Which of the following is NOT a contraindication to Diamox?

• A. Sulfa allergy
• B. COPD
• C. Pregnancy
• D. Asthma

Answer: (D)

Diamox (acetazolamide) acts as a carbonic anhydrase inhibitor, reducing production of aqueous humor to lower intraocular pressure, but it also promotes metabolic acidosis by wasting bicarbonate in the kidney. Because of this systemic effect, certain conditions make using it unsafe: a known sulfonamide allergy due to potential hypersensitivity reactions; pregnancy due to teratogenic risk; and significant renal or hepatic impairment or electrolyte disturbances where the risk of acidosis or toxicity is heightened. COPD is a concern because additional metabolic acidosis can worsen respiratory function in someone with chronic CO2 retention, so it’s avoided in that setting. Asthma, however, does not inherently increase risk with acetazolamide, so it is not considered a contraindication. Hence asthma is the NOT contraindication.