- Side effects: Patients should be warned of the adverse side effects of acetazolamide, which include increased risk of diarrhea, dysgeusia, fatigue, nausea, paresthesia, tinnitus, vomiting, depression, and rarely renal stones
Other considerations
- Topiramate: In the event that acetazolamide is not effective or not tolerated, topiramate, which also reduces CSF production and has the added benefit of weight loss, may be considered. The starting dosage is 25 mg with weekly dose escalation to 50 mg . However, female patients should be informed that topiramate can reduce the efficacy of oral contraceptives and other hormonal contraceptives
- Weight loss: Weight loss remains a key management strategy for IIH, particularly in obese patients
- Monitoring: Regular ophthalmologic evaluations, including visual field testing and optic disc assessment, as well as periodic lumbar punctures to measure ICP, are necessary to monitor treatment efficacy.
In conclusion, acetazolamide is a frequently used and effective treatment for IIH, but it is important to consider other therapeutic options and closely monitor patients for side effects and treatment efficacy.