Diacarb 250 mg 30 tablets

• Edema syndrome (of mild or moderate severity, in combination with alkalosis);
• Relief of acute glaucoma attack, preoperative preparation of patients, persistent cases of glaucoma (in combination therapy);
• In epilepsy as an adjunct therapy to antiepileptic medications;
• Acute mountain sickness (the drug reduces acclimatization time);
• Liquorodynamic disorders, intracranial hypertension (benign intracranial hypertension, intracranial hypertension after ventriculoperitoneal shunting) in combination therapy.

The medication is taken orally, strictly as prescribed by a doctor.
In case of a missed dose, do not increase the dose at the next intake.
• Edema syndrome
At the beginning of treatment, take 250 mg in the morning.
To achieve maximum diuretic effect, it is necessary to take Diacarb® once a day every other day or for 2 consecutive days with a one-day break. Increasing the dose does not enhance the diuretic effect. If there is a decrease in the previously achieved response to therapy with acetazolamide, the medication should be discontinued for one day (to restore kidney carbonic anhydrase activity). The use of acetazolamide does not eliminate the need for other medications, adherence to bed rest (if recommended by a doctor), and restriction of sodium chloride intake.
• Glaucoma
Diacarb® should be taken as part of combination therapy.
For adults with open-angle glaucoma, the medication is prescribed at a dose of 250 mg 1-4 times a day. Doses exceeding 1000 mg do not increase the therapeutic effect. In secondary glaucoma, the medication is prescribed at a dose of 250 mg every 4 hours during the day. In some patients, the therapeutic effect is observed after a short course of the medication at a dose of 250 mg twice a day.
In acute glaucoma attacks: 250 mg 4 times a day.
For children over 3 years old during glaucoma attacks: 10-15 mg/kg body weight per day in 3-4 doses.
After 5 days of treatment, take a break for 2 days. For long-term treatment, potassium supplements and a potassium-sparing diet are necessary.
When preparing for surgery, prescribe 250-500 mg the day before and in the morning on the day of the surgery.
• Epilepsy
Doses for adults:
250-500 mg/day in a single dose for 3 days, followed by a break on the 4th day.
When acetazolamide is used simultaneously with other anticonvulsants, start treatment with 250 mg once a day, gradually increasing the dose if necessary. The maximum daily dose for adults is 1000 mg.
Doses for children over 3 years old:
8-30 mg/kg per day, divided into 1-4 doses. The maximum daily dose is 750 mg.
• Acute mountain sickness
The recommended dose is 500-1000 mg per day.
In case of rapid ascent - 1000 mg per day.
The medication should be taken 24-48 hours before ascent. If symptoms of the illness appear, continue treatment for the next 48 hours or longer if necessary.
• Liquorodynamic disorders, intracranial hypertension
The recommended dose is 250 mg per day or 125-250 mg every 8-12 hours. The maximum therapeutic effect is achieved with a dose of 750 mg per day. To achieve optimal therapeutic effect, daily intake of the medication without intervals may be required.

One tablet contains:
active ingredient: acetazolamide, calculated as 100% substance - 250 mg;
excipients: microcrystalline cellulose - 83.15 mg, povidone (type K90) - 6.25 mg, colloidal silicon dioxide - 1.8 mg, sodium croscarmellose - 7 mg, magnesium stearate - 1.8 mg.

Round flat-cylindrical tablets of white color or white with a yellowish or grayish tint, with a bevel and a score line.

• Hypersensitivity to acetazolamide (or other sulfonamides), as well as any other components of the drug; acute renal failure;

• uremia;

• liver failure (risk of developing encephalopathy); refractory hypokalemia and hyponatremia;

• metabolic acidosis;

• hypocortisolism;

• Addison's disease;

• decompensated diabetes mellitus;

• pregnancy (first trimester);

• lactation period;

• children under 3 years of age (solid dosage form).
With caution:
Edema of hepatic and renal origin, simultaneous use with acetylsalicylic acid (doses over 300 mg/day), pulmonary embolism and pulmonary emphysema (risk of developing acidosis), pregnancy (second and third trimesters), elderly age, disturbances in water-electrolyte balance, liver dysfunction, in patients at risk of urinary tract obstruction.
Use during pregnancy and lactation.
During pregnancy, Diacarb® is contraindicated in the first trimester, and in the second and third trimesters, it is used with caution and only in cases where the potential benefit to the mother outweighs the potential risk to the fetus. Acetazolamide is excreted in small amounts in breast milk, therefore, if it is necessary

In case of hypersensitivity to the drug, life-threatening hypersensitivity reactions to acetazolamide (sulfonamides) may occur, such as Stevens-Johnson syndrome, Lyell's syndrome, fulminant liver necrosis, agranulocytosis, aplastic anemia, and hemorrhagic diathesis. If these symptoms occur, the use of the drug should be immediately discontinued and a doctor should be consulted.
The drug Diacarb®, when used in doses exceeding the recommended amounts, does not increase diuresis but may enhance drowsiness and paresthesia, and may sometimes also decrease diuresis.
When acetazolamide is used for more than 5 days, there is a high risk of developing metabolic acidosis. Acetazolamide should be used with caution in patients with bronchial obstruction and pulmonary emphysema (conditions associated with impaired alveolar ventilation) due to the possibility of exacerbating acidosis. Acetazolamide alkalinizes urine. In patients with a history of urolithiasis, the balance of treatment benefits and the risk of stone formation should be assessed.
If transient hearing impairment occurs, acetazolamide should be discontinued. The concurrent use of acetazolamide with high doses of acetylsalicylic acid (more than 300 mg per day) is not recommended due to the high risk of severe side effects. During epilepsy treatment with specific antiepileptic drugs, a slight increase in the risk of suicidal thoughts and behavior has been noted. The mechanism of this phenomenon is unknown, but existing data do not exclude such a risk when using acetazolamide. Therefore, when using acetazolamide for the treatment of epilepsy, patients should be monitored for possible signs of suicidal behavior and thoughts, and if necessary, seek medical assistance immediately. The drug Diacarb® should be used with caution in patients with diabetes mellitus due to the increased risk of hyperglycemia. If prescribed for more than 5 days, there is a high risk of developing metabolic acidosis. Blood count and platelet levels should be monitored at the beginning of treatment and at regular intervals during treatment, as well as periodic monitoring of serum electrolytes.
Effect on the ability to drive vehicles and operate machinery:
The drug Diacarb®, especially in high doses, may cause drowsiness, less frequently fatigue, dizziness, ataxia, and disorientation; during treatment, patients should not drive vehicles or operate machinery that requires increased attention and rapid psychomotor reactions.

Adverse effects are classified according to frequency of occurrence and by organ systems. The following definitions of frequency of adverse effects are accepted: very common (> 1/10); common (> 1/100, 1/1000, 1/10,000, < 1/1,000); very rare (< 1/10,000); frequency unknown (cannot be determined based on agranulocytosis, leukopenia, thrombocytopenic purpura, myelosuppression, pancytopenia).Disorders of the immune system: frequency unknown - anaphylactic reactions.Metabolism and nutrition disorders: common - decreased appetite, taste disturbances, metabolic acidosis, metabolic acidosis and electrolyte disturbances (this can usually be corrected by administering bicarbonate); uncommon - thirst; rare - glucosuria; frequency unknown - hypokalemia, hyponatremia.Psychiatric disorders: uncommon - depression, irritability; frequency unknown - agitation, confusion, disorientation.Nervous system disorders: common - dizziness, paresthesia, particularly a tingling sensation in the limbs; uncommon - hot flashes, headache; very rare - drowsiness, peripheral paresis, seizures; frequency unknown - ataxia.Eye disorders: rare - transient myopia (this condition completely resolved with dose reduction or discontinuation of the drug).Ear disorders and labyrinthine disorders: rare - hearing impairment and tinnitus.Gastrointestinal disorders: uncommon - nausea, vomiting, diarrhea, melena; frequency unknown - dry mouth, dysgeusia.Liver and biliary tract disorders: rare - fulminant liver necrosis, liver function impairment, hepatitis, cholestatic jaundice; frequency unknown - liver failure, hepatic colic.Skin and subcutaneous tissue disorders: rare - photosensitivity; frequency unknown - pruritus, skin rash, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria.Musculoskeletal and connective tissue disorders: frequency unknown - arthralgia.Kidney and urinary tract disorders: frequency unknown - formation of kidney stones, crystalluria, renal and ureteral colic and kidney damage, polyuria, hematuria, renal failure.Reproductive system and breast disorders: uncommon - decreased libido.General disorders and administration site conditions: common - fatigue; uncommon - fever, weakness.Symptoms of overdose are not described. Possible symptoms of overdose may include disturbances in water-electrolyte balance, metabolic acidosis, as well as central nervous system disorders. Treatment: there is no specific antidote. Symptomatic and supportive therapy is recommended. Electrolyte levels in plasma, especially potassium and sodium, as well as blood pH, should be monitored. In cases of metabolic acidosis, sodium bicarbonate is used. Acetazolamide is eliminated by hemodialysis.Acetazolamide may enhance the effects of folic acid antagonists, hypoglycemic agents, and oral anticoagulants. Concurrent use of acetazolamide and acetylsalicylic acid may cause metabolic acidosis and increase toxic effects on the central nervous system. When used together with cardiac glycosides or drugs that raise blood pressure, the dose of acetazolamide should be adjusted. Acetazolamide increases the serum concentration of phenytoin. Acetazolamide exacerbates manifestations of osteomalacia caused by the use of antiepileptic medications. Concurrent use of acetazolamide with amphetamine, atropine, or quinidine may enhance their side effects. Potentiation of the diuretic effect occurs when used in combination with methylxanthines (aminophylline). Reduction of the diuretic effect occurs with combined use with ammonium chloride and other acid-forming diuretics. Increased hypotensive effect regarding intraocular pressure is possible with concurrent use of cholinergic agents and beta-blockers. Acetazolamide enhances the action of ephedrine. It increases the plasma concentration of carbamazepine and non-depolarizing muscle relaxants. Acetazolamide may increase the concentration of cyclosporine. It increases the excretion of lithium. Acetazolamide may reduce the antiseptic action of methenamine on the urogenital system. Concurrent use of acetazolamide and sodium bicarbonate increases the risk of kidney stone formation.

Acetazolamide is a systemic carbonic anhydrase inhibitor with weak diuretic activity. Carbonic anhydrase (CA) is an enzyme involved in the hydration of carbon dioxide and the dehydration of carbonic acid. Inhibition of carbonic anhydrase reduces the formation of bicarbonate ions, subsequently decreasing sodium transport into cells. The effects of the drug Diacarb® are due to the target sites of the molecule: the choroid plexus of the brain, the proximal part of the nephron, the ciliary body of the eye, and red blood cells. Acetazolamide is used to treat cerebrospinal fluid dynamics disorders and intracranial hypertension by reducing excessive cerebrospinal fluid production at the level of the choroid plexus of the brain. Inhibition of carbonic anhydrase in the ependymocytes of the choroid plexus lowers the excessive negative charge in ependymal cells and reduces the gradient filtration of plasma into the ventricles of the brain. Acetazolamide is used in the therapy of edema syndrome due to its weak diuretic effect. As a result of the inhibition of carbonic anhydrase activity in the proximal part of the nephron, there is a decrease in the formation of carbonic acid and a reduction in the reabsorption of bicarbonate and Na+ by the tubular epithelium, which significantly increases water excretion. Acetazolamide increases the excretion of bicarbonates, which may lead to the development of metabolic acidosis. Acetazolamide causes the kidneys to excrete phosphates, magnesium, and calcium, which can also lead to metabolic disturbances. During the subsequent three days of therapy, compensatory reabsorption of Na+ in the distal part of the nephron is activated, reducing the diuretic effect of Diacarb®. After three days from the start of administration, acetazolamide loses its diuretic properties. After a treatment break of several days, re-administered acetazolamide resumes its diuretic action due to the restoration of normal carbonic anhydrase activity in the proximal part of the nephron. Acetazolamide is used to treat glaucoma. In the process of aqueous humor formation, bicarbonate ions are actively transported into the posterior chamber from the cytoplasm of non-pigmented cells to compensate for the positive ion gradient caused by the active transport of Na+ ions. CA inhibitors block the formation of carbonic acid, thereby reducing the production of HCO3-. In the absence of sufficient HCO3- ions, the positive ion gradient increases, leading to a decrease in aqueous humor secretion. Inhibition of carbonic anhydrase in the ciliary body reduces the secretion of aqueous humor in the anterior chamber of the eye, which lowers intraocular pressure. Tolerance to this effect does not develop. Ocular tension begins to decrease within 40-60 minutes after taking acetazolamide, with peak action observed within 3-5 hours, and intraocular pressure remains below baseline levels for 6-12 hours. On average, intraocular pressure decreases by 40-60% from baseline levels. The drug is used as an adjunctive treatment for epilepsy, as inhibition of carbonic anhydrase in brain nerve cells suppresses pathological excitability.

Acetazolamide is well absorbed from the gastrointestinal tract. After oral administration of a dose of 500 mg, the maximum concentration (12-27 mcg/ml) is reached within 1-3 hours. It is maintained at minimal concentrations in the blood for 24 hours from the time of administration. Acetazolamide is distributed in erythrocytes, blood plasma, and the kidneys, to a lesser extent in the liver, muscles, eyeball, and central nervous system. Acetazolamide crosses the placental barrier and is excreted in small amounts in breast milk. It does not accumulate in tissues and is not metabolized in the body. It is excreted by the kidneys in unchanged form. After oral administration, about 90% of the administered dose is excreted by the kidneys within 24 hours.