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After sulfanilamide was introduced as an antibiotic it was found to inhibit carbonic anhydrase, but too weakly to be a useful diuretic for patients with congestive heart failure.1 In search of a more potent compound, Roblin and Clapp synthetized 20 heterocyclic sulfonamides and discovered C4H6N4O3S2, an agent with 2000 times the inhibitory activity of sulfanilamide.2 Named acetazolamide, it was soon tested for its ability to lower intracranial pressure. Maren and colleagues administered the drug to 20 institutionalized children with hydrocephalus.3 Mean spinal pressure declined from 237 mm H2O at baseline to 128 mm H2O with a low dose (19 mg/kg/d) and 68 mm H2O with a high dose (61 mg/kg/d). Acetazolamide subsequently became accepted as a treatment for patients with high intracranial pressure. However, there has never been a randomized clinical trial to prove that it is effective.4
Horton JC. Acetazolamide for Pseudotumor CerebriEvidence From the NORDIC Trial. JAMA. 2014;311(16):1618–1619. doi:10.1001/jama.2014.3325
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