(FDA approved in bold)

• Adjunctive treatment for centrencephalic epilepsies (petit mal, unlocalized)
  
• Acute mountain sickness
  
• Edema due to congestive heart failure or medication
  
• Glaucoma
  
• Idiopathic intracranial hypertension (IIH) (pseudotumor cerebrii)
  
• Episodic ataxias type 1 and 2
  
• Hemiplegic migraine
  
• Marfan syndrome
  
• Sleep apnea

• Blocks the carbonic anhydrase enzyme, which is responsible for converting CO₂ and H₂O to bicarbonate. This increases excretion of sodium, potassium, bicarbonate and water, producing alkaline diuresis. In epilepsy, decreases excessive neuronal discharge in CNS due either to inhibition of carbonic anhydrase or slight degree of acidosis. It also reduces production of CSF and aqueous humor

• Seizures – by 2–3 weeks
  
• IIH – maximum benefit in 4–6 weeks

• Seizures – goal is the remission of seizures. Continue as long as effective and well-tolerated. Consider tapering and slowly stopping after 2 years seizure-free, depending on the type of epilepsy
  
• IIH – monitor visual fields and papilledema and symptoms such as visual obscurations and headache

Increase to highest tolerated dose

• Seizures – consider changing to another agent, adding a second agent or referral for epilepsy surgery evaluation. When adding a second agent keep in mind the drug interactions that can occur
  
• IIH – eliminate symptomatic causes such as drugs or toxins, encourage weight loss if patient is obese, consider loop diuretics or topiramate. Lumbar puncture often provides short-term relief of symptoms. For visual loss, optic nerve defenestration or CSF shunting (lumboperitoneal or ventriculoperitoneal) may be needed

• Epilepsy – acetazolamide itself is usually an augmenting agent. Relatively few interactions with other AEDs. Topiramate and zonisamide have similar mechanisms of action, so acetazolamide is not usually combined with these agents
  
• IIH – furosemide and topiramate may be helpful. Combine with caution due to risk of kidney stone formation

• Obtain a CBC when starting drug and during therapy. Check bicarbonate, potassium, and sodium levels if symptoms of metabolic acidosis develop