Acetazolamide may play a role in the treatment of acute metabolic alkalosis caused by diuresis or steroids in patients with hypercapnic COPD. A short course may correct the underlying metabolic alkalosis that may be the cause of worsening hypercapnia. Acetazolamide has not been demonstrated in large controlled trials to have significant benefit for the long-term management of hypercapnia in COPD patients.

When used used as respiratory stimulant in COPD and OSA (unlabeled use), acetazolamide dose is 250 mg twice daily. It may induce agranulocytosis and monitoring of CBC is needed with prolonged use.
----------------------------------------------------------------------------

 

ACET could be useful for improving minute ventilation in patients with significant reduction of respiratory drive during weaning from mechanical ventilation, since failure of weaning depends on the balance between the ventilatory request and the ventilatory reserve of the patient.
-> Conclusion

use of ACET at the dosage of 500 mg per day reduces metabolic alkalosis but has no benefit in terms of improving PaCO2 and respiratoryparameters in weaning COPD patients from mechanical ventilation.

 

We used a population pharmacodynamic model to characterize the dose-response relationship associated with ACET response in invasively ventilated COPD patients.
According to our model, an ACET dosage > 500 mg twice daily is required to reduce serum HCO3 concentrations by > 5 mmol/L in the presence of high serum chloride concentrations or coadministration of furosemide or corticosteroids.

Unanswered questions remain, such as the effect of ACET administration on PaCO2 levels and minute ventilation in these patients.