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Acetazolamide-Accelerated Anticonvulsant Osteomalacia

Acetazolamide-Accelerated Anticonvulsant Osteomalacia Abstract Severe osteomalacia was present in two epileptic patients who were under long-term treatment with congeners of phenytoin, phenobarbital, and acetazolamide. These patients showed slightly low serum calcium, normal or low serum phosphate, and normal parathyroid hormone concentrations. Discontinuation of acetazolamide produced an immediate threefold drop in the level of urinary calcium excretion and a slight rise in tubular reabsorption of phosphate, with no detectable change in serum calcium or phosphate concentrations. Acetazolamide may have accelerated the development of osteomalacia by several mechanisms, including increased renal calcium excretion. (Arch Intern Med 137:1013-1017, 1977) References 1. Anticonvulsant osteomalacia , editorial. Lancet 2:805-806, 1972. 2. Anast, CS: Anticonvulsant drugs and calcium metabolism . N Engl J Med 292:587-588, 1975.Crossref 3. Christensen C, Kristensen M, Rodbro P: Latent osteomalacia in epileptic patients on anticonvulsants . Br Med J 3:738-739, 1972.Crossref 4. Lifshitz F, Maclaren, NK: Vitamin D-dependent rickets in institutionalized, mentally retarded children receiving long-term anticonvulsant therapy: I. A survey of 288 patients . J Pediatr 83:613-621, 1973. 5. Genuth SM, Klein L, Rabinovich S, et al: Osteomalacia accompanying chronic anticonvulsant therapy . J Clin Endocrinol Metab 35:378-386, 1972.Crossref 6. Greenlaw R, Pryor J, Winnacker J, et al: Osteomalacia (om) from anticonvulsant (acv) drugs: Therapeutic implications . Clin Res 20:56, 1972. 7. Stamp TCB, Round JM, Rowe DJF, et al: Plasma levels and therapeutic effect of 25-hydroxycholecalciferol in epileptic patients taking anticonvulsant drugs . Br Med J 4:9-12, 1972.Crossref 8. Maclaren N, Lifshitz F: Vitamin D-dependency rickets in institutionalized mentally retarded children on long term anticonvulsant therapy: II. The response to 25-hydroxycholecalciferol and to vitamin D, . Pediatr Res 7:914-922, 1973.Crossref 9. Hahn TJ, Hendin BA, Scharp CR, et al: Effect of chronic anticonvulsant therapy on serum 25-hydroxycalciferol levels in adults . N Engl J Med 287:900-904, 1972.Crossref 10. Hahn TJ, Hendin BA, Scharp CR, et al: Serum 25-hydroxycalciferol levels and bone mass in children on chronic anticonvulsant therapy . N Engl J Med 292:550-554, 1975.Crossref 11. Avioli LV, Haddad JG: Vitamin D: Current concepts . Metabolism 22:507-531, 1973.Crossref 12. Schaefer K, Kraft D, von Herrath D, et al: Intestinal absorption of vitamin D, in epileptic patients and phenobarbital treated rats . Epilepsia 13:509, 1972.Crossref 13. Hahn TJ, Birge SJ, Scharp CR, et al: Phenobarbital-induced alterations in vitamin D metabolism . J Clin Invest 51:741-748, 1972.Crossref 14. Koch HU, Kraft D, von Herrath D, et al: Influence of diphenylhydantoin and phenobarbital on intestinal calcium transport in the rat . Epilepsia 13:829-834, 1972.Crossref 15. Jenkins MV, Harris M, Wills MR: The effect of phenytoin on parathyroid extract and 25-hydroxycholecalciferol-induced bone resorption: Adenosine 3′, 5′-cyclicclic monophosphate production . Calcif Tissue Res 16:163-167, 1974.Crossref 16. Bowden AN: Anticonvulsants and calcium metabolism . Dev Med Child Neurol 16:214-217, 1974.Crossref 17. Greenwood RH, Prunty FTG, Silver J: Osteomalacia after prolonged glutethimide administration . Br Med J 1:643-645, 1973.Crossref 18. Kuntzman R: Drugs and enzyme induction . Ann Rev of Pharmacol 9:21-36, 1969.Crossref 19. Segre GV, Habener JF, Powell D, et al: Parathyroid hormone in human plasma, immunochemical characterization and biological implications . J Clin Invest 51:3163-3172, 1972.Crossref 20. Belsey R, Clark MB, Bernat M, et al: The physiologic significance of plasma transport of vitamin D and metabolites . Am J Med 57:50-56, 1974.Crossref 21. Mallette LE, Sode JE, Marx SJ, et al: Total body retention of orally administered 47 calcium in primary hyperparathyroidism . J Clin Endocrinol Metab 40:582-588, 1975.Crossref 22. Mallette LE, Patten BM, Engel WK: Neuromuscular disease in secondary hyperparathyroidism . Ann Intern Med 82:474-483, 1975.Crossref 23. Rose GA: Discussion on generalized aches and pains from metabolic bone disease . Proc R Soc Med 50:371-373, 1957. 24. Matsuda I, Takekoshi Y, Shida N, et al: Renal tubular acidosis and skeletal demineralization in patients on long-term anticonvulsant therapy . J Pediatr 87:202-205, 1975.Crossref 25. Kenny AD: Effect of dietary acetazolamide on plasma electrolytes, bone mass, and renal mineral contents in rats . Proc Soc Exp Biol Med 140:135-139, 1972.Crossref 26. Conaway HH, Waite LC, Kenny AD: Immobilization and bone mass in rats . Calcif Tissue Res 11:323-330, 1973.Crossref 27. Waite LC: Carbonic anhydrase inhibitors, parathyroid hormone and calcium metabolism . Endocrinology 91:1160-1165, 1972.Crossref 28. Wolinsky I, Kenny AD: Mechanical strength and mineral content of bone from rats fed acetazolamide . Calcif Tissue Res 16:257-260, 1974.Crossref 29. Eknoyan G, Suki WN, Martinez-Maldonado M: Effect of diurectics on urinary excretion of phosphate, calcium, and magnesium in thyroparathyroidectomized dogs . J Lab Clin Med 76:257-266, 1970. 30. Beck LH, Goldberg M: Effects of acetazolamide and parathyroidectomy on renal transport of sodium, calcium, and phosphate . Am J Physiol 224:1136-1142, 1973. 31. Parfitt AM: Acetazolamide and sodium bicarbonate induced nephrocalcinosis and nephrolithiasis: Relationship to citrate and calcium excretion . Arch Intern Med 124:736-740, 1969.Crossref 32. Coe FL, Firpo JJ, Hollandsworth DL, et al: Effect of acute and chronic metabolic acidosis on serum immunoreactive parathyroid hormone in man . Kidney Int 8:262-273, 1975.Crossref 33. Deller DJ, Worthley BW, Martin H: Measurement of calcium-47 absorption by wholebody gamma spectrometry . Aust Ann Med 14:223-231, 1965. 34. Dyck WP, Hightower NC, Janowitz HD: Effect of acetazolamide on human pancreatic secretion . Gastroenterology 62:547-552, 1972. 35. Gerson CD, Cohen N, Finkel M, et al: Effect of parenteral acetazolamide on intestinal absorption of salt and water in man . Proc Soc Exp Biol Med 149:950-952, 1975.Crossref 36. Stanbury SW: Osteomalacia . Clinics in Endocrinology and Metabolism 1:239-266, 1972.Crossref 37. Lee SW, Russell JE, Avioli LV: Impaired conversion of 250HD, to 1,25(OH)2D3 induced by systemic acidosis . The Endocrine Society 58th Annual Meeting: Program and Abstracts . San Francisco, (June) 1976, p 108. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Acetazolamide-Accelerated Anticonvulsant Osteomalacia

Archives of Internal Medicine , Volume 137 (8) – Aug 1, 1977

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Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1977.03630200021009
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Abstract

Abstract Severe osteomalacia was present in two epileptic patients who were under long-term treatment with congeners of phenytoin, phenobarbital, and acetazolamide. These patients showed slightly low serum calcium, normal or low serum phosphate, and normal parathyroid hormone concentrations. Discontinuation of acetazolamide produced an immediate threefold drop in the level of urinary calcium excretion and a slight rise in tubular reabsorption of phosphate, with no detectable change in serum calcium or phosphate concentrations. Acetazolamide may have accelerated the development of osteomalacia by several mechanisms, including increased renal calcium excretion. (Arch Intern Med 137:1013-1017, 1977) References 1. Anticonvulsant osteomalacia , editorial. Lancet 2:805-806, 1972. 2. Anast, CS: Anticonvulsant drugs and calcium metabolism . N Engl J Med 292:587-588, 1975.Crossref 3. Christensen C, Kristensen M, Rodbro P: Latent osteomalacia in epileptic patients on anticonvulsants . Br Med J 3:738-739, 1972.Crossref 4. Lifshitz F, Maclaren, NK: Vitamin D-dependent rickets in institutionalized, mentally retarded children receiving long-term anticonvulsant therapy: I. A survey of 288 patients . J Pediatr 83:613-621, 1973. 5. Genuth SM, Klein L, Rabinovich S, et al: Osteomalacia accompanying chronic anticonvulsant therapy . J Clin Endocrinol Metab 35:378-386, 1972.Crossref 6. Greenlaw R, Pryor J, Winnacker J, et al: Osteomalacia (om) from anticonvulsant (acv) drugs: Therapeutic implications . Clin Res 20:56, 1972. 7. Stamp TCB, Round JM, Rowe DJF, et al: Plasma levels and therapeutic effect of 25-hydroxycholecalciferol in epileptic patients taking anticonvulsant drugs . Br Med J 4:9-12, 1972.Crossref 8. Maclaren N, Lifshitz F: Vitamin D-dependency rickets in institutionalized mentally retarded children on long term anticonvulsant therapy: II. The response to 25-hydroxycholecalciferol and to vitamin D, . Pediatr Res 7:914-922, 1973.Crossref 9. Hahn TJ, Hendin BA, Scharp CR, et al: Effect of chronic anticonvulsant therapy on serum 25-hydroxycalciferol levels in adults . N Engl J Med 287:900-904, 1972.Crossref 10. Hahn TJ, Hendin BA, Scharp CR, et al: Serum 25-hydroxycalciferol levels and bone mass in children on chronic anticonvulsant therapy . N Engl J Med 292:550-554, 1975.Crossref 11. Avioli LV, Haddad JG: Vitamin D: Current concepts . Metabolism 22:507-531, 1973.Crossref 12. Schaefer K, Kraft D, von Herrath D, et al: Intestinal absorption of vitamin D, in epileptic patients and phenobarbital treated rats . Epilepsia 13:509, 1972.Crossref 13. Hahn TJ, Birge SJ, Scharp CR, et al: Phenobarbital-induced alterations in vitamin D metabolism . J Clin Invest 51:741-748, 1972.Crossref 14. Koch HU, Kraft D, von Herrath D, et al: Influence of diphenylhydantoin and phenobarbital on intestinal calcium transport in the rat . Epilepsia 13:829-834, 1972.Crossref 15. Jenkins MV, Harris M, Wills MR: The effect of phenytoin on parathyroid extract and 25-hydroxycholecalciferol-induced bone resorption: Adenosine 3′, 5′-cyclicclic monophosphate production . Calcif Tissue Res 16:163-167, 1974.Crossref 16. Bowden AN: Anticonvulsants and calcium metabolism . Dev Med Child Neurol 16:214-217, 1974.Crossref 17. Greenwood RH, Prunty FTG, Silver J: Osteomalacia after prolonged glutethimide administration . Br Med J 1:643-645, 1973.Crossref 18. Kuntzman R: Drugs and enzyme induction . Ann Rev of Pharmacol 9:21-36, 1969.Crossref 19. Segre GV, Habener JF, Powell D, et al: Parathyroid hormone in human plasma, immunochemical characterization and biological implications . J Clin Invest 51:3163-3172, 1972.Crossref 20. Belsey R, Clark MB, Bernat M, et al: The physiologic significance of plasma transport of vitamin D and metabolites . Am J Med 57:50-56, 1974.Crossref 21. Mallette LE, Sode JE, Marx SJ, et al: Total body retention of orally administered 47 calcium in primary hyperparathyroidism . J Clin Endocrinol Metab 40:582-588, 1975.Crossref 22. Mallette LE, Patten BM, Engel WK: Neuromuscular disease in secondary hyperparathyroidism . Ann Intern Med 82:474-483, 1975.Crossref 23. Rose GA: Discussion on generalized aches and pains from metabolic bone disease . Proc R Soc Med 50:371-373, 1957. 24. Matsuda I, Takekoshi Y, Shida N, et al: Renal tubular acidosis and skeletal demineralization in patients on long-term anticonvulsant therapy . J Pediatr 87:202-205, 1975.Crossref 25. Kenny AD: Effect of dietary acetazolamide on plasma electrolytes, bone mass, and renal mineral contents in rats . Proc Soc Exp Biol Med 140:135-139, 1972.Crossref 26. Conaway HH, Waite LC, Kenny AD: Immobilization and bone mass in rats . Calcif Tissue Res 11:323-330, 1973.Crossref 27. Waite LC: Carbonic anhydrase inhibitors, parathyroid hormone and calcium metabolism . Endocrinology 91:1160-1165, 1972.Crossref 28. Wolinsky I, Kenny AD: Mechanical strength and mineral content of bone from rats fed acetazolamide . Calcif Tissue Res 16:257-260, 1974.Crossref 29. Eknoyan G, Suki WN, Martinez-Maldonado M: Effect of diurectics on urinary excretion of phosphate, calcium, and magnesium in thyroparathyroidectomized dogs . J Lab Clin Med 76:257-266, 1970. 30. Beck LH, Goldberg M: Effects of acetazolamide and parathyroidectomy on renal transport of sodium, calcium, and phosphate . Am J Physiol 224:1136-1142, 1973. 31. Parfitt AM: Acetazolamide and sodium bicarbonate induced nephrocalcinosis and nephrolithiasis: Relationship to citrate and calcium excretion . Arch Intern Med 124:736-740, 1969.Crossref 32. Coe FL, Firpo JJ, Hollandsworth DL, et al: Effect of acute and chronic metabolic acidosis on serum immunoreactive parathyroid hormone in man . Kidney Int 8:262-273, 1975.Crossref 33. Deller DJ, Worthley BW, Martin H: Measurement of calcium-47 absorption by wholebody gamma spectrometry . Aust Ann Med 14:223-231, 1965. 34. Dyck WP, Hightower NC, Janowitz HD: Effect of acetazolamide on human pancreatic secretion . Gastroenterology 62:547-552, 1972. 35. Gerson CD, Cohen N, Finkel M, et al: Effect of parenteral acetazolamide on intestinal absorption of salt and water in man . Proc Soc Exp Biol Med 149:950-952, 1975.Crossref 36. Stanbury SW: Osteomalacia . Clinics in Endocrinology and Metabolism 1:239-266, 1972.Crossref 37. Lee SW, Russell JE, Avioli LV: Impaired conversion of 250HD, to 1,25(OH)2D3 induced by systemic acidosis . The Endocrine Society 58th Annual Meeting: Program and Abstracts . San Francisco, (June) 1976, p 108.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 1, 1977

References