Dosage regimen

* Oral acetazolamide is usually given at 0.25-1g daily in divided dose.

Patient knowledge

* Does the patient understand the need for their medication? As patients can not directly see or feel any benefit from glaucoma medication, concordance may be an issue. Ensure they understand the need for regular dosing, and the consequences of compliance failure.

Is the medicine working?

* It is important to counsel in the regular and correct use of their medication to maximize the effectiveness of treatment. If medication is not working, patient should go back to their GP as another glaucoma eye drops may be added to their current medication.

Side effects

* Nausea, vomiting, diarrhoea and taste disturbance are common side effect with patients taking oral acetazolamide. Rarer side effects include blood dyscrasias and hepatotoxicity.

Monitoring

* Acetazolamide is contraindicated in patients with severe hepatic and renal impairment, and those sensitive to sulphonamides. Patient should be advised to have their blood count and electrolytes monitored regularly as blood disorders and rashes can occur. If so, discontinuation is urgently required.

* Patients should be reminded of the need for regular intraocular pressure checks.

Lifestyle

* Double-check whether patients are taking any OTC medication. Look out for hayfever and travel sickness products as sedating antihistamines have significant antimuscarinic activity and should be avoided in glaucoma patients.

* Remind patients to order their repeat prescription on time to prevent them running out.

Ken P.K Wan, community pharmacist, Clacton-on-Sea, Essex

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