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has been seen in the offspring of animals given acetazolamide, and the drug should definitely be avoided by women of child-bearing age.15

Urolithiasis is believed to be much more common in patients taking CAIs, most likely because of the depressed excretion of renal citrate and the higher urine levels of calcium available to form urate stones. In a case study with controls, the incidence of renal stones was 15 times higher after treatment with acetazolamide than before its administration.16 The incidence was 11 times higher than in the age-matched control group. The incidence of stones in this study did not seem to increase after 15 months, suggesting that susceptible persons ordinarily experience this side effect during the first or second year of treatment, if at all. Although methazolamide has been linked to the formation of kidney stones in several patients on high doses (> 200 mg/day),17 the lack of a significant renal effect with low-dose therapy seems to suggest a potentially lower risk of urolithiasis with regimens such as 50 mg twice a day.

Because blood dyscrasias have been reported after the use of both agents,18 there has been considerable debate about whether surveillance of blood count is justified. Despite the poor outcome in patients who develop idiosyncratic aplastic anemia,19,20 some patients also develop isolated neutropenia, thrombocytopenia, and pancytopenia but have an uneventful recovery if the condition is discovered and the drug discontinued.21 Because such reactions are rare, with an incidence of about 1 in 14,000, it would not seem justified to continue obtaining blood counts during the entire course of therapy. It is reasonable and relatively inexpensive to obtain a pretreatment ''complete blood count'' and one or two follow-up studies during the first 6 months of treatment, when most of the serious hematologic events were noted to occur. Although some ophthalmologists believe that oral therapy with CAIs should be abandoned, oral CAIs may still be useful in some patients who show a documented efficacy advantage or who have difficulty instilling topical CAI eye drops.

Table 6.3 Side Effects of Oral Carbonic Anhydrase Inhibitors

Ocular

Systemic

Decreased intraocular pressure

Paresthesia

Decreased vision

Malaise syndrome

Myopia

Acidosis

Decreased accommodation

Asthenia

Forward displacement of lens

Anorexia

Eyelid or conjunctival disorder

Weight loss

Allergic reactions

Depression

Erythema

Somnolence

Photosensitivity

Confusion

Urticaria

Impotence

Purpura

Decreased libido

Erythema multiforme

Gastrointestinal disorder

Stevens-Johnson syndrome

Nausea

Lyell's syndrome

Vomiting

Loss of eyelashes or eyebrows

Renal disorder

Retinal or macular edema

Urolithiasis

Iritis

Polyuria

Ocular signs of gout

Hematuria

Globus hystericus

Glycosuria

Subconjunctival or retinal hemorrhages

Blood dyscrasia

secondary to drug-induced anemia

Aplastic anemia

Color vision disorder (with methazolamide)

Thrombocytopenia

Color vision defect

Agranulocytosis

Objects have yellow tinge

Hypochromic anemia

Convulsion

Source: Reprinted with permission from Fraunfelder FT, Grove JA, eds. Drug-Induced Ocular Side Effects. Baltimore, MD: Williams & Wilkins; 1996:439-441.

Convulsion

Source: Reprinted with permission from Fraunfelder FT, Grove JA, eds. Drug-Induced Ocular Side Effects. Baltimore, MD: Williams & Wilkins; 1996:439-441.

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How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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