|Year : 1983 | Volume
| Issue : 4 | Page : 459-461
Rare toxicity of diamox (acetazolamide)
Railway Hospital, Allahabad, India
N K Bhatnagar
Railway Hospital, Allahabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhatnagar N K. Rare toxicity of diamox (acetazolamide). Indian J Ophthalmol 1983;31:459-61
Diamox is widely used in ophthalmic practice in glaucoma, and pre and post operative medication in cataract surgery. It is also given as adjuvant therapy along with other drugs in Epilepsies and also as diuretic. It is also used in some cases of increased intracranial tension.
The following symptoms & signs of its toxicity have been reported.
| Symptoms|| |
Paresthesia, drowsiness, lassitude, Anorexia, vomitting, tingling, Ataxia, renal colic, Excitement, thirst, precoma and coma in hepatic cirrhosis.
| Signs|| |
Renal calculii, Expoliative dermatitis, leucopenia, Agranulocytosis, thrombocytopaenia, Lupses Erythematosis.
Latest reports on this subject are of Steven Johnson Syndrome and Erythema Multiforme.
The present study includes cases where the drug had shown usual reactions in some cases, but in addition some entirely new features were exhibited.
| Materials and methods|| |
All cases of different Eye diseases who were given diamox and who exhibited the hitherto described toxicity were included in this study. They were subjected to various clinical, pathological and microbiological tests and results co-related with findings.
Number of cases studied were ten which included 5 cases of cataract, 3 cases of injury and 2 cases of glaucoma. In each case the Diamox tablet (Lederle) of batch No. 358 was given either alone or alongwith other drugs. When by exclusion methods of other drugs it was established that the typical reaction in all cases was due to diamox then its administration was stopped. Subsequently no case was reported when other drugs to lower the intraocular tension were used as follow up and centrol group of ten patients, where lasix, mannitol, and phenergan were used.
All cases were treated by inj. C.P. 5 lac BD, lnj. B. Complex and local applications of gentian voilet.
| Discussion|| |
Diamox (Acetazolamide) acting by inhibiting carbonic anhydrase in lowering the intraocular tension is bound to plasma protein and excreated unchanged in urine is known to cause various toxic effects like other sulpha drugs as described in introduction. The remarkable feature of this present study are :-
1. In all cases the drug belonged to batch No. 358. There is possibility of some impurity in this batch which might have caused this common reaction in all the cases.
2. Blood picture in all the cases were normal.
3. Some virus epidemic like foot and mouth disease was considered in differential diognosis but skin biopsy did not reveal any virus or fungus.
4. Most of case consumed 20 to 40 tablets within a period of 6 to 15 days leading to classical picture described earlier, it is possible that the amount of drug consumed might have caused depletion of B Complex level in blood and also by killing the normal bacterial flora of intestines. Inj. B. Complex, however, given as therapy has helped in early recovery.
5. The onset of symptoms leading to acute gastritis and stomatitis in 100°0 cases and even haematamesis in one cases shows that it had as direct corrosive action on gastric mucosa hitherto not descrived by any of the workers. Stomatitis may be due to B Complex deficiency.
6. Involvement of groin and scrotum leading to ulceration in 70% cases is also an a-typical finding of interest reported in the present series which is not reported so far. Similarly involvement of dursum of hand and foot in 40% cases in a typical pattern is also a rare finding. So is the cases of angular cheilosis in 90% cases.
7. Buccal smear showed gram positive coccii Gram negative bacillii and fungi are due to superadded infection.
| Summary|| |
10 cases of adverse and rare toxic effects of Dimox reported. Acute gastritis in 100% cases, ulcerative dermatitis of groin and scrotum in 70% cases, baematemesis in 10% cases and angular cheilosis in 90% cases are rare effects not reported so far by other workers.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]