Acetazolamide in heart failure: past-or future-oriented treatment?

Optimizing diuretic prescription for heart failure remains an unresolved issue. Combined diuretic therapy is known to be advisable. However, there is an unresolved question: what drugs should be used? Recently, much attention has been drawn to carbonic anhydrase inhibitor acetazolamide. The aim of the study is to present an overview of clinical studies and clinical and pharmacological rationale for acetazolamide prospects in hospitalized patients with acute heart failure. Materials and Methods. To gather information, search was conducted in the PubMed database and the eLIBRARY database. Results. The article presents data on the acetazolamide pharmacokinetics and pharmacodynamics. It also touches upon the results of recent clinical studies on combined diuretic therapy in heart failure. It is shown that the mechanism of action of carbonic anhydrase inhibitors has advantages for their use in combination diuretic therapy. Acetazolamide therapy statistically significantly increased natriuresis, more often led to the disappearance of hyperhydration symptoms, and reduced the likelihood of metabolic alkalosis while treating patients with acute heart failure with loop diuretics. Side effects were rare and not severe. At the same time, no decrease in short- and long-term mortality was observed. Conclusion. Combined diuretic therapy results in significant reductions in overhydratation in patients with acute heart failure under a satisfactory safety profile. Acetazolamide should be considered as a valuable option when fast diuretic effect is required in patients with heart failure, as well as in patients with metabolic complications such as alkalosis or hyperchloremia. However, more research and clinical studies are needed to develop optimal strategies for prescribing carbonic anhydrase inhibitors.