Carbonic acid anhydrase inhibitors Inducers of urolithiasis, CYP3A4, N-acetyl transferase or glucuronic acid Digoxin, quinidine. St.Johns Wort

Hypersensitivity , anorexia, psychiatric disorders, agitation, irritability, confusional states Ataxia, anxiety, depression, emotional lability, Headache, dizziness, parasthesia, memory impairment, somnloence, insomnia, Tremor, abnormal vision, nystagmus, kidney stones, diarrkea, G.I Upset, nausea, rash, ecchymosis, loss of attention, speech disorder, Diplopia, abnormal pain, weight loss, pyrexia, flu-like syndrome, fatigue, decreased bicarbonate. Suicidal ideation oe behaviour Rarely, Stevens-Johnson syndrome

Severe renal or hepatic impairment Hypersensitivity to sulphonamides Pancreatitis Muscle pain, or weakness Pregnancy, lactation

Special Precautions- Mild to moderate renal or hepatic impairment Titrate slowly and monitor more frequently. Risk of nephrolithiasis or hypercalciuria. Ensure adequate contraception in women of childbearing potential Elderly, patients less than 40 kg, withdraw gradually Substantial weight loss or unexpected rash, discontinue Depression.Suicidal ideation. Maintain adequate hydration, exposure to heat Monitor closely for oliohidrosis and hyperthermia Avoid abrupt cessation

Initially 50 mg daily in two divided doses After 1 week, increase if necessary to 100mg daily Titrate at weekly intervals in increments of up to 100mg daily Usual maintenance 300 - 500mg daily in single or two divided doses. Not recommended for patients below 18 years