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Injection of acetazolamide sodium.

Drugs List

  • acetazolamide 500mg injection
  • DIAMOX 500mg sodium injection
  • Therapeutic Indications


    Treatment of all forms of epilepsy


    Intravenous or intramuscular injection.

    The direct intravenous route is the preferred route of administration. The intramuscular route is not recommended as it is painful due to the alkaline pH of the solution.


    Glaucoma (simple acute congestive and secondary)
    250mg to 1000mg in 24 hours, usually in divided doses if administering over 250mg daily.

    Abnormal retention of fluid (congestive heart failure, drug induced oedema)
    For diuresis, 250mg to 375mg once daily in the morning.
    If, after an initial response, the patient fails to continue to lose oedema fluid, do not increase the dose but allow renal function to improve by omitting for one day.
    Best results are often obtained on a regime of 250mg to 375mg daily for two days, rest a day, and repeat. Alternatively, give every other day.

    Fluid retention (associated with pre-menstrual tension)
    125mg to 375mg as a single daily dose.

    250mg to 1000mg daily in divided doses.


    8mg/kg to 30mg/kg in daily divided doses. Maximum dose is 750mg daily.
    The following alternative dosing schedule may be suitable:
    Children aged 12 to 18 years
    250mg two to four times a day.
    Children aged 1 month to 12 years
    Initial dose: 2.5mg/kg two to three times a day.
    Maintenance dose: 5mg/kg to 7mg/kg two to three times a day.
    Maximum dose: 750mg a day.

    Raised intra-ocular pressure (unlicensed)
    Children aged 12 to 18 years
    250mg two to four times a day.
    Children aged 1 month to 12 years
    5mg/kg two to four times a day, titrated to response.
    Maximum dose: 750mg a day.

    Raised intracranial pressure (unlicensed)
    Children aged 1 month to 12 years
    8mg/kg three times a day. If necessary, increase to a maximum of 100mg/kg a day.


    Initial dose: 2.5mg/kg two to three times a day.
    Maintenance dose: 5mg/kg to 7mg/kg two to three times a day.

    Patients with Renal Impairment

    In patients with moderate renal impairment doses should be restricted. The Renal Drug Handbook suggests doses of 250mg up to twice daily for patients with a GFR of 10-50 ml/min.


    Intravenous or intramuscular injection. The direct intravenous route is the preferred as intramuscular route is painful due to the alkaline pH of the solution.

    Care should be taken during intravenous administration to avoid extravasation and possible development of skin necrosis.


    Adrenal insufficiency
    Hepatic cirrhosis
    Hyperchloraemic acidosis
    Long term use in chronic non-congestive narrow angle glaucoma
    Severe hepatic impairment
    Severe renal impairment

    Precautions and Warnings

    Children under 18 years
    Diabetes mellitus
    Disorder of acid-base balance
    Electrolyte imbalance
    Hepatic impairment
    Obstructive pulmonary disease
    Pulmonary emphysema
    Renal impairment

    Advise ability to drive/operate machinery may be affected by side effects
    Diuresis is not dose-related
    If extravasation occurs follow local policy & seek expert help immediately
    Blood counts should be performed before and periodically during treatment
    Monitor serum electrolytes before and during treatment
    Consider AGEP if feverish generalised erythema occurs
    Monitor fluid balance
    Monitor for depressive disorders/suicidal ideation-consider discontinuation
    Patients on prolonged therapy should be regularly reviewed
    Advise patients to report any unusual rash to the prescriber
    Advise patients/carers to seek medical advice if suicidal intent develops
    Discontinue if hypersensitivity reactions occur
    Discontinue immediately if any severe fall in blood counts occur
    Discontinue permanently if AGEP is diagnosed
    Not licensed for all indications in all age groups

    Pregnancy and Lactation


    Acetazolamide sodium parenteral is contraindicated in pregnancy.

    The manufacturer notes that acetazolamide has been reported to be teratogenic and embryotoxic in rats, mice, hamsters and rabbits at parenteral doses in excess of ten times those recommended in human beings. As there are no adequate studies in pregnant women, this medication should not be used in pregnancy, especially during the first trimester.

    Briggs notes animal data has shown toxicity in offspring but a comparison to the human dose has not been provided and most studies found no adverse effects. Limited human data does not suggest a risk of developmental toxicity and no reports linking the use of acetazolamide with congenital defects have been located.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use acetazolamide sodium parenteral with caution in breastfeeding.

    Acetazolamide has been detected in low levels in the milk of lactating women, although it is thought to be unlikely that this will lead to any harmful effects in the infant.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abnormal liver function
    Acute generalised exanthematous pustulosis
    Aplastic anaemia
    Bone marrow depression
    Cholestatic jaundice
    Decreased appetite
    Electrolyte disturbances
    Erythema multiforme
    Flaccid paralysis
    Fulminant hepatic necrosis
    Hearing disturbances
    Metabolic acidosis
    Pain on intramuscular injection
    Reduced libido
    Renal colic
    Renal failure
    Renal lesions
    Skin necrosis (application site)
    Stevens-Johnson syndrome
    Taste disturbances
    Thrombocytopenic purpura
    Tingling in extremities
    Toxic epidermal necrolysis
    Ureteral colic


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: May 2018

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

    Summary of Product Characteristics: Diamox Sodium 500mg Powder for Solution for Injection. Mercury Pharmaceuticals Ltd. Revised January 2018.

    The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

    NICE Evidence Services Available at: Last accessed: 16 May 2018

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