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Acetazolamide use in idiopathic intracranial hypertension: a real-world cohort study of side effects
Ronya Sari1,2, Martin Jørgen Lønborg Friis3, Henrik Schytz1,2
1Department of Neurology, Danish Headache Center, University of Copenhagen, Rigshospitalet-Glostrup, Denmark.
Background:
Acetazolamide is an off-label-first-line treatment for idiopathic intracranial hypertension (IIH) with high discontinuation rates due to side effects. This research assesses prescribing patterns and tolerability by dosage, papilledema severity, and potassium supplementation.
Methods:
Within a prospective cohort of newly diagnosed IIH patients from two tertiary headache centers, acetazolamide-related side effects were retrospectively registered until tapering due to intolerance or papilledema remission. Side effects were categorized by dose (>0-1000 mg, >1000-2000 mg, >2000-3000 mg, >3000-4000 mg). Potassium and bicarbonate supplementation were evaluated.
Results:
Among 139 acetazolamide-treated patients (97% female, median age 28 years (IQR 25-36), median BMI 35 (IQR 30-39)) side effects were noted in 99%, but led to dosage reduction or discontinuation in 22%. Acroparesthesia (85%) was most frequent, hereafter dysgeusia (51%), fatigue (46%), nausea/vomiting (34%), and tinnitus, dizziness, and cognitive symptoms (25% each). Serious adverse events included liver impairment (n = 1), kidney stones (n = 3), hearing loss (n = 1) and pulmonary embolism (n = 1). Potassium supplementation yielded fewer dosage-limiting side effects (p = 0.02), and bicarbonate alleviated metabolic acidosis symptoms in 8/12 patients.
Conclusion:
Side effects are near-universal but tolerable. Further research is needed whether potassium and bicarbonate supplementation improves acetazolamide tolerability and adherence.
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