Acetazolamide is excreted by the kidneys and affects electrolyte balance. Patients with severe hepatic or renal impairment and those with hyponatremia or hypokalemia are at higher risk and must be especially cautious.

1. Patients with severe hepatic impairment

Risk: The metabolism and clearance of this drug may be affected in patients with liver disease, and it may induce hepatic encephalopathy.

What to know:

Patients with severe hepatic impairment or cirrhosis should avoid use.

If use is unavoidable, it must be done under close medical monitoring.

During treatment, closely observe mental status and behavioral changes, and watch for hepatic encephalopathy.

Regularly check liver function indicators.

If drowsiness, confusion, or asterixis occurs, seek medical attention immediately.

2. Patients with severe renal impairment

Risk: The drug is excreted by the kidneys, and reduced renal function may lead to drug accumulation; it may also worsen metabolic acidosis.

What to know:

Patients with severe renal impairment should avoid use or significantly reduce the dose.

Assess creatinine clearance before use.

Regularly monitor renal function, blood gases, and electrolytes.

If urine output decreases significantly, edema occurs, or breathing difficulty develops, seek medical attention promptly.

Avoid concomitant use with other nephrotoxic drugs.

3. Patients with hyponatremia

Risk: This drug may worsen hyponatremia, leading to dizziness, fatigue, impaired consciousness, and even seizures.

What to know:

Check blood sodium levels before use.

Patients with hyponatremia should use it with caution or avoid it.

Regularly recheck blood sodium during treatment.

If headache, nausea, confusion, or seizures occur, seek medical attention immediately.

Avoid drinking large amounts of water or using other diuretics at the same time.

4. Patients with hypokalemia

Risk: This drug may worsen hypokalemia, inducing arrhythmias, muscle weakness, and even paralysis.

What to know:

Check blood potassium levels before use.

Patients with hypokalemia should first correct potassium levels before considering this medication.

Regularly monitor blood potassium and electrocardiograms during treatment.

If palpitations, muscle cramps, or fatigue occur, seek medical attention promptly.

Supplement potassium under a doctor's guidance when necessary.

5. Other precautions

Drink plenty of water during treatment to reduce the risk of kidney stones.

Avoid alcohol to prevent worsening drowsiness and electrolyte disturbances.

Do not stop the medication or adjust the dose on your own; all changes require a doctor's guidance.

If a severe rash, persistent headache, or vision changes occur, seek medical attention immediately.