Diamox (The generic name is acetazolamide.) is the most commonly prescribed treatment for intracranial hypertension.
First, let's look at how Diamox works then we can try to understand what side effects it causes and what can be done about those.
The brain has it's own circulation. Cerebral spinal fluid is generated deep inside the brain then circulates through the ventricles then flows around the outside of the brain where it is reabsorbed near the top of the head.
One of the important things to understand is that this fluid is secreted deep inside the brain by a tissue called choroid plexus. The choroid plexus uses an enzyme called carbonic anhydrase to pump in the fluid. Specifically, carbonic anhydrase combines water molecules (H2O) and carbon dioxide molecules (CO2) to make bicarbonate (HCO3-) and hydrogen ions (H+) These ions are then pumped into the fluid and create more pressure.
Don't worry too much about the chemistry.
Diamox works by blocking the enzyme carbonic anhydrase so the brain produces less fluid.
Other parts of your body use carbonic anhydrase for other purposes.
For example, there is carbonic anhydrase in your saliva. If you drink a carbonated beverage (which is loaded with carbon dioxide), Diamox would alter the way your mouth tastes the carbonation. Many patients say it gives a nasty, metallic taste to sodas.
Even more important, carbonic anhydrase is in your kidneys to control the amount of fluid excreted and the pH (or acid level) of the blood and urine.
Using Diamox will mean your kidneys will make more urine.
It also has an effect on your blood pH. It makes the urine less acidic and the blood more acidic. This shift in pH causes a tingling sensation and most other Diamox side effects.
(In fact, Diamox is even used to treat patients with a pH problem- altitude sickness. In a low oxygen environment they breathe too hard and blow away too much carbon dioxide and have problems with the blood pH, so Diamox is used to regulate the pH in those patients.)
So, is there anything to do about Diamox side effects?
An antacid electrolyte replacement that contains bicarbonate would be nice.
A pharmacist pointed this out to me one day:
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| There used to be a gold package with something like this. The newer packaging can be confusing. Make sure to find this kind with anhydrous citric acid and sodium bicarbonate. Not the kind with aspirin or NSAID or anything else. |
Alka-Seltzer (make sure it is the right kind) can be taken as needed to reduce Diamox side effects.
So, in summary your body uses carbonic anhydrase to pump up CSF pressure. Diamox counteracts carbonic anhydrase, but that causes other problems related to pH of your bodily fluids. Antacids with electrolytes like Alka-Seltzer Upset Stomach Relief can offset some of those unintended side effects.