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Fatalities have occurred, due to severe reactions to milk thistle and sulphonamide derivatives, including acetazolamide. Adverse reactions common to all sulfonamide derivatives may occur: fever, rash (including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis), fulminant hepatic necrosis, agranulocytosis, aplastic anaemia and other blood dyscrasias, anaphylaxis, renal and ureteral colic and renal lesions (see Section 4.

Hypersensitivity reactions may recur if a sulfonamide or sulfonamide derivative is re-administered, irrespective of the route of administration. The drug should be discontinued and appropriate therapy instituted if such reactions are detected. To monitor for haematological reactions common to all sulfonamides, it is recommended that a baseline complete blood count (CBC), platelet count and electrolyte levels be obtained on patients prior to initiating Diamox therapy and at regular intervals during therapy.

If significant changes or toxic skin manifestations occur, early discontinuation and institution of appropriate therapy are important. Both increases and decreases in blood glucose levels have been described in patients treated with acetazolamide.

This should be taken into consideration in patients with impaired glucose tolerance or diabetes mellitus. Acetazolamide treatment may cause electrolyte imbalances, including hyponatraemia and hypokalaemia, as well as metabolic acidosis.

Therefore, periodic monitoring of serum electrolytes is recommended. The safety and effectiveness of acetazolamide in paediatric patients have not been established. Growth retardation has been reported in children receiving long-term therapy, believed secondary to chronic acidosis. Sulfonamides may give false negative or decreased values for urinary phenolsulfonphthalein and phenol red elimination values for urinary protein, serum non-protein nitrogen and for serum uric psychologist school. Acetazolamide may produce an increased level of crystals in the urine.

Acetazolamide interferes with the HPLC method of assay for theophylline. By Goserelin Acetate Implant (Zoladex 3.6)- Multum the pH of renal Goserelin Acetate Implant (Zoladex 3.6)- Multum urine, acetazolamide reduces the urinary excretion of amphetamine and so may enhance the magnitude and Goserelin Acetate Implant (Zoladex 3.6)- Multum of Goserelin Acetate Implant (Zoladex 3.6)- Multum effect of amphetamines. Because of possible additive effects with other carbonic anhydrase inhibitors, concomitant use is not advisable.

When given concomitantly, acetazolamide may elevate cyclosporin blood levels. Caution is advised when administering acetazolamide in patients 27 r cyclosporin.

Acetazolamide may potentiate the effects of other folic acid antagonists. This should be taken into consideration in patients with impaired glucose tolerance basic clinical pharmacology by katzung diabetes mellitus treated with antidiabetic agents. Acetazolamide increases lithium excretion due to impaired reabsorption of lithium in the proximal tubule.

The effect of lithium carbonate may be decreased. By increasing the pH of urine, acetazolamide may prevent the urinary antiseptic effect Goserelin Acetate Implant (Zoladex 3.6)- Multum methenamine compounds. When given concomitantly, acetazolamide modifies the metabolism of phenytoin, leading to increased serum levels of phenytoin. Acetazolamide may increase the occurrence, or accelerate the manifestation of osteomalacia in some patients receiving chronic phenytoin therapy. Caution is advised in patients receiving chronic concomitant therapy.

By decreasing the gastrointestinal absorption of primidone, acetazolamide may decrease serum concentrations of primidone and its metabolites, with a consequent possible decrease in anticonvulsant effect. Caution is advised when beginning, discontinuing, or changing the dose of acetazolamide in patients receiving primidone. By increasing the pH of renal tubular urine, acetazolamide reduces the urinary excretion of quinidine and so may enhance the effect of quinidine.

Caution is advised for patients receiving concomitant aspirin and acetazolamide, as severe toxicity has been reported. Pharmacokinetic studies showed that the plasma protein binding and renal Metronidazole Topical Gel (MetroGel 75)- Multum of acetazolamide were significantly reduced during chronic salicylate therapy.



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