Idiopathic Intracranial Hypertension
(Pseudotumor Cerebri)
Michael Wall, M.D.
The University of Iowa
Department of Neurology and
Department of Ophthalmology and Visual Sciences
Diamox (acetazolamide) side effects
Tingling or pins and needles feelings around the mouth and in the hands and feet is a common side effect of Diamox and suggests the medicine is working. Nearly everyone who takes Diamox notices that carbonated beverages taste metallic. Renal stones, althouth painful are very treatable. These occur in a few percent of patients.
A rare but serious side effect is aplastic anemia. This is when the bone marrow fails to produce an adequete number of red and white blood cells. It occurs in one in 15,000 patient years on Diamox. That means for every 15,000 patients on Diamox for one year, one will develop this potentially fatal side effect.
Should you have repeated blood work to check for aplastic anemia?
- aplastic anemia usually occurs in the first six months of therapy
- aplastic anemia from Diamox has been reported most often in the elderly
- in 1987 dollars it has been estimated that it would cost about $650,000 to detect one case.
- finding the case and stopping the medication does not necessarily cure the patient.
- mammograms, chest x-rays and proctoscopy are much more likely to detect a potentially fatal treatable disease
- statistically, if you drive a car you are more likely to die from an automobile accident.
Of course, it would be ideal if we could test everybody for everything that is potentially fatal and provide all people with all available medical care; of course this is not realistic to do.
Side effects as rare as aplastic anemia from Diamox are often not tested for. Do you burden thousands of patients with the cost and inconvenience of monthly and bimonthly testing to find something very rare that you may not be able to treat? It is a philosophical issue. It is the patient's money and life and is, therefore, the patient's decision whether to spend their money or maybe their health provider's money on monitoring the blood (a complete blood count) for aplastic anemia while taking Diamox.
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