Acetazolamide 500mg Oral Tablet – Indications, Contraindications

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 12 min read
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Acetazolamide 500mg Oral Tablet/Acetazolamide is a sulfonamide derivative with diuretic, antiglaucoma, and anticonvulsant properties. Acetazolamide is a non-competitive inhibitor of carbonic anhydrase, an enzyme found in cells in the proximal tube of the kidney, the eye, and glial cells. Inhibition of this enzyme in the...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

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Article Summary

Acetazolamide 500mg Oral Tablet/Acetazolamide is a sulfonamide derivative with diuretic, antiglaucoma, and anticonvulsant properties. Acetazolamide is a non-competitive inhibitor of carbonic anhydrase, an enzyme found in cells in the proximal tube of the kidney, the eye, and glial cells. Inhibition of this enzyme in the kidney prevents excretion of hydrogen, leading to increased bicarbonate and cation excretion and increased urinary volume, which results in an alkaline diuresis. Acetazolamide...

Key Takeaways

  • This article explains Mechanism of Action in simple medical language.
  • This article explains Indication of Acetazolamide in simple medical language.
  • This article explains Contraindications of Acetazolamide in simple medical language.
  • This article explains Dosage of Acetazolamide in simple medical language.
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  • New weakness, severe pain, high fever, or symptoms after a serious injury.
  • Any symptom that feels urgent, unusual, or unsafe for the patient.
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Acetazolamide 500mg Oral Tablet/Acetazolamide is a sulfonamide derivative with diuretic, antiglaucoma, and anticonvulsant properties. Acetazolamide is a non-competitive inhibitor of carbonic anhydrase, an enzyme found in cells in the proximal tube of the kidney, the eye, and glial cells. Inhibition of this enzyme in the kidney prevents excretion of hydrogen, leading to increased bicarbonate and cation excretion and increased urinary volume, which results in an alkaline diuresis. Acetazolamide reduces the concentration of bicarbonate, resulting in a decreased synthesis of aqueous humor in the eye, thereby lowering intraocular pressure. Although its mechanism of action is unknown, acetazolamide has anti-convulsant properties resulting from indirect effects secondary to metabolic acidosis or direct effects on neuronal transmission. Acetazolamide also produces respiratory stimulant effects in response to changes to both carbon dioxide and oxygen tension levels within the lungs.

Acetazolamide and methazolamide are carbonic anhydrase inhibitors used as diuretics and in the therapy of glaucoma. Both acetazolamide and methazolamide have been linked to rare cases of clinically apparent drug-induced liver disease.

Mechanism of Action

The anticonvulsant activity of Acetazolamide may depend on direct inhibition of carbonic anhydrase in the CNS, which decreases carbon dioxide tension in the pulmonary alveoli, thus increasing arterial oxygen tension. The diuretic effect depends on the inhibition of carbonic anhydrase, causing a reduction in the availability of hydrogen ions for active transport in the renal tubule lumen. This leads to alkaline urine and an increase in the excretion of bicarbonate, sodium, potassium, and water.

Acetazolamide is a sulfonamide derivative with diuretic, antiglaucoma, and anticonvulsant properties. Acetazolamide is a non-competitive inhibitor of carbonic anhydrase, an enzyme found in cells in the proximal tube of the kidney, the eye, and glial cells. Inhibition of this enzyme in the kidney prevents excretion of hydrogen, leading to increased bicarbonate and cation excretion and increased urinary volume, which results in an alkaline diuresis. Acetazolamide reduces the concentration of bicarbonate, resulting in a decreased synthesis of aqueous humor in the eye, thereby lowering intraocular pressure. Although its mechanism of action is unknown, acetazolamide has anti-convulsant properties resulting from indirect effects secondary to metabolic acidosis or direct effects on neuronal transmission. Acetazolamide also produces respiratory stimulant effects in response to changes to both carbon dioxide and oxygen tension levels within the lungs.

Indication of Acetazolamide

  • For adjunctive treatment of: edema due to congestive heart failure; drug-induced edema; centrencephalic epilepsies; chronic simple (open-angle) glaucoma
  • For adjunctive treatment of edema due to congestive heart failure or drug-induced edema.
  • Glaucoma
  • Acute Mountain Sickness
  • Hydrocephalus
  • Epilepsy
  • Edema
  • Hypokalemic Periodic Paralysis
  • Mountain Sickness / Altitude Sickness
  • Pseudotumor Cerebri
  • Seizure Prevention
  • For the prevention or amelioration of symptoms associated with acute mountain sickness despite gradual ascent.

Therapeutic Uses

  • Anticonvulsants; Carbonic Anhydrase Inhibitors; Diuretics
  • Carbonic anhydrase inhibitors are indicated primarily as adjuncts to other agents in the treatment of open-angle (chronic simple) glaucoma and secondary glaucoma, and to lower intraocular pressure prior to surgery for some types of glaucoma.
  • Acetazolamide is used to lower intraocular pressure in the treatment of malignant (ciliary block) glaucoma, which may occur after infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation surgery, trauma, or use of miotics. /NOT included in US product labeling/
  • Acetazolamide is indicated as an adjunct to other anticonvulsants in the management of absence seizures (petit mal), generalized tonic-clonic seizures (grand mal), mixed seizure patterns. It may be especially useful for intermittent therapy in females who experience increased seizure activity at the time of menstruation.
  • Oral acetazolamide is indicated to decrease the incidence and/or severity of symptoms (such as pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।" data-rx-term="headache" data-rx-definition="Headache means pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।">headache, nausea, shortness of breath, dizziness, drowsiness, and fatigue) associated with acute altitude sickness in mountain climbers who are attempting rapid ascent and in those who are very susceptible to altitude sickness despite gradual ascent. Gradual ascent is desirable for the prevention of acute altitude sickness even when acetazolamide is used. However, prompt descent may still be necessary if severe manifestations of acute altitude sickness, such as pulmonary edema or cerebral edema, occur.
  • Acetazolamide is used to treat both the hypokalemic and hyperkalemic forms of familial periodic paralysis. It terminates the acute attacks and, with chronic use, prevents their recurrence. It may be the drug of choice in the hypokalemic form of the condition.
  • Parenteral acetazolamide is used to produce a forced alkaline diuresis as a method of increasing the elimination of certain weakly acidic medications.
  • Oral acetazolamide is used to alkalinize the urine as a means of preventing the occurrence or recurrence of uric acid renal stones, especially in patients receiving uricosuric antigout agents, or of cysteine renal stones.
  • Acetazolamide has also been used to prevent or counteract metabolic alkalosis, including that which may occur following open-heart surgery; however, it is no longer used for these indications.
  • Acetazolamide has also been used as a diuretic in the treatment of edema due to congestive heart disease and drug-induced edema. However, it has been replaced by newer diuretics for these indications
  • A placebo-controlled study of the therapy of acute altitude sickness in 12 mountain climbers, 6 of whom were given 250 mg of oral acetazolamide every 8 hr for 2 doses, is reported. After 24 hr, the patients treated with acetazolamide were asymptomatic, whereas those given the placebo still had acute altitude sickness. The alveolar to arterial oxygen pressure difference decor slightly over 24 hr in the acetazolamide group but incr slightly in the placebo group. Acetazolamide improved the arterial partial oxygen pressure over 24 hr when compared with placebo. It was concluded that in established cases of acute altitude sickness, treatment with acetazolamide relieves symptoms, improves arterial oxygenation, and prevents further impairment of pulmonary gas exchange.

Contraindications of Acetazolamide

  • Hyperchloremic acidosis
  • Hypokalemia (low blood potassium)
  • Hyponatremia (low blood sodium)
  • Adrenal insufficiency
  • Impaired kidney function
  • Hypersensitivity to acetazolamide or other sulfonamides.
  • Marked liver disease or impairment of liver function, including cirrhosis because of the risk of development of hepatic encephalopathy. Acetazolamide decreases ammonia clearance
  • type 1 insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes mellitus
  • a condition where the adrenal glands produce less hormones called Addison’s disease
  • a type of joint disorder due to excess uric acid in the blood called gout
  • respiratory acidosis, an acid-base disorder
  • a blood disorder
  • decreased lung function
  • liver problems
  • severe liver disease
  • renal tubular acidosis
  • recurrent calcium-containing kidney stones
  • decreased kidney function
  • hyperchloremic acidosis

Dosage of Acetazolamide

Strengths: 500 mg; 125 mg; 250 mg

Edema

  • Initial dose: 250 to 375 mg orally/IV once a day
  • If after initial response there is a lack of response, hold therapy for a day
  • Maintenance dose: One dose every other day or once a day for 2 days alternating with a day of rest

Acute Mountain Sickness

  • 500 to 1000 mg orally per day in divided doses
  • Guideline dose: 125 mg orally twice a day
  • AMS Treatment: Guideline dose: 250 mg orally twice a day
  • May use immediate-release or extended-release as appropriate for Acute Mountain Sickness (AMS)/High Altitude Cerebral Edema (HACE) Prevention

Glaucoma

Open-Angle Glaucoma

  • Immediate-release (IR) tablets: 250 to 1000 mg orally per day; amounts over 250 mg should be administered in divided doses
  • Extended-release (ER) capsules: 500 mg orally 2 times a day
  • Maintenance: Adjust doses individually based on symptomatology and ocular tension; for patients inadequately controlled on ER capsules 1 g/day, may supplement with IR tablets
  • Doses in excess of 1 g/24 hour generally do not produce increased effects

Preoperatively in Closed-Angle Glaucoma

  • Various regimens have been used including 250 mg orally every 4 hours; 250 mg orally twice a day; OR 500 mg orally followed by 125 mg or 250 mg orally every 4 hours

Glaucoma (Open Angle)

Open-Angle Glaucoma

  • Immediate-release (IR) tablets: 250 to 1000 mg orally per day; amounts over 250 mg should be administered in divided doses
  • Extended-release (ER) capsules: 500 mg orally 2 times a day
  • Maintenance: Adjust doses individually based on symptomatology and ocular tension; for patients inadequately controlled on ER capsules 1 g/day, may supplement with IR tablets
  • Doses in excess of 1 g/24 hour generally do not produce increased effects

Preoperatively in Closed-Angle Glaucoma

  • Various regimens have been used including 250 mg orally every 4 hours; 250 mg orally twice a day; OR 500 mg orally followed by 125 mg or 250 mg orally every 4 hours

Seizure Prophylaxis

  • Initial dose: 8 to 30 mg/kg orally/IV in divided doses
  • Range: 375 to 1000 mg per day
  • Initial dose for patients on other anticonvulsants: 250 mg orally/IV once a day

Pediatric Dose

Acute Mountain Sickness

12 years or older:

  • Extended-release capsules: 500 mg orally once or twice a day
  • Guideline dose (immediate-release): 2.5 mg/kg orally every 12 hours
  • Maximum: 125 mg per dose

Glaucoma

12 years or older

  • Extended-release (ER) capsules: 500 mg orally 2 times a day
  • Doses in excess of 1 g/24 hour generally do not produce increased effects.

Glaucoma (Open Angle)

12 years or older

  • Extended-release (ER) capsules: 500 mg orally 2 times a day

Side Effects of Acetazolamide

The most Common

  • paresthesias, “tingling” feeling in the extremities,
  • some loss of appetite,
  • polyuria,
  • occasional drowsiness,
  • confusion and photosensitivity
  • papular or erythematous skin eruptions,
  • nausea,
  • acidosis and blood dyscrasias.
  • myopia, malaise syndrome,
  • fatigue,
  • anorexia,
  • loss of weight,
  • depression and loss of libido;
  • gastrointestinal distress,
  • elevated blood urate,
  • acute gouty arthritis skin rashes and hair loss or excess growth of hair.

Common 

  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of too much acid in the blood (acidosis) like confusion; fast breathing; fast heartbeat; a heartbeat that does not feel normal; very bad stomach pain, upset stomach, or throwing up; feeling very sleepy; shortness of breath; or feeling very tired or weak.
  • Signs of electrolyte problems like mood changes, confusion, muscle pain or weakness, a heartbeat that does not feel normal, seizures, not hungry, or very bad upset stomach or throwing up.
  • Change in eyesight.
  • Change in hearing.
  • Ringing in ears.

Rare

  • Paresthesias, hearing dysfunction or tinnitus, anorexia, altered taste, nausea, vomiting, diarrhea, polyuria, drowsiness, confusion.
  • A burning, numbness, or tingling feeling that is not normal.
  • Pain when passing urine or blood in the urine.
  • Not able to pass urine or change in how much urine is passed.
  • Muscle weakness.
  • Change in balance.
  • Trouble moving around.
  • Upset stomach or throwing up.
  • Change in taste.
  • Diarrhea.
  • Not hungry.
  • Blurred eyesight.
  • Feeling dizzy, sleepy, tired, or weak.
  • Headache.
  • Flushing.
  • Feeling nervous and excitable.

Drug Interactions of Acetazolamide

View interaction reports for acetazolamide and the medicines listed below.

  • diphenhydramine
  • CoQ10 ubiquinone
  • duloxetine
  • Fish Oil (omega-3 polyunsaturated fatty acids)
  • furosemide
  • pregabalin
  • esomeprazole
  • acetaminophen / hydrocodone
  • acetaminophen
  • albuterol
  • magnesium salicylate
  • metformin
  • methazolamide
  • dichlorphenamide
  • dofetilide
  • dronedarone
  • droperidol
  • citalopram
  • clobazam
  • clonazepam
  • clorazepate
  • clozapine
  • corticorelin
  • corticotropin
  • cortisone
  • montelukast
  • levothyroxine
  • topiramate
  • acetaminophen
  • Vitamin B12 (cyanocobalamin)
  • Vitamin C (ascorbic acid)
  • Vitamin D2 (ergocalciferol)
  • Vitamin D3 (cholecalciferol)
  • ondansetron
  • cetirizine

Pregnancy Category

  • US FDA pregnancy category –  C
  • Pregnancy category – B3 in Australia

Pregnancy

Acetazolamide is pregnancy category B3 in Australia, which means that studies in rats, mice and rabbits in which acetazolamide was given intravenously or orally caused an increased risk of fetal malformations, including defects of the limbs.[rx] Despite this, there is insufficient evidence from studies in humans to either support or discount this evidence.[rx]

Lactation

Limited data are available on the effects of nursing mothers taking acetazolamide. Therapeutic doses create low levels of breast milk and are not expected to cause problems in infants.[rx]

Before taking acetazolamide,

  • tell your doctor and pharmacist if you are allergic to acetazolamide, sulfa drugs, diuretics (‘water pills’), or any other drugs.
  • tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially amphetamines, aspirin, cyclosporine (Neoral, Sandimmune), medications for depression or irregular heartbeat, diflunisal (Dolobid), digoxin (Lanoxin), diuretics (‘water pills’), lithium (Eskalith, Lithobid), phenobarbital, primidone (Mysoline), and vitamins.
  • tell your doctor if you have or have ever had heart, liver, or kidney disease; or diabetes.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking acetazolamide, call your doctor immediately.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking acetazolamide.
  • you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
  • remember that alcohol can add to the drowsiness caused by this drug.
  • plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Acetazolamide may make your skin sensitive to sunlight.

References

Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Medicine doctor / pediatrician for children / qualified clinician
Tests to discuss with doctor
  • Temperature chart and hydration assessment
  • CBC with platelet count if fever persists or dengue/other infection is possible
  • Urine test, malaria/dengue tests, chest evaluation, or blood culture only when clinically indicated
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Do I need antibiotics, or is this more likely viral?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Acetazolamide 500mg Oral Tablet – Indications, Contraindications

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

Add references, clinical guidelines, textbooks, journal articles, or trusted medical sources here. You can edit this area from the RX Article Professional Blocks panel.

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