用乙醯唑胺直至達到最大海拔。也可以間歇性服用乙醯唑胺,以加速海拔升高時的適應過程或治療輕度急性高山症。停藥後症狀不會復發。儘管急性高山症 (AMS) 的危險在幾天的適應後就會消失,但乙醯唑胺仍然可能對治療睡眠障礙有用。 (參見上文 『症狀輕微的病人』 )乙醯唑胺
最顯著的副作用是周圍感覺異常。
其他症狀包括多尿、
碳酸飲料味覺淡化,
以及較不常見的噁心、嗜睡、頭痛、陽痿和近視。
乙醯唑胺會引起超敏反應、過敏反應,罕見情況下還會引起過敏性休克或史蒂文斯-約翰遜症候群。
儘管乙醯唑胺是一種磺胺類藥物,但它是一種非抗菌磺胺類藥物,據信它與磺胺類抗菌藥物(如甲氧芐啶-磺胺甲噁唑)沒有交叉反應。儘管如此,大多數乙醯唑胺產品說明書都將對任何磺胺類藥物過敏列為可能的禁忌症。 (請參閱“磺胺類藥物超敏反應”,關於‘交叉反應性’一節)來自 Drug.com乙醯唑胺
from Drug.com
乙醯唑胺是一種碳酸酐酶抑制劑,透過多種機制加速適應並改善低氧血症[ 79,80 ]。抑制腎臟碳酸酐酶會減緩二氧化碳的水化,減少碳酸氫鹽和鈉的重吸收,並導致碳酸氫鹽利尿,從而導致攝入後一小時內開始的代謝性酸中毒。乙醯唑胺可解除中樞化學感受器的抑制並刺激通氣,從而迅速改善氧合。重要的是,乙醯唑胺能在睡眠期間維持氧合,並防止極度低氧血症[ 81 ]。乙醯唑胺的溫和利尿作用有助於抵消與高山症相關的液體滯留。它還會減少夜間抗利尿激素的分泌和腦脊髓液的產生和量,並可能降低顱內壓(ICP)[ 20,82 ]。
禁忌症
對乙醯唑胺或製劑中的任何賦形劑過敏。由於乙醯唑胺是磺醯胺衍生物,乙醯唑胺、磺醯胺類藥物和其他磺醯胺衍生物之間可能存在交叉敏感性。
在鈉和/或鉀血清水平降低的情況下、在明顯的腎臟和肝臟疾病或功能障礙的情況下、在腎上腺功能衰竭的情況下以及在高氯性酸中毒的情況下,禁用乙醯唑胺治療。由於有肝性腦病變的風險,肝硬化患者禁用。
患有慢性非充血性閉角型青光眼的患者禁止長期服用乙醯唑胺,因為它可能導致角膜有機閉合,而惡化的青光眼卻被降低的眼壓所掩蓋。
from uptodate
Acetazolamide is the preferred pharmacologic agent for the prevention of AMS for those at moderate to high risk for developing HAI (table 6) [33]. Systematic reviews and multiple randomized trials have found that acetazolamide reduces symptoms of AMS by approximately 75 percent when used as a single agent for this purpose [30,66-75].
A clinically effective preventive dose that also minimizes side effects is 125 mg every 12 hours (250 mg daily) (table 5). However, the ideal dose of acetazolamide for AMS prophylaxis is not established, and most clinical trials have been performed with higher doses [20,52,54,73,76,77]. Some experts suggest that the ideal dose is at which renal carbonic anhydrase is inhibited (5 mg/kg per day), but no clinical trial has demonstrated superior results using a weight-based regimen in adults [20]. For AMS prevention, higher doses are unlikely to provide added benefit but increase the incidence of side effects.
Duration of prophylactic use depends upon the ascent profile. Individuals ascending to a fixed sleeping altitude (eg, recreational skiers) may start acetazolamide the day before ascent and continue for 48 hours. If further ascent is planned, acetazolamide can be continued until maximum elevation is attained. Acetazolamide can also be taken episodically to speed acclimatization while gaining altitude or to treat mild AMS. Symptoms do not recur when the drug is discontinued. Although the danger of AMS passes after a few days of acclimatization, acetazolamide may still be useful to treat disturbed sleep. (See 'Patient with mild symptoms' above.)
The most notable side effect of acetazolamide is peripheral paresthesia. Others include polyuria, flattened taste of carbonated beverages, and less commonly, nausea, drowsiness, headache, impotence, and myopia. Acetazolamide can induce hypersensitivity, allergic reactions, and, rarely, anaphylaxis or Stevens-Johnson syndrome.
Patients with a history of significant allergic reactions to other sulfonamide drugs should be evaluated before travel to determine if acetazolamide is tolerated [78]. Even though acetazolamide is a sulfonamide, it is a nonantimicrobial sulfonamide, which are believed to have no cross-reactivity with sulfonamide antimicrobials, such as trimethoprim-sulfamethoxazole. Despite this, most acetazolamide product inserts list allergy to any sulfonamide as a possible contraindication. (See "Sulfonamide hypersensitivity", section on 'Cross-reactivity'.)
from Drug.com
Acetazolamide is a carbonic anhydrase inhibitor that works by many mechanisms to accelerate acclimatization and ameliorate hypoxemia [79,80]. Inhibition of renal carbonic anhydrase slows the hydration of carbon dioxide, reduces reabsorption of bicarbonate and sodium, and causes a bicarbonate diuresis with resultant metabolic acidosis starting within one hour of ingestion. Acetazolamide disinhibits the central chemoreceptors and stimulates ventilation, which rapidly improves oxygenation. Importantly, acetazolamide maintains oxygenation during sleep and prevents periods of extreme hypoxemia [81]. Acetazolamide's mild diuretic action helps to counteract fluid retention associated with high-altitude illness. It also diminishes nocturnal antidiuretic hormone secretion and cerebrospinal fluid production and volume, and possibly lowers intracranial pressure (ICP) [20,82].
Contraindications
Hypersensitivity to acetazolamide or any excipients in the formulation. Since acetazolamide is a sulfonamide derivative, cross sensitivity between acetazolamide, sulfonamides and other sulfonamide derivatives is possible.
Acetazolamide therapy is contraindicated in situations in which sodium and/or potassium blood serum levels are depressed, in cases of marked kidney and liver disease or dysfunction, in suprarenal gland failure, and in hyperchloremic acidosis. It is contraindicated in patients with cirrhosis because of the risk of development of hepatic encephalopathy.
Long-term administration of acetazolamide is contraindicated in patients with chronic noncongestive angle-closure glaucoma since it may permit organic closure of the angle to occur while the worsening glaucoma is masked by lowered intraocular pressure.
from Drug.com
乙醯唑胺是一種碳酸酐酶抑制劑,透過多種機制加速適應並改善低氧血症[ 79,80 ]。抑制腎臟碳酸酐酶會減緩二氧化碳的水化,減少碳酸氫鹽和鈉的重吸收,並導致碳酸氫鹽利尿,從而導致攝入後一小時內開始的代謝性酸中毒。乙醯唑胺可解除中樞化學感受器的抑制並刺激通氣,從而迅速改善氧合。重要的是,乙醯唑胺能在睡眠期間維持氧合,並防止極度低氧血症[ 81 ]。乙醯唑胺的溫和利尿作用有助於抵消與高山症相關的液體滯留。它還會減少夜間抗利尿激素的分泌和腦脊髓液的產生和量,並可能降低顱內壓(ICP)[ 20,82 ]。
禁忌症
對乙醯唑胺或製劑中的任何賦形劑過敏。由於乙醯唑胺是磺醯胺衍生物,乙醯唑胺、磺醯胺類藥物和其他磺醯胺衍生物之間可能存在交叉敏感性。
在鈉和/或鉀血清水平降低的情況下、在明顯的腎臟和肝臟疾病或功能障礙的情況下、在腎上腺功能衰竭的情況下以及在高氯性酸中毒的情況下,禁用乙醯唑胺治療。由於有肝性腦病變的風險,肝硬化患者禁用。
患有慢性非充血性閉角型青光眼的患者禁止長期服用乙醯唑胺,因為它可能導致角膜有機閉合,而惡化的青光眼卻被降低的眼壓所掩蓋。
from uptodate
Acetazolamide is the preferred pharmacologic agent for the prevention of AMS for those at moderate to high risk for developing HAI (table 6) [33]. Systematic reviews and multiple randomized trials have found that acetazolamide reduces symptoms of AMS by approximately 75 percent when used as a single agent for this purpose [30,66-75].
A clinically effective preventive dose that also minimizes side effects is 125 mg every 12 hours (250 mg daily) (table 5). However, the ideal dose of acetazolamide for AMS prophylaxis is not established, and most clinical trials have been performed with higher doses [20,52,54,73,76,77]. Some experts suggest that the ideal dose is at which renal carbonic anhydrase is inhibited (5 mg/kg per day), but no clinical trial has demonstrated superior results using a weight-based regimen in adults [20]. For AMS prevention, higher doses are unlikely to provide added benefit but increase the incidence of side effects.
Duration of prophylactic use depends upon the ascent profile. Individuals ascending to a fixed sleeping altitude (eg, recreational skiers) may start acetazolamide the day before ascent and continue for 48 hours. If further ascent is planned, acetazolamide can be continued until maximum elevation is attained. Acetazolamide can also be taken episodically to speed acclimatization while gaining altitude or to treat mild AMS. Symptoms do not recur when the drug is discontinued. Although the danger of AMS passes after a few days of acclimatization, acetazolamide may still be useful to treat disturbed sleep. (See 'Patient with mild symptoms' above.)
The most notable side effect of acetazolamide is peripheral paresthesia. Others include polyuria, flattened taste of carbonated beverages, and less commonly, nausea, drowsiness, headache, impotence, and myopia. Acetazolamide can induce hypersensitivity, allergic reactions, and, rarely, anaphylaxis or Stevens-Johnson syndrome.
Patients with a history of significant allergic reactions to other sulfonamide drugs should be evaluated before travel to determine if acetazolamide is tolerated [78]. Even though acetazolamide is a sulfonamide, it is a nonantimicrobial sulfonamide, which are believed to have no cross-reactivity with sulfonamide antimicrobials, such as trimethoprim-sulfamethoxazole. Despite this, most acetazolamide product inserts list allergy to any sulfonamide as a possible contraindication. (See "Sulfonamide hypersensitivity", section on 'Cross-reactivity'.)
from Drug.com
Acetazolamide is a carbonic anhydrase inhibitor that works by many mechanisms to accelerate acclimatization and ameliorate hypoxemia [79,80]. Inhibition of renal carbonic anhydrase slows the hydration of carbon dioxide, reduces reabsorption of bicarbonate and sodium, and causes a bicarbonate diuresis with resultant metabolic acidosis starting within one hour of ingestion. Acetazolamide disinhibits the central chemoreceptors and stimulates ventilation, which rapidly improves oxygenation. Importantly, acetazolamide maintains oxygenation during sleep and prevents periods of extreme hypoxemia [81]. Acetazolamide's mild diuretic action helps to counteract fluid retention associated with high-altitude illness. It also diminishes nocturnal antidiuretic hormone secretion and cerebrospinal fluid production and volume, and possibly lowers intracranial pressure (ICP) [20,82].
Contraindications
Hypersensitivity to acetazolamide or any excipients in the formulation. Since acetazolamide is a sulfonamide derivative, cross sensitivity between acetazolamide, sulfonamides and other sulfonamide derivatives is possible.
Acetazolamide therapy is contraindicated in situations in which sodium and/or potassium blood serum levels are depressed, in cases of marked kidney and liver disease or dysfunction, in suprarenal gland failure, and in hyperchloremic acidosis. It is contraindicated in patients with cirrhosis because of the risk of development of hepatic encephalopathy.
Long-term administration of acetazolamide is contraindicated in patients with chronic noncongestive angle-closure glaucoma since it may permit organic closure of the angle to occur while the worsening glaucoma is masked by lowered intraocular pressure.