Re: Is Diamox contraindicated with Inspra?

[Guest guest]

What ever you do keep good records and we can post here an n of 1 experience.

May your pressure be low!

Clarence E. Grim, BS, MS, MD

Senior Consultant to Shared Care Research and Consulting, Inc.

(sharedcareinc.com)

Clinical Professor of Internal Medicine and Epidemiology Med. Col. WI

Clinical Professor of Nursing, Univ. of WI, Milwaukee

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

**************

Start the year off right. Easy ways to stay in shape.

http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489

[Guest guest]

Additional information:

Acetazolamide Drug Interactions

Acetazolamide (aka Diamox) is frequently prescribed as therapy for

the periodic paralyses. While most patients take this drug without

incident it can have major interactions with other drugs and

physicians should be aware of potential problems which might arise.

Acetazolamide can decrease excretion of dextroamphetamine,

anticholinergics, mecamylamine, ephedrine, mexiletine, or quinidine

because carbonic anhydrase inhibitors increase the alkalinity of the

urine, thereby increasing the amount of nonionized drug available

for renal tubular reabsorption. The effects of these drugs can be

prolonged or enhanced. Increased urine alkalinity also can inhibit

the conversion of methenamine to formaldehyde, which is the active

bacteriostatic form. Concurrent use of methenamine and acetazolamide

is not recommended.

Acetazolamide produces alkaline urine and can increase the rate of

excretion of weakly acidic drugs including barbiturates and

salicylates. Acetazolamide can potentiate salicylate toxicity by

causing metabolic acidosis and enhancing the penetration of the

salicylate into tissues. In addition, salicylates decrease the

elimination of acetazolamide, which could result in CNS toxicity.

Acetazolamide can induce osteomalacia in patients being

concomitantly treated with carbamazepine, primidone, or phenytoin.

Potential mechanisms for this interaction include an acetazolamide-

induced increase in the urinary excretion of calcium and effects

resulting from metabolic acidosis.

Acetazolamide can enhance the effect of other diuretics, such as

thiazides, when used concurrently. The hypokalemic and hyperuricemic

effects, however, also can be potentiated.

Acetazolamide can potentiate the hypokalemia caused by

corticosteroids, amphotericin B, or corticotropin, ACTH. In

addition, patients receiving digoxin and acetazolamide concurrently

are at an increased risk for digoxin toxicity if hypokalemia

develops during treatment. A large proportion of ciprofloxacin is

normally excreted unchanged in the urine. If acetazolamide is used

concomitantly, the solubility of ciprofloxacin can be decreased

because of alkaline urine. Patients should be monitored for

crystalluria and nephrotoxicity.

Adverse Reactions:

The inhibition of carbonic anhydrase affects excretion of

electrolytes. Hyperchloremia and/or metabolic acidosis can result

from an increase in plasma chloride concentrations. Acetazolamide

increases the excretion of bicarbonate and sodium, decreasing the

extracellular fluid concentration of bicarbonate and causing

metabolic acidosis. Increased excretion of potassium is most likely

to occur during the use of high dosages or during concurrent use of

other potassium-depleting agents, and can result in hypokalemia.

Carbonic anhydrase inhibitors are sulfonamide derivatives and have

caused crystalluria and sulfonamide-like nephrotoxicity

characterized by renal intratubular obstruction, hematuria, dysuria,

and oliguria. An increase in calcium excretion can cause

nephrolithiasis. Patients with preexisting hypercalcemia develop

renal calculi most frequently.

There has also been a report of fatal anaphylactic shock occurring

in a patient who had a sulphonamide allergy. Before prescribing

acetazolamide, the physician should inquire about sulphonamide

allergy because of the related chemical structure of the substances.

Such an allergy should be regarded as a contraindication. (1)

1: Ned Tijdschr Geneeskd 2000 Jun 17;144(25):1228-30

Fatal anaphylactic reaction after oral acetazolamide (diamox) for

glaucoma; Gerhards LJ, van Arnhem AC, Holman ND, Nossent GD Afd.

Cardiologie, i Ziekenhuis, Groningen. PMID: 10897303, UI:

20355494

>

> Since Diamox is a carbonic anhydrase inhibitor which can cause

> hypokalemia can it be taken with Inspra an Aldosterone Receptor

> Antagonist and Aldosterone Blocker if I want to use Diamox for

> prevention of high altitude sickness?

>

>

>

____________________________________________________________________

>

>

> Diamox (Acetazolamide)

>

> Mechanism

> Carbonic Anhydrase Inhibitor

>

>

> Indications

> High Altitude Sickness treatment and prevention

> Pseudotumor Cerebri

>

>

> Contraindications

> Sulfonamide allergy

>

>

> Dosing

> High Altitude Sickness

> Prevention: 125 mg PO bid

> Start 24 hours before ascent

> Continue for 72 hours

> Insomnia at altitude: 125 mg PO qhs

> Treatment: 250 to 400 mg PO bid

> Pseudotumor Cerebri

> Dose range: 125-250 mg PO qd-tid

>

>

> Adverse Effects

> Peripheral Paresthesias

> Polyuria

>

>

>

____________________________________________________________________

>

>

> Inspra (Eplerenone)

>

> Selective Aldosterone Receptor Antagonist

> Selective Aldosterone Blocker

>

> More selective for aldosterone than Spironolactone

>

>

> Indication

> Congestive Heart Failure

> Hypertension

>

>

> Contraindications

> Serum Potassium >5.5 mEq/L

> Tyep II Diabetes Mellitus with Microalbuminuria

> Renal insufficiency

> Serum Creatinine >2.0 in men or >1.8 mg/dl in women

> Creatinine Clearance <50 ml/min

>

>

> Adverse Effects

> Hyperkalemia

> Hypertriglyceridemia

> Hyponatremia

> Dizziness

> Fatigue

> Diarrhea

> Cough

> Less Gynecomastia and Impotence than Spironolactone

>

>

> Drug Interactions

> Potassium supplements

> Potassium sparing Diuretics

> Cytochrome P450 3A4 inhibitors (e.g. Ketoconazole)

> ACE Inhibitors

>