Acetazolamide-Induced Metabolic Acidosis

Mechanism and Clinical Applications

• Acetazolamide inhibits carbonic anhydrase, which produces a metabolic acidosis by increasing bicarbonate excretion in the kidneys 1
• For management of edema in nephrotic syndrome, acetazolamide may be used as part of combination diuretic therapy, but with awareness of its effect on acid-base balance 2, 3
• Acetazolamide has no role in the routine management of obstructive sleep apnea due to limited efficacy and poor tolerability, with metabolic acidosis being one of the limiting factors 1