Why would we dose acetazolamide (Diamox) 250 mg BID?

• A. For acute IOP lowering, given 30-50% reduction
• B. For chronic pain management
• C. To treat infection
• D. To lower blood glucose

Answer: (D)

Acetazolamide works by blocking carbonic anhydrase in the ciliary body, which reduces bicarbonate formation and thereby lowers the production of aqueous humor. That direct action on the eye translates into a meaningful decrease in intraocular pressure, making it useful when a rapid IOP reduction is needed or when topical therapies aren’t enough. The 250 mg twice-daily dosing provides a practical systemic regimen to achieve this effect. It isn’t used to treat pain, infection, or to lower blood glucose, because those outcomes aren’t produced by acetazolamide. Remember also that it can cause metabolic acidosis and other systemic side effects, so its use is weighed against these risks.