▶UncommonBone marrow disorders.depression.dizziness
.electrolyte imbalance.hearing impairment.hepatic
disorders.leucopenia.nausea.renal colic.renal
impairment.renal lesions.severe cutaneous adverse
reactions (SCARs).skin reactions.thrombocytopenia.
urinary tract discomfort.urine abnormalities.vomiting
▶Rare or very rareAnaphylactic reaction.appetite changes.
confusion.diarrhoea.fatigue.fever.flushing.headache.
irritability.libido decreased.paralysis.photosensitivity
reaction.seizure
▶Frequency not knownAgranulocytosis.drowsiness.
myopia.polyuria.taste altered.thirst
SPECIFIC SIDE-EFFECTS
▶Uncommon
▶With oral useOsteomalacia
▶Rare or very rare
▶With oral useAtaxia.hyperglycaemia.hypoglycaemia.
renal tubular necrosis
▶Frequency not known
▶With oral useAgitation
SIDE-EFFECTS, FURTHER INFORMATIONAcetazolamide is a
sulfonamide derivative; blood disorders, rashes, and other
sulfonamide-related side-effects occur occasionally—
patients should be told to report any unusual skin rash.
If electrolyte disturbances and metabolic acidosis occur,
these can be corrected by administering bicarbonate.
lALLERGY AND CROSS-SENSITIVITYContra-indicated if
history of sulfonamide hypersensitivity.
lPREGNANCYManufacturer advises avoid, especially infirst
trimester (toxicity inanimalstudies).
lBREAST FEEDINGAmount too small to be harmful.
lHEPATIC IMPAIRMENTManufacturer advises avoid.
lRENAL IMPAIRMENTAvoid—risk of metabolic acidosis.
lMONITORING REQUIREMENTSMonitor blood count and
plasma electrolyte concentrations with prolonged use.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Tablet
CAUTIONARY AND ADVISORY LABELS 3
▶Acetazolamide (Non-proprietary)
Acetazolamide 250 mgAcetazolamide 250 mg tablets|
112 tabletP£ 75. 36 DT = £ 16. 86
Powder for solution for injection
▶Diamox(AMCo)
Acetazolamide 500 mgDiamox Sodium Parenteral 500 mg powder
for solution for injection vials| 1 vialP£ 17. 71
Modified-release capsule
CAUTIONARY AND ADVISORY LABELS3, 25
▶Diamox SR(AMCo)
Acetazolamide 250 mgDiamox SR 250 mg capsules|
30 capsuleP£ 16. 66 DT = £ 16. 66
▶Eytazox(Teva UK Ltd)
Acetazolamide 250 mgEytazox 250 mg modified-release capsules|
30 capsuleP£ 16. 60 DT = £ 16. 66Brinzolamide
lINDICATIONS AND DOSE
Reduction of intra-ocular pressure in primary and
secondary glaucoma either as adjunct to beta-blockers
or prostaglandin analogues or used alone if
unresponsive to beta-blockers or if beta-blockers contra-
indicated
▶TO THE EYE
▶Child:Apply twice daily, then increased if necessary up
to 3 times a daylUNLICENSED USENot licensed for use in children.lCONTRA-INDICATIONSHyperchloraemic acidosis
lCAUTIONSRenal tubular immaturity or abnormality—risk
of metabolic acidosis.systemic absorption follows topical
application
lINTERACTIONS→Appendix 1 : brinzolamide
lSIDE-EFFECTS
▶Common or very commonEye discomfort.eye disorders.
taste altered.vision disorders
▶UncommonArrhythmias.asthenia.cardio-respiratory
distress.chest discomfort.cough.depression.diarrhoea.
dizziness.dry eye.dry mouth.dyspnoea.epistaxis.eye
deposit.eye inflammation.feeling abnormal.foreign
body in eye.gastrointestinal discomfort.gastrointestinal
disorders.headache.increased risk of infection.memory
loss.motor dysfunction.muscle complaints.nasal
complaints.nausea.nervousness.oral disorders.
oropharyngeal pain.pain.palpitations.renal pain.scleral
discolouration.sensation abnormal.sexual dysfunction.
skin reactions.sleep disorders.throat complaints.
vomiting
▶Rare or very rareAlopecia.angina pectoris.drowsiness.
irritability.optic nerve disorder.respiratory disorders.
tinnitus
▶Frequency not knownAppetite decreased.arthralgia.
asthma.hypertension.malaise.peripheral oedema.
tremor.urinary frequency increased.vertigo
SIDE-EFFECTS, FURTHER INFORMATIONSystemic
absorption can rarely cause sulfonamide-like side-effects
and may require discontinuation if severe.
lALLERGY AND CROSS-SENSITIVITYContra-indicated if
history of sulfonamide hypersensitivity.
lPREGNANCYAvoid—toxicity inanimalstudies.
lBREAST FEEDINGUse only if benefit outweighs risk.
lHEPATIC IMPAIRMENTManufacturer advises avoid.
lRENAL IMPAIRMENTAvoid if estimated glomerular
filtration rate less than 30 mL/minute/ 1. 73 m^2.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Eye drops
EXCIPIENTS:May contain Benzalkonium chloride, disodium edetate
▶Brinzolamide (Non-proprietary)
Brinzolamide 10 mg per 1 mlBrinzolamide 10 mg/ml eye drops|
5 mlP£ 6. 92 DT = £ 1. 89
▶Azopt(Novartis Pharmaceuticals UK Ltd)
Brinzolamide 10 mg per 1 mlAzopt 10 mg/ml eye drops|
5 mlP£ 6. 92 DT = £ 1. 89Dorzolamide
lINDICATIONS AND DOSE
Raised intra-ocular pressure in primary and secondary
glaucoma used alone in patients unresponsive to beta-
blockers or if beta-blockers contra-indicated
▶TO THE EYE
▶Child:Apply 3 times a day
Raised intra-ocular pressure in primary and secondary
glaucoma as adjunct to a beta-blocker
▶TO THE EYE
▶Child:Apply twice dailylUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONSHyperchloraemic acidosis
lCAUTIONSChronic corneal defects.history of intra-ocular
surgery.history of renal calculi.immature renal tubules
(neonates and infants)—risk of metabolic acidosis.low
endothelial cell count.systemic absorption follows topical
application
lINTERACTIONS→Appendix 1 : dorzolamide684 Glaucoma and ocular hypertension BNFC 2018 – 2019
Eye11