What are the mechanisms of action and pharmacokinetics of carbonic anhydrase inhibitors?

Updated: Jan 28, 2020
  • Author: Juan G Ochoa, MD; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Answer

Inhibition of the enzyme carbonic anhydrase increases the concentration of hydrogen ions intracellularly and decreases the pH. The potassium ions shift to the extracellular compartment to buffer the acid-base status. This event results in hyperpolarization and an increase in seizure threshold of the cells.

Acetazolamide has been used as an adjunctive therapy in refractory seizures with catamenial pattern (ie, seizure clustering around menstrual period). Topiramate and zonisamide (ZNS) also are weak inhibitors of this enzyme; however, this is not believed to be an important mechanism for their antiseizure efficacy.


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