abbreviations: R, renal excretion of intact drug; M, metabolism; ID, insufficient data.

The major indication for carbonic anhydrase inhibitors is open-angle glaucoma. Carbonic anhy-drase inhibitors also may be employed for secondary glaucoma and preoperatively in acute angle-closure glaucoma to lower IOP before surgery (see Chapter 63). Acetazolamide also is used for the treatment of epilepsy, but the rapid development of tolerance may limit its usefulness. Acetazolamide may provide symptomatic relief in patients with altitude sickness; however, it is more effective when given prophylactically. Acetazolamide also is useful in patients with familial periodic paralysis. The mechanism for the beneficial effects of acetazolamide in altitude sickness and familial periodic paralysis may be related to the induction of a metabolic acidosis. Finally, carbonic anhydrase inhibitors can be useful for correcting metabolic alkalosis, especially that caused by diuretic-induced increases in H+ excretion.

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