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Experience with carbonic anhydrase inhibitors?

Messages
45
.I just wish to add a document about side effects from Acetazolamide use. Diamox can lead to metabolic acidosis, kidney stones, and some other issues.

(Sodium bicarbonate may increase the kidney stones occurence)

That’s an intimidating outline! Thank you for sharing it.
 

Ema

Senior Member
Messages
4,729
Location
Midwest USA
(Sodium bicarbonate may increase the kidney stones occurence)
Funny, because Diana Driscoll recommends taking bicarb with Diamox...she goes so far as to say that it doesn't "work" without it, which makes very little sense to me.

She says Diamox will lower CO2 levels, but that seems in direct contrast to what other sources say.

For example, "Acetazolamide will block the conversion of CO2 into bicarbonate, which will acutely increase the levels of carbon dioxide in the tissues and blood." https://www.medscape.com/viewarticle/442088

This next article states, "Urinary pH increased from 6 to about 8.5 during the first 2 days on Diamox. On further administration of Diamox urinary pH returned to its pretreatment level of about 6.0 and remained constant at that level." Carbonic anhydrase inhibition in the management of symptomatic peptic ulcers : Clinical studies with diamox on 125 patients

I also wonder if it is even possible to use urine pH as a valid measure given that many of us have mild cases of DI. It seems like that would naturally increase the pH level of the urine.
 
Messages
45
I also wonder if it is even possible to use urine pH as a valid measure given that many of us have mild cases of DI. It seems like that would naturally increase the pH level of the urine.

I didn’t realize that I wasn’t alone w/n the ME community in having lab results that appear like a “mild case of DI”. I realize this can be common in CIRS cases (which also applies to me). I’d not come across it related to ME, though. How common is it? Is anyone focused on examining this aspect any further via research, as far as you know?
 

pattismith

Senior Member
Messages
3,931
interestingly, acetazolamide is also effective to treat mountain sickness and sleep apnea (@TiredBill )

https://emedicine.medscape.com/article/304967-medication

it's important to know that acetazolamide can sometimes induce increased ammonemia.

"Acetazolamide may induce hyperammonaemia in two ways.

First, carbonic anhydrase activity is essential for hepatic urea synthesis from ammonium ions. Carbonic anhydrase inhibitors such as acetazolamide can inhibit this urea synthesis. This inhibition of urea synthesis occurs proximally in the urea cycle, at a step prior to citrulline formation, 8,9 thus causing hyperammonaemia.

Acetazolamide can also interfere with the normal production and excretion of ammonia from the kidney. Normal kidney cells produce free ammonium ions that are either excreted into the urine or released into the renal vein. The release of ammonia into the renal vein represents a major source of the normal ammonia concentration in blood. 10,11 Acetazolamide acts through changes in the acid-base balance and by a direct effect on the kidney. The total amount of ammonia produced by the kidney and its partition into the renal vein or the urine is modified in response to the acid–base balance, potassium status and kidney function. 12,13 Acidosis induces an increase in the total kidney ammonia production and a significant rise in the urinary excretion of ammonia. In contrast, metabolic alkalosis is associated with a marked reduction in urinary ammonium excretion and a rise in the ammonium released into the kidney’s venous blood. In the kidney, carboxic anhydrase is located on the brush border of the tubular cells, where it promotes hydrogen ion loss and reabsorption of bicarbonate. Acetazolamide mainly acts on the proximal tubule of the kidney and induces a metabolic acidosis by inhibiting bicarbonate re-uptake. Acetazolamide also reduces the urinary excretion of ammonium by shifting the ammonia from the urinary compartment to the renal vein, 14 thus further contributing to the hyperammonaemia – as seen in our patient. As acetazolamide is mainly excreted by the kidney, patients with renal failure are at risk for acetazolamide accumulation resulting in hyperammonaemia. 15"
 

Ema

Senior Member
Messages
4,729
Location
Midwest USA
I didn’t realize that I wasn’t alone w/n the ME community in having lab results that appear like a “mild case of DI”. I realize this can be common in CIRS cases (which also applies to me). I’d not come across it related to ME, though. How common is it? Is anyone focused on examining this aspect any further via research, as far as you know?
I’m not sure. I do know that it’s not uncommon on the forums to read about low ADH/vasopressin and symptoms of mild DI. I don’t think I’ve ever read a study on it specifically though it would make sense since the hypothalamus seems to be commonly dysfunctional.
 

pattismith

Senior Member
Messages
3,931
I just did a search on diamox and it said suicidal ideation can be side effect with anti-epleptics--interesting as that is how I felt on baclofen--not literally suicidal but caused very negative cloudy outlook in teeniest dose--CDB oil can do that to me too--has anyone experienced that or other bothersome side effects with diamox?

The small trial I did with Diamox was very interesting. Although I didn't follow it very long because I was not confortable on it, it helped me with head pressure which was very informative and helped me to understand what was going on.

Head pressure/intracranial hypertension is also a known symptom in hypothyroidism, so I checked my thyroid panel and actually found that I am euthyroid low fT3 and very high rT3.
I started T3 supplement 10 days ago, and got some improvement with it. I have to fill a lot of tanks together with T3 intake in order to tolerate it and not crashing, but I have some hopes it will give me more relief soon.

Did you checked your thryoid and your rT3?
 

pattismith

Senior Member
Messages
3,931
I haven't. Have you had success with it?

Yes, I'm very impressed by the power of this herbal extract to quickly fix any of my headache or nausea.

I feel sorry that I didn't try it earlier!

However, the active compound in it, strychnine, can be very toxic, so you must be careful with the dose.

I gave some informations about the dosing here, so feel free to ask more if you need:

Intense nausea, what do you do? | Page 2 | Phoenix Rising ME/CFS Forums

100 years ago, strychine was used for neuritis, for stomach motricity, and is still used in chinese medecine, but toxicity still happen, and it's safer to use Nux Vomica extract dilutions, they are easy to obtain as homeopathic remedies.