The information regarding fetal effects of acetazolamide use during pregnancy and lactation is sparse. We report the clinical and pharmacodynamic characteristics of maternal acetazolamide use and the timing of its effects on acid-base balance in three cases who presented with metabolic acidosis in the newborn period. We found that the infants’ clinical status soon after birth was inconsistently correlated with maternal drug dose and concentrations of medication in maternal serum. However, there was low transfer of the drug in breast milk and its use did not affect clinical symptomatology. We also present a review of literature on this subject to help consolidate our current knowledge on this topic.
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References
1.
HellerI, HalevyJ, CohenS, TheodorE. Significant metabolic acidosis induced by acetazolamide. Not a rare complication. Arch Intern Med. 1985;145(10):1815–7.
2.
MerlobP, LitwinA, MorN. Possible association between acetazolamide administration during pregnancy and metabolic disorders in the newborn. Eur J Obstet Gynecol Reprod Biol. 1990;35(1):85–8.
3.
OzawaH, AzumaE, ShindoK, HigashigawaM, MukouharaR, KomadaY. Transient renal tubular acidosis in a neonate following transplacental acetazolamide. Eur J Pediatr. 2001;160(5):321–2.
4.
ChapronDJ, GomolinIH, SweeneyKR. Acetazolamide blood concentrations are excessive in the elderly: Propensity for acidosis and relationship to renal function. J Clin Pharmacol. 1989;29(4):348–53.
5.
RoyLF, DufresneLR, LegaultL, LongH, MorinC. Acetazolamide in hemodialysis patients: A rational use after ocular surgery. Am J Kidney Dis. 1992;20(6):650–2.
Van der AaEM, Peereboom-StegemanJH, NoordhoekJ, GribnauFW, RusselFG. Mechanisms of drug transfer across the human placenta. Pharmacy World & Science: PWS. 1998;20(4):139–48.
8.
DieckmannWJ, HarrodJ, MonardoA. The treatment of pre-eclamptic edema with acetazoleamide (diamox). Am J Obstet Gynecol. 1957;73(4):789–800.
9.
CraneCH. Effect on fetus of mother taking a diuretic. JAMA. 1957;165(11):1517.
10.
HeiononenOP, SlaneD. Birth defects and drugs in pregnancy. Littleton, MA, USA, 1977.
11.
WilsonJG. Use of rhesus monkeys in teratological studies. Federation Proceedings. 1970;30(1):104–409.
12.
WorshamFJr, BeckmanEN, MitchellEH. Sacrococcygeal teratoma in a neonate. Association with maternal use of acetazolamide. JAMA. 1978;240(3):251–2.
13.
HolmesLB, KawanishiH, MunozA. Acetazolamide: Maternal toxicity, pattern of malformations, and litter effect. Teratology. 1988;37(4):335–42.
14.
MillerTA, ScottWJJr. Abnormalities in ureter and kidney development in mice given acetazolamide-amiloride or dimethadione (DMO) during embryogenesis. Teratology. 1992;46(6):541–50.
15.
ScottWJ, DugganCA, SchreinerCM, CollinsMD. Reduction of embryonic intracellular pH: A potential mechanism of acetazolamide-induced limb malformations. Toxicol Appl Pharmacol. 1990;103(2):238–54.
16.
RazeghinejadMR, NowroozzadehMH. Anti-glaucoma medication exposure in pregnancy: An observational study and literature review. Clinical & Eexperimental Optometry. 2010;93(6):458–65.
17.
FalardeauJ, LobbBM, GoldenS, MaxfieldSD, TanneE. The use of acetazolamide during pregnancy in intracranial hypertension patients. J Neuroophthalmol. 2013;33(1):9–12.
18.
LeeAG, PlessM, FalardeauJ, CapozzoliT, WallM, KardonRH. The use of acetazolamide in idiopathic intracranial hypertension during pregnancy. Am J Ophthalmol. 2005;139(5):855–9.
19.
SodermanP, HartvigP, FagerlundC. Acetazolamide excretion into human breast milk. Br J Clin Pharmacol. 1984;17(5):599–600.
LongoLD, Delivoria-PapadopoulosM, ForsterRE
2nd . Placental CO2 transfer after fetal carbonic anhydrase inhibition. Am J Physiol. 1974;226(3):703–10.
22.
FilippiL, BagnoliF, MargollicciM, ZammarchiE, TronchinM, RubaltelliFF. Pathogenic mechanism, prophylaxis, and therapy of symptomatic acidosis induced by acetazolamide. J Investig Med. 2002;50(2):125–32.
23.
JohansonCE, ParandooshZ, DyasML. Maturational differences in acetazolamide-altered pH and HCO3 of choroid plexus, cerebrospinal fluid, and brain. Am J Physiol (1992) 262(5 Pt 2):R909–14.
24.
LeeA, ChenML, AbeshausS, PoliakovA, OjemannJG. Posterior fossa tumors and their impact on sleep and ventilatory control: A clinical perspective. Respir Physiol Neurobiol. 2013;189(2):261–71.
