Acetazolamide blood concentrations are excessive in the elderly: propensity for acidosis and relationship to renal function

Journal of Clinical Pharmacology
D J ChapronK R Sweeney

Abstract

Elderly glaucoma patients are often treated with acetazolamide, a carbonic anhydrase inhibitor with clearance dependent on renal function. A high incidence of metabolic acidosis and other adverse effects have been noted among these patients but the reasons for this have not been explained. We hypothesized that commonly used doses of acetazolamide among the elderly result in excessive blood concentrations and that these concentrations are related to acid-base disturbances. We measured steady-state acetazolamide levels in plasma, plasma ultrafiltrate (unbound), and erythrocytes among 12 elderly subjects (79.2 +/- 7.6 years old). Mean plasma (18.9 +/- 10.9 micrograms/mL) and ultrafiltrate concentrations (1.0 +/- 0.7 microgram/mL) exceeded the therapeutic range (plasma 5-10 micrograms/mL; ultrafiltrate 0.25-0.50 microgram/mL) for glaucoma control by two fold and were elevated in 75% of subjects. Plasma and ultrafiltrate acetazolamide levels significantly correlated with the dose adjusted for creatinine clearance (r = 0.91, P less than 0.001; r = 0.89, P less than 0.001, respectively). Acidotic subjects (serum total carbon dioxide less than or equal to 22 mEq/L) tended to have higher plasma, ultrafiltrate, and erythrocyte acetazolam...Continue Reading

References

Aug 1, 1977·Archives of Ophthalmology·D L Epstein, W M Grant
Jan 1, 1976·Nephron·D W Cockcroft, M H Gault
Feb 1, 1989·Journal of the American Geriatrics Society·J R FriedmanT T Yoshikawa
Nov 1, 1986·Clinical Pharmacology and Therapeutics·K R SweeneyP A Kramer
Mar 1, 1985·British Journal of Clinical Pharmacology·D J ChapronP A Kramer
Oct 1, 1967·Physiological Reviews·T H Maren
Jan 1, 1984·Annals of the New York Academy of Sciences·T D DuBose
Jan 1, 1984·Annals of the New York Academy of Sciences·P J Wistrand
Feb 1, 1982·Acta Ophthalmologica·A AlmM Roosdorp
Nov 1, 1980·Journal of the American Geriatrics Society·T Gral, M Young

❮ Previous
Next ❯

Citations

Nov 4, 1998·Journal of Pharmaceutical and Biomedical Analysis·N IchikawaK Iwamoto
Oct 11, 2011·Cardiology in Review·Rahim Kassamali, Domenic A Sica
Mar 13, 2014·Expert Opinion on Drug Safety·Erik R Swenson
Jan 26, 2010·Expert Opinion on Drug Safety·Pantelis A SarafidisAnastasios N Lasaridis
Aug 10, 2005·Expert Opinion on Pharmacotherapy·Maria A Poca, Juan Sahuquillo
Dec 1, 1992·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·L F RoyC Morin
Feb 26, 2013·Clinical & Experimental Ophthalmology·Constantine D GeorgakopoulosNikolaos Pharmakakis
Mar 10, 2005·The Medical Clinics of North America·Steven Gabardi, Stuart Abramson
Aug 1, 1993·Journal of the American Geriatrics Society·P Rousseau, A Fuentevilla-Clifton
May 6, 1999·Journal of Ocular Pharmacology and Therapeutics : the Official Journal of the Association for Ocular Pharmacology and Therapeutics·M InataniK I Inui
Nov 7, 2018·Oxford Medical Case Reports·William MuñozSteven Lamm
Apr 20, 2010·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·George LiamisMoses Elisaf
Feb 27, 2016·F1000Research·Amy Quynh Trang PhamOrson W Moe
Apr 4, 2002·Journal of Investigative Medicine : the Official Publication of the American Federation for Clinical Research·Luca FilippiFirmino F Rubaltelli
Feb 16, 2007·Current Opinion in Ophthalmology·Dennis S C LamDexter Y L Leung
Oct 30, 2004·Seminars in Ophthalmology·Sek-Tien HohPaul T K Chew
Apr 26, 2020·BMJ Open Respiratory Research·Christopher N SchmicklAtul Malhotra
Feb 2, 2018·BMJ Open Sport & Exercise Medicine·Arthur R BradwellUNKNOWN Birmingham Medical Research Expeditionary Society
Dec 12, 2018·European Journal of Ophthalmology·Constantine D GeorgakopoulosOlga E Makri
Nov 28, 2019·Journal of Neonatal-perinatal Medicine·A Ibrahim, N Hussain
May 1, 1996·The Annals of Pharmacotherapy·W G Reiss, K S Oles
Mar 1, 2016·Expert Review of Endocrinology & Metabolism·Ingrid Jullian-DesayesMarie Joyeux-Faure
Feb 23, 2020·Seizure : the Journal of the British Epilepsy Association·Sherif Hanafy MahmoudS Nizam Ahmed
Mar 1, 1993·The American Journal of Physiology·A CaranoH C Blair
Jul 12, 2012·Annals of Clinical Biochemistry·David Wile

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.