Neptazane

methazolamide

(meth-a-zole-a-mide) methazolamide,

Neptazane

(trade name)

Classification

Therapeutic: diuretics
Pharmacologic: carbonic anhydrase inhibitors
Pregnancy Category: C

Indications

Lowering of intraocular pressure in the treatment of glaucoma.

Action

Inhibition of carbonic anhydrase in the eye results in decreased secretion of aqueous humor.Inhibit renal carbonic anhydrase, resulting in self-limiting urinary excretion of sodium, potassium, bicarbonate, and water.

Therapeutic effects

Lowering of intraocular pressure.

Pharmacokinetics

Absorption: Well absorbed after oral administration.Distribution: Crosses the placenta.Metabolism and Excretion: 15–30% excreted unchanged in urine.Half-life: 14 hr.

Time/action profile (↓ intraocular pressure)

ROUTE	ONSET	PEAK	DURATION
PO	2–4 hr	6–8 hr	10–18 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity or cross-sensitivity with sulfonamides may occur ; Obstetric: Avoid during first trimester of pregnancy; Concurrent use of oral and ophthalmic carbonic anhydrase inhibitors is not recommended.Use Cautiously in: Chronic respiratory disease; Electrolyte abnormalities; Renal or hepatic disease; Diabetes mellitus; Obstetric / Lactation: Second or third trimester of pregnancy or lactation (safety not established).

Adverse Reactions/Side Effects

Central nervous system

depression (most frequent)
fatigue (most frequent)
weakness (most frequent)
drowsiness

Ear, Eye, Nose, Throat

transient nearsightedness

Gastrointestinal

anorexia (most frequent)
metallic taste (most frequent)
nausea
vomiting

Genitourinary

crystalluria
renal calculi

Dermatologic

rashes

Endocrinologic

hyperglycemia

Fluid and Electrolyte

hyperchloremic acidosis (most frequent)
hypokalemia

Hematologic

aplastic anemia (life-threatening)
hemolytic anemia (life-threatening)
leukopenia (life-threatening)

Metabolic

weight loss (most frequent)
hyperuricemia

Neurologic

paresthesias (most frequent)

Miscellaneous

allergic reactions

Interactions

Drug-Drug interaction

May ↑ excretion of barbiturates, aspirin, and lithium and lead to ↓ effectiveness.May ↓ excretion of amphetamines,quinidine,procainamide, cyclosporine, and possibly tricyclic antidepressants and lead to toxicity.

Route/Dosage

Oral (Adults) 50–100 mg 2–3 times daily.

Availability (generic available)

Tablets: 25 mg, 50 mg

Nursing implications

Nursing assessment

Assess for eye discomfort or decrease in visual acuity.
Observe patient for signs of hypokalemia (muscle weakness, malaise, fatigue, ECG changes, vomiting).
- Assess for allergy to sulfonamides.
Lab Test Considerations: Evaluate serum electrolytes, CBC, and platelet counts initially and periodically during prolonged therapy. May cause ↓ potassium, bicarbonate, WBC, and RBC. May cause ↑ serum chloride.
- May cause ↑ in serum and urine glucose; monitor serum and urine glucose carefully in patients with diabetes.
- May cause false-positive results for urine protein and 17-hydroxysteroid tests.
- May cause ↑ blood ammonia, bilirubin, uric acid, urine urobilinogen, and calcium. May ↓ urine citrate.

Potential Nursing Diagnoses

Disturbed sensory perception(visual) (Indications)

Implementation

Encourage fluids to 2000–3000 mL/day, unless contraindicated, to prevent crystalluria and stone formation.
- A potassium supplement without chloride should be administered concurrently with carbonic anhydrase inhibitors.
Oral: Give with food to minimize GI irritation. Tablets may be crushed and mixed with fruit-flavored syrup to minimize bitter taste for patients with difficulty swallowing.

Patient/Family Teaching

Instruct patient to take as directed. Take missed doses as soon as possible unless almost time for next dose. Do not double doses.
Advise patient of the need for periodic ophthalmologic exams; loss of vision may be gradual and painless.
Advise patient to report numbness or tingling of extremities, weakness, rash, sore throat, unusual bleeding or bruising, or fever to health care professional. If hematopoietic reactions, fever, rash, or renal problems occur, carbonic anhydrase inhibitor therapy should be discontinued.
May occasionally cause drowsiness. Caution patient to avoid driving and other activities that require alertness until response to the drug is known.
Caution patient to use sunscreen and wear protective clothing to prevent photosensitivity reactions.

Evaluation/Desired Outcomes

Decrease in intraocular pressure when used for glaucoma. If therapy is not effective or patient is unable to tolerate one carbonic anhydrase inhibitor, using another may be effective and more tolerable.