Ulyanovsk Medico-biological Journal

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DOI 10.34014/2227-1848-2025-3-41-59

 

ACETAZOLAMIDE IN HEART FAILURE: PAST- OR FUTURE-ORIENTED TREATMENT

 

V.A. Serov, D.V. Shiryaevskaya, O.A. Shiryaevskiy, E.V. Efremova

 

Ulyanovsk State University, Ulyanovsk, Russia

 

Optimizing diuretic prescription for heart failure remains an unresolved issue. Combined diuretic therapy is known to be advisable. However, there is an unresolved question: what drugs should be used? Recently, much attention has been drawn to carbonic anhydrase inhibitor acetazolamide.

The aim of the study is to present an overview of clinical studies and clinical and pharmacological rationale for acetazolamide prospects in hospitalized patients with acute heart failure.

Materials and Methods. To gather information, search was conducted in the PubMed database and the eLIBRARY database.

Results. The article presents data on the acetazolamide pharmacokinetics and pharmacodynamics. It also touches upon the results of recent clinical studies on combined diuretic therapy in heart failure. It is shown that the mechanism of action of carbonic anhydrase inhibitors has advantages for their use in combination diuretic therapy. Acetazolamide therapy statistically significantly increased natriuresis, more often led to the disappearance of hyperhydration symptoms, and reduced the likelihood of metabolic alkalosis while treating patients with acute heart failure with loop diuretics. Side effects were rare and not severe. At the same time, no decrease in short- and long-term mortality was observed.

Conclusion. Combined diuretic therapy results in significant reductions in overhydratation in patients with acute heart failure under a satisfactory safety profile. Acetazolamide should be considered as a valuable option when fast diuretic effect is required in patients with heart failure, as well as in patients with metabolic complications such as alkalosis or hyperchloremia. However, more research and clinical studies are needed to develop optimal strategies for prescribing carbonic anhydrase inhibitors.

Key words: acetazolamide, heart failure, combined diuretic therapy.

 

Conflict of interest. The authors declare no conflict of interest.

Author contributions

Research concept and design: Serov V.A.

Literature search, data processing: Serov V.A., Shiryaevskaya D.V., Shiryaevskiy O.A., Efremova E.V.

Data analysis and interpretation: Serov V.A., Shiryaevskaya D.V.

Text writing and editing: Serov V.A., Shiryaevskaya D.V.

 

References

  1. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M., Burri H., Butler J., Čelutkienė J., Chioncel O., Cleland J.G.F., Coats A.J.S., Crespo-Leiro M.G., Farmakis D., Gilard M., Heymans S., Hoes A.W., Jaarsma T., Jankowska E.A., Lainscak M., Lam C.S.P., Lyon A.R., McMurray J.J.V., Mebazaa A., Mindham R., Muneretto C., Piepoli F. M., Price S., Rosano G.M.C., Ruschitzka F., Skibelund K.A.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2021; 42 (36): 3599–3726.

  2. Bauersachs J. Heart failure drug treatment: the fantastic four. Eur. Heart J. 2021; 42: 681–683.

  3. Abdin A., Bauersachs J., Soltani S., Eden M., Frey N., Böhm M. A practical approach to the guideline-directed pharmacological treatment of heart failure with reduced ejection fraction. ESC Heart Fail. 2023; 10: 24–31.

  4. Mebazaa A., Davison B., Chioncel O., Cohen-Solal A., Diaz R., Filippatos G., Metra M., Ponikowski P., Sliwa K., Voors A.A., Edwards C., Novosadova M., Takagi K., Damasceno A., Saidu H., Gayat E., Pang P.S., Celutkiene J., Cotter G. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022; 400 (10367): 1938–1952.

  5. Bashirov A.U. Epidemiologiya khronicheskoy serdechnoy nedostatochnosti v Kazakhstane i drugikh stranakh [Chronic heart failure epidemiology in Kazakhstan and other countries]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2024; 3: 17–27 (in Russian).

  6. Polyakov D.S., Fomin I.V., Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Artem'eva E.G., Badin Yu.V., Bakulina E.V., Vinogradova N.G., Galyavich A.S., Ionova T.S., Kamalov G.M., Kechedzhieva S.G., Koziolova N.A., Malenkova V.Yu., Mal'chikova S.V., Mareev Yu.V., Smirnova E.A., Tarlovskaya E.I., Shcherbinina E.V., Yakushin S.S. Khronicheskaya serdechnaya nedostatochnost' v Rossiyskoy Federatsii: chto izmenilos' za 20 let nablyudeniya? Rezul'taty issledovaniya EPOKhA-KhSN [Chronic heart failure in the Russian Federation: What has changed over 20 years of follow-up? Results of the EPOCH-CHF study]. Kardiologiya. 2021; 61 (4): 4–14 (in Russian).

  7. Heidenreich P.A., Bozkurt B., Aguilar D., Allen L.A., Byun J.J., Colvin M.M., Deswal A., Drazner M.H., Dunlay S.M., Evers L.R., Fang J.C., Fedson S.E., Fonarow G.C., Hayek S.S., Hernandez A.F., Khazanie P., Kittleson M.M., Lee C.S., Link M.S., Milano C.A., Nnacheta L.C., Sandhu A.T., Stevenson L.W., Vardeny O., Vest A.R., Yancy C.W.; ACC/AHA Joint Committee Members. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145 (18): e895–e1032.

  8. Mullens W., Damman K., Harjola V.P., Mebazaa A., Brunner-La Rocca H.P., Martens P., Testani J.M., Tang W.H.W., Orso F., Rossignol P., Metra M., Filippatos G., Seferovic P.M., Ruschitzka F., Coats A.J. The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. Eur. J. Heart Fail. 2019; 21 (2): 137–155.

  9. Kataoka H. Proposal for heart failure progression based on the ‘chloride theory’: worsening heart failure with increased vs. non-increased serum chloride concentration. ESC Hear Fail. 2017; 4: 623–631.

  10. Biegus J., Zymliński R., Fudim M., Testani J., Sokolski M., Marciniak D., Ponikowska B., Guzik M., Garus M., Urban S., Ponikowski P. Spot urine sodium in acute heart failure: differences in prognostic value on admission and discharge. ESC Heart Fail. 2021; 8 (4): 2597–2602.

  11. Biegus J., Nawrocka-Millward S., Zymliński R., Fudim M., Testani J., Marciniak D., Rosiek-Biegus M., Ponikowska B., Guzik M., Garus M., Ponikowski P. Distinct renin/aldosterone activity profiles correlate with renal function, natriuretic response, decongestive ability and prognosis in acute heart failure. Int. J. Cardiol. 2021; 345: 54–60.

  12. Mocan D., Lala R.I., Puschita M., Pilat L., Darabantiu D.A., Pop-Moldovan A. The Congestion "Pandemic" in Acute Heart Failure Patients. Biomedicines. 2024; 12 (5): 951.

  13. Sabina M., Barakat Z., Feliciano A., Lamb A., Alsamman M.M. Unlocking the Potential of Acetazolamide: A Literature Review of an Adjunctive Approach in Heart Failure Management. J. Clin. Med. 2024; 13 (1): 288.

  14. Chioncel O., Mebazaa A., Maggioni A.P., Harjola V.P., Rosano G., Laroche C., Piepoli M.F., Crespo-Leiro M.G., Lainscak M., Ponikowski P., Filippatos G., Ruschitzka F., Seferovic P., Coats A.J.S., Lund L.H.; ESC-EORP-HFA Heart Failure Long-Term Registry Investigators. Acute heart failure congestion and perfusion status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry. Eur. J. Heart Fail. 2019; 21 (11): 1338–1352.

  15. Lala A., McNulty S.E., Mentz R.J., Dunlay S.M., Vader J.M., AbouEzzeddine O.F., DeVore A.D., Khazanie P., Redfield M.M., Goldsmith S.R., Bart B.A., Anstrom K.J., Felker G.M., Hernandez A.F., Stevenson L.W. Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF). Circ. Heart Fail. 2015; 8 (4): 741–748.

  16. Bilgeri V., Spitaler P., Puelacher C., Messner M., Adukauskaite A., Barbieri F., Bauer A., Senoner T., Dichtl W. Decongestion in Acute Heart Failure-Time to Rethink and Standardize Current Clinical Practice? J. Clin. Med. 2024; 13 (2): 311.

  17. Boyko A.N., Gusev E.I., Bykova O.V., Kuzenkova L.M., Maslova O.I. Atsetozolamid v detskoy nevrologicheskoy praktike: istoriya i perspektivy prakticheskogo primeneniya [Acetazolamide in pediatric neurological practice: History and prospects of practical application]. Voprosy sovremennoy pediatrii. 2006; 5 (3): 40–45 (in Russian).

  18. Belousov Yu.B., Kukes V.G., Lepakhin V.K., Petrov V.I., red. Klinicheskaya farmakologiya: natsional'noe rukovodstvo [Clinical pharmacology: National guidelines]. Moscow.: GEOTAR-Media; 2014. 976 (in Russian).

  19. Kassamali R., Sica D.A. Acetazolamide: a forgotten diuretic agent. Cardiol. Rev. 2011; 19 (6): 276–278.

  20. Loon N.R., Wilcox C.S. Mild metabolic alkalosis impairs the natriuretic response to bumetanide in normal human subjects. Clin. Sci. 1998, 94: 287–292.

  21. Arrigo M., Jessup M., Mullens W., Reza N., Shah A.M., Sliwa K., Mebazaa A. Acute heart failure. Nat. Rev. Dis. Primers. 2020; 6 (1): 16.

  22. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M., Burri H., Butler J., Čelutkienė J., Chioncel O., Cleland J.G.F., Coats A.J.S., Crespo-Leiro M.G., Farmakis D., Gilard M., Heymans S., Hoes A.W., Jaarsma T., Jankowska E.A., Lainscak M., Lam C.S.P., Lyon A.R., McMurray J.J.V., Mebazaa A., Mindham R., Muneretto C., Francesco Piepoli M., Price S., Rosano G.M.C., Ruschitzka F., Kathrine Skibelund A.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. J. Heart Fail. 2022; 24 (1): 4–131.

  23. Wilcox C.S., Testani J.M., Pitt B. Pathophysiology of Diuretic Resistance and Its Implications for the Management of Chronic Heart Failure. Hypertension. 2020; 76 (4): 1045–1054.

  24. Cuthbert J.J., Cleland J.G.F., Clark A.L. Diuretic Treatment in Patients with Heart Failure: Current Evidence and Future Directions-Part II: Combination Therapy. Curr. Heart Fail. Rep. 2024; 21 (2): 115–130.

  25. Trullàs J.C., Morales-Rull J.L., Casado J., Carrera-Izquierdo M., Sánchez-Marteles M., Conde-Martel A., Dávila-Ramos M.F., Llácer P., Salamanca-Bautista P., Pérez-Silvestre J., Plasín M.Á., Cerqueiro J.M., Gil P., Formiga F., Manzano L.; CLOROTIC trial investigators. Combining loop with thiazide for decompensated heart failure: the CLOROTIC trial. Eur. Heart J. 2023; 44 (5): 411–421.

  26. Sánchez-Marteles M., Garcés-Horna V., Morales-Rull J.L., Casado J., Carrera-Izquierdo M., Conde-Martel A., Dávila-Ramos M.F., Llácer P., Salamanca-Bautista  P., Ruiz  R., Aramburu-Bodas  O., Formiga F., Manzano L.,  Trullàs J.C. Combining Loop and Thiazide Diuretics Across the Left Ventricular Ejection Fraction Spectrum: The CLOROTIC Trial. JACC Heart Fail. 2024; 12 (10): 1719–1730.

  27. Conde-MartelThis email address is being protected from spambots. You need JavaScript enabled to view it.."> A., Trullàs J.C., Morales-Rull J.L., Casado J., Carrera-Izquierdo M., Sánchez-Marteles M., Llácer P., Salamanca-Bautista P., Manzano L., Formiga F. Sex differences in clinical characteristics and outcomes in the CLOROTIC (combining loop with thiazide diuretics for decompensated heart failure) trial. Rev. Clin. Esp. (Barc.). 2024; 224 (2): 67–76.

  28. Mullens W., Dauw J., Martens P., Verbrugge F.H., Nijst P., Meekers E., Tartaglia K., Chenot F., Moubayed S., Dierckx R., Blouard P., Troisfontaines P., Derthoo D., Smolders W., Bruckers L., Droogne W., Ter Maaten J.M., Damman K., Lassus J., Mebazaa A., Filippatos G., Ruschitzka F., Dupont M.; ADVOR Study Group. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload. N. Engl. J. Med. 2022; 387 (13): 1185–1195.

  29. Verbrugge F.H., Martens P., Dauw J., Nijst P., Meekers E., Augusto S.N. Jr., Ter Maaten J.M., Damman K., Filippatos G., Lassus J., Mebazaa A., Ruschitzka F., Dupont M., Mullens W. Natriuretic Response to Acetazolamide in Patients With Acute Heart Failure and Volume Overload. J. Am. Coll. Cardiol. 2023; 81 (20): 2013–2024.

  30. Meekers E., Dauw J., Martens P., Dhont S., Verbrugge F.H., Nijst P., Ter Maaten J.M., Damman K., Mebazaa A., Filippatos G., Ruschitzka F., Tang W.H.W., Dupont M., Mullens W. Renal function and decongestion with acetazolamide in acute decompensated heart failure: the ADVOR trial. Eur. Heart J. 2023; 44 (37): 3672–3682.

  31. Efremova E.V., Shutov A.M., Borodulina E.O. Problema komorbidnosti pri khronicheskoy serdechnoy nedostatochnosti [Problem of comorbidity in chronic heart failure]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2015; 4: 46–52 (in Russian).

  32. Greene S.J., Felker G.M. Considering Addition of Acetazolamide to Loop Diuretics as Treatment for Acute Heart Failure: ADVOR Reappraisal. JACC Heart Fail. 2023; 11 (3): 365–367.

  33. Ge Y. Acetazolamide As A Valuable Addition to Acute Heart Failure? J. Am. Board. Fam. Med. 2024; 37 (2): 351–353.

  34. Biegus J., Voors A.A., Collins S.P., Kosiborod M.N., Teerlink J.R., Angermann C.E., Tromp J., Ferreira J.P., Nassif M.E., Psotka M.A., Brueckmann M., Salsali A., Blatchford J.P., Ponikowski P. Impact of empagliflozin on decongestion in acute heart failure: the EMPULSE trial. Eur. Heart J. 2023; 44 (1): 41–50.

  35. Voors A.A., Angermann C.E., Teerlink J.R., Collins S.P., Kosiborod M., Biegus J., Ferreira J.P., Nassif M.E., Psotka M.A., Tromp J., Borleffs C.J.W., Ma C., Comin-Colet J., Fu M., Janssens S.P., Kiss R.G., Mentz R.J., Sakata Y., Schirmer H., Schou M., Schulze P.C., Spinarova L., Volterrani M., Wranicz J.K., Zeymer U., Zieroth S., Brueckmann M., Blatchford J.P., Salsali A., Ponikowski P. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat. Med. 2022; 28 (3): 568–574.

  36. Schulze P.C., Bogoviku J., Westphal J., Aftanski P., Haertel F., Grund S., von Haehling S., Schumacher U., Möbius-Winkler S., Busch M. Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF). Circulation. 2022; 146 (4): 289–298.

  37. Damman K., Beusekamp J.C., Boorsma E.M., Swart H.P., Smilde T.D.J., Elvan A., van Eck J.W.M., Heerspink H.J.L., Voors A.A. Randomized, double-blind, placebo-controlled, multicentre pilot study on the effects of empagliflozin on clinical outcomes in patients with acute decompensated heart failure (EMPA-RESPONSE-AHF). Eur. J. Heart Fail. 2020; 22 (4): 713–722.

  38. Felker G.M., Lee K.L., Bull D.A., Redfield M.M., Stevenson L.W., Goldsmith S.R., LeWinter M.M., Deswal A., Rouleau J.L., Ofili E.O., Anstrom K.J., Hernandez A.F., McNulty S.E., Velazquez E.J., Kfoury A.G., Chen H.H., Givertz M.M., Semigran M.J., Bart B.A., Mascette A.M., Braunwald E., O'Connor C.M.; NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N. Engl. J. Med. 2011; 364 (9): 797–805.

  39. Martín V.P., Munoz M.A., Ortiz S.D., Domínguez F., Royuela A., Marcos C.M. CANDI: Chlorthalidone versus acetazolamide in patients with diuretic resistance and acute heart failure. Rev. Esp. Cardiol. 2023; 76: 473–485.

  40. Malik B.A., Nnodebe I., Fayaz A., Inayat H., Murtaza S.F., Umer M., Zaidi S.A.T., Amin A. Effect of Acetazolamide as Add-On Diuretic Therapy in Patients With Heart Failure: A Meta-Analysis. Cureus. 2023; 15 (4): e37792.

  41. Galyavich A.S., Tereshchenko S.N., Uskach T.M., Ageev F.T., Aronov D.M., Arutyunov G.P., Begrambekova Yu.L., Belenkov Yu.N., Boytsov S.A., Bubnova M.G., Vasyuk Yu.A., Villeval'de S.V., Vinogradova N.G., Garganeeva A.A., Gendlin G.E., Gilyarevskiy S.R., Glezer M.G., Got'e S.V., Grinshteyn Yu.I., Dovzhenko T.V., Drapkina O.M., Duplyakov D.V., Zhirov I.V., Zateyshchikov D.A., Zvartau N.E., Irtyuga O.B., Kobalava Zh.D., Koziolova N.A., Koroteev A.V., Libis R.A., Lopatin Yu.M., Mareev V.Yu., Mareev Yu.V., Matskeplishvili S.T., Mikhaylov E.N., Nasonova S.N., Narusov O.Yu., Nedogoda S.V., Nedoshivin A.O., Ovchinnikov A.G., Orlova Ya.A., Perepech N.B., Pogosova N.V., Rimskaya E.M., Samko A.N., Saidova M.A., Sapel'nikov O.V., Safiullina A.A., Sitnikova M.Yu., Skvortsov A.A., Skibitskiy V.V., Stukalova O.V., Tarlovskaya E.I., Tereshchenko A.S., Chesnikova A.I., Fedotov P.A., Fomin I.V., Khasanov N.R., Shevchenko A.O., Shaposhnik I.I., Shariya M.A., Shlyakh­to E.V., Yavelov I.S., Yakushin S.S. Khronicheskaya serdechnaya nedostatochnost'. Klinicheskie rekomendatsii 2024 [Chronic heart failure. Clinical guidelines 2024]. Rossiyskiy kardiologicheskiy zhurnal. 2024; 29 (11): 251–349 (in Russian).

  42. Sorokina K.V., Poltavskaya M.G., Pal'man A.D., Kuklina M.D., Kharkevich K.Yu., Andreev A.D., Kulikov V.M., Sedov V.P. Atsetozolamid v terapii dykhaniya Cheyna-Stoksa u bol'nykh s khronicheskoy serdechnoy nedostatochnost'yu: randomizirovannoe issledovanie [Acetazolamide in the Cheyne-Stokes respiration therapy in patients with chronic heart failure: a pilot randomized study]. Fiziologiya cheloveka. 2022; 48 (1): 97–105 (in Russian).

  43. Siddiqi A.K., Maniya M.T., Alam M.T., Ambrosy A.P., Fudim M., Greene S.J., Khan M.S. Acetazolamide as an Adjunctive Diuretic Therapy for Patients with Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis. Am. J. Cardiovasc. Drugs. 2024; 24 (2): 273–284.

  44. Rubanenko O.A., Rubanenko A.O., Villeval'de S.V., Duplyakov D.V. Effektivnost' i bezopasnost' primeneniya atsetazolamida u patsientov s dekompensirovannoy khronicheskoy serdechnoy nedostatochnost'yu II-IV funktsional'nogo klassa NYHA: protokol otkrytogo prospektivnogo randomizirovannogo mnogotsentrovogo issledovaniya (ORION-A) [Efficacy and safety of acetazolamide in patients with NYHA class II-IV decompensated heart failure: protocol of an open-label prospective randomized multicenter study (ORION-A)]. Rossiyskiy kardiologicheskiy zhurnal. 2023; 28 (3S): 14–21 (in Russian).

  45. Bavandpour Karvane H., Ashraf H., Aghakouchakzadeh M., Navid H., Bozorgi A. Efficacy of Oral Acetazolamide as Add-on Diuretic Therapy in Decongestion in Patients with Heart Failure: A Study Protocol for a Randomized Controlled Trial. J. Tehran. Heart Cent. 2024; 19 (1): 47–53.

  46. Giamello J.D., Savioli G., Longhitano Y., Ferrari F., D'Agnano S., Esposito C., Tesauro M., Zanza C. The role of acetazolamide in critical care and emergency medicine. J. Geriatr. Cardiol. 2024; 21 (11): 1085–1095.

  47. Schmickl C.N., Owens R.L., Orr J.E., Edwards B.A., Malhotra A. Side effects of acetazolamide: a systematic review and meta-analysis assessing overall risk and dose dependence. BMJ Open Respir. Res. 2020; 7 (1): e000557.

  48. Wallace T.R., Fraunfelder F.T., Petursson G.J., Epstein D.L. Decreased libido – a side effect of carbonic anhydrase inhibitor. Ann. Ophthalmol. 1979; 11 (10): 1563–1566.

  49. Epstein R.J., Allen R.C., Lunde M.W. Organic impotence associated with anhydrase inhibitor therapy for glaucoma. Ann. Ophthalmol. 1987; 19 (2): 48–50.

  50. Ten Hove M.W., Friedman D.I., Patel A.D., Irrcher I., Wall M., McDermott M.P.; NORDIC Idiopathic Intracranial Hypertension Study Group. Safety and Tolerability of Acetazolamide in the Idiopathic Intracranial Hypertension Treatment Trial. J. Neuroophthalmol. 2016; 36 (1): 13–19.

  51. Sosa Mercado I., Putot S., Fertu E., Putot A. Acetazolamide Tolerance in Acute Decompensated Heart Failure: An Observational Study. J. Clin. Med. 2024; 13 (12): 3421.

  52. Kazory A., Ronco C. Tackling Congestion in Acute Heart Failure: Is It the Primetime for "Combo Diuretic Therapy?". Cardiorenal Med. 2023; 13 (1): 184–188.

  53. Verbrugge F.H., Dupont M., Steels P., Grieten L., Swennen Q., Tang W.H., Mullens W. The kidney in congestive heart failure: 'are natriuresis, sodium, and diuretics really the good, the bad and the ugly?'. Eur. J. Heart Fail. 2014; 16: 133–142.

  54. Verbrugge F.H., Martens P., Mullens W. SGLT-2 Inhibitors in Heart Failure: Implications for the Kidneys. Curr. Heart Fail. Rep. 2017; 14 (4): 331–337.

  55. An Y., Zhang J.Z., Han J., Yang H.P., Tie L., Yang X.Y., Xiaokaiti Y., Pan Y., Li X.J. Hypoxia-inducible factor-1α dependent pathways mediate the renoprotective role of acetazolamide against renal ischemia-reperfusion injury. Cell Physiol. Biochem. 2013; 32 (5): 1151–1166.

  56. Shimoda L.A., Suresh K., Undem C., Jiang H., Yun X., Sylvester J.T., Swenson E.R. Acetazolamide prevents hypoxia-induced reactive oxygen species generation and calcium release in pulmonary arterial smooth muscle. Pulm. Circ. 2021; 11 (4): 1–12.

  57. Oslyakova A.O., Petrochenko E.P. Vliyanie giperkapnii i okisi azota na reologicheskie svoystva krovi [Effect of hypercapnia and nitric oxide on the rheological properties of blood]. Tromboz, gemostaz i reologiya. 2016; 68 (4): 72–77 (in Russian).

  58. Misaka T., Sato Y., Sugawara Y., Ogawara R., Ichimura S., Tomita Y., Anzai F., Yokokawa T., Sato A., Shimizu T., Sato T., Oikawa M., Kobayashi A., Yoshihisa A., Takeishi Y. Elevated blood bicarbonate levels and long-term adverse outcomes in patients with chronic heart failure. ESC Heart Fail. 2024;

    11 (6): 4420–4426.

  59. Milbradt T.L., Sudo R.Y.U., Gobbo MODS, Akinfenwa S., Moura B. Acetazolamide therapy in patients with acute heart failure: a systematic review and meta-analysis of randomized controlled trials. Heart Fail. Rev. 2024; 29 (5): 1039–1047.

Received April 07, 2025; accepted June 18, 2025.

 

Information about the authors

Serov Valeriy Anatol'evich, Doctor of Sciences (Medicine), Professor, Chair of Therapy and Occupational Diseases, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy St., 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: http://orcid.org/0000-0002-8262-8816

Shiryaevskaya Diana Valer'evna, Candidate of Sciences (Medicine), Associate Professor, Chair of Therapy and Occupational Diseases, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy St., 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: http://orcid.org/0000-0001-7729-552X

Shiryaevskiy Oleg Aleksandrovich, Teaching Assistant, Chair of Therapy and Occupational Diseases, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy St., 42; e-mail: Ostap This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: http://orcid.org/0009-0009-5395-7950

Efremova Elena Vladimirovna, Doctor of Sciences (Medicine), Professor, Chair of Therapy and Occupational Diseases, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy St., 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: http://orcid.org/0000-0002-7579-4824

 

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Serov V.A., Shiryaevskaya D.V., Shiryaevskiy O.A., Efremova E.V. Primenenie atsetazolamida pri lechenii serdechnoy nedostatochnosti: proshloe ili budushchee [Acetazolamide in heart failure: past- or future-oriented treatment]? Ul'yanovskiy mediko-biologicheskiy zhurnal. 2025; 3: 41–59. DOI: 10.34014/2227-1848-2025-3-41-59 (in Russian).

 

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УДК 616-085

DOI 10.34014/2227-1848-2025-3-41-59

 

ПРИМЕНЕНИЕ АЦЕТАЗОЛАМИДА ПРИ ЛЕЧЕНИИ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ: ПРОШЛОЕ ИЛИ БУДУЩЕЕ?

 

В.А. Серов, Д.В. Ширяевская, О.А. Ширяевский, Е.В. Ефремова

 

ФГБОУ ВО «Ульяновский государственный университет», г. Ульяновск, Россия

 

Одним из нерешенных вопросов при лечении сердечной недостаточности является оптимизация назначения мочегонных препаратов. Предложено использовать комбинированную диуретическую терапию. Однако остается открытым вопрос: прием каких лекарственных средств наиболее целесообразен? В последние годы большое внимание привлекает ацетозоламид – ингибитор карбоангидразы.

Цель – представить обзор клинических исследований и клинико-фармакологическое обоснование перспективы применения ацетозоламида у стационарных пациентов с острой сердечной недостаточностью.

Материалы и методы. Проведен поиск в базах данных PubMed и eLIBRARY.

Результаты. Приведены данные по фармакокинетике и фармакодинамике ацетозоламида, а также результаты недавно проведенных клинических исследований, касающихся применения комбинированной диуретической терапии при сердечной недостаточности. Показано, что особенности механизма действия ингибиторов карбоангидразы создают ряд преимуществ для их использования в схемах комбинированной диуретической терапии. Применение ацетозоламида статистически значимо увеличивало натрийурез, чаще приводило к исчезновению симптомов гипергидратации, уменьшало вероятность развития метаболического алколоза при лечении петлевыми диуретиками пациентов с острой сердечной недостаточностью. Побочные явления возникали редко и не носили тяжелого характера. В то же время как в краткосрочной, так и в долгосрочной перспективе не было выявлено снижения смертности.

Выводы. Комбинированная диуретическая терапия приводит к выраженному уменьшению гипергидратации у пациентов с острой сердечной недостаточностью при удовлетворительном профиле безопасности. Ацетозоламид следует рассматривать как ценный вариант при необходимости быстрого устранения застойных явлений у пациентов с сердечной недостаточностью, а также у пациентов с метаболическими осложнениями, такими как алкалоз или гиперхлоремия, однако необходимы дополнительные клинические исследования для выработки оптимальной тактики назначения ингибиторов карбоангидразы.

Ключевые слова: ацетозоламид, сердечная недостаточность, комбинированная диуретическая терапия.

 

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Вклад авторов

Концепция и дизайн исследования: Серов В.А.

Литературный поиск, обработка материала: Серов В.А., Ширяевская Д.В., Ширяевский О.А., Ефремова Е.В.

Анализ и интерпретация данных: Серов В.А., Ширяевская Д.В.

Написание и редактирование текста: Серов В.А., Ширяевская Д.В.

 

Литература

  1. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M., Burri H., Butler J., Čelutkienė J., Chioncel O., Cleland J.G.F., Coats A.J.S., Crespo-Leiro M.G., Farmakis D., Gilard M., Heymans S., Hoes A.W., Jaarsma T., Jankowska E.A., Lainscak M., Lam C.S.P., Lyon A.R., McMurray J.J.V., Mebazaa A., Mindham R., Muneretto C., Piepoli F. M., Price S., Rosano G.M.C., Ruschitzka F., Skibelund K.A.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2021; 42 (36): 3599–3726.

  2. Bauersachs J. Heart failure drug treatment: the fantastic four. Eur. Heart J. 2021; 42: 681–683.

  3. Abdin A., Bauersachs J., Soltani S., Eden M., Frey N., Böhm M. A practical approach to the guideline-directed pharmacological treatment of heart failure with reduced ejection fraction. ESC Heart Fail. 2023; 10: 24–31.

  4. Mebazaa A., Davison B., Chioncel O., Cohen-Solal A., Diaz R., Filippatos G., Metra M., Ponikowski P., Sliwa K., Voors A.A., Edwards C., Novosadova M., Takagi K., Damasceno A., Saidu H., Gayat E., Pang P.S., Celutkiene J., Cotter G. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022; 400 (10367): 1938–1952.

  5. Баширов А.У. Эпидемиология хронической сердечной недостаточности в Казахстане и других странах. Ульяновский медико-биологический журнал. 2024; 3: 17–27.

  6. Поляков Д.С., Фомин И.В., Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т., Артемьева Е.Г., Бадин Ю.В., Бакулина Е.В., Виноградова Н.Г., Галявич А.С., Ионова Т.С., Камалов Г.М., Кечеджиева С.Г., Козиолова Н.А., Маленкова В.Ю., Мальчикова С.В., Мареев Ю.В., Смирнова Е.А., Тарловская Е.И., Щербинина Е.В., Якушин С.С. Хроническая сердечная недостаточность в Российской Федерации: что изменилось за 20 лет наблюдения? Результаты исследования ЭПОХА-ХСН. Кардиология. 2021; 61 (4): 4–14.

  7. Heidenreich P.A., Bozkurt B., Aguilar D., Allen L.A., Byun J.J., Colvin M.M., Deswal A., Drazner M.H., Dunlay S.M., Evers L.R., Fang J.C., Fedson S.E., Fonarow G.C., Hayek S.S., Hernandez A.F., Khazanie P., Kittleson M.M., Lee C.S., Link M.S., Milano C.A., Nnacheta L.C., Sandhu A.T., Stevenson L.W., Vardeny O., Vest A.R., Yancy C.W.; ACC/AHA Joint Committee Members. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145 (18): e895–e1032.

  8. Mullens W., Damman K., Harjola V.P., Mebazaa A., Brunner-La Rocca H.P., Martens P., Testani J.M., Tang W.H.W., Orso F., Rossignol P., Metra M., Filippatos G., Seferovic P.M., Ruschitzka F., Coats A.J. The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. Eur. J. Heart Fail. 2019; 21 (2): 137–155.

  9. Kataoka H. Proposal for heart failure progression based on the ‘chloride theory’: worsening heart failure with increased vs. non-increased serum chloride concentration. ESC Hear Fail. 2017; 4: 623–631.

  10. Biegus J., Zymliński R., Fudim M., Testani J., Sokolski M., Marciniak D., Ponikowska B., Guzik M., Garus M., Urban S., Ponikowski P. Spot urine sodium in acute heart failure: differences in prognostic value on admission and discharge. ESC Heart Fail. 2021; 8 (4): 2597–2602.

  11. Biegus J., Nawrocka-Millward S., Zymliński R., Fudim M., Testani J., Marciniak D., Rosiek-Biegus M., Ponikowska B., Guzik M., Garus M., Ponikowski P. Distinct renin/aldosterone activity profiles correlate with renal function, natriuretic response, decongestive ability and prognosis in acute heart failure. Int. J. Cardiol. 2021; 345: 54–60.

  12. Mocan D., Lala R.I., Puschita M., Pilat L., Darabantiu D.A., Pop-Moldovan A. The Congestion "Pandemic" in Acute Heart Failure Patients. Biomedicines. 2024; 12 (5): 951.

  13. Sabina M., Barakat Z., Feliciano A., Lamb A., Alsamman M.M. Unlocking the Potential of Acetazolamide: A Literature Review of an Adjunctive Approach in Heart Failure Management. J. Clin. Med. 2024; 13 (1): 288.

  14. Chioncel O., Mebazaa A., Maggioni A.P., Harjola V.P., Rosano G., Laroche C., Piepoli M.F., Crespo-Leiro M.G., Lainscak M., Ponikowski P., Filippatos G., Ruschitzka F., Seferovic P., Coats A.J.S., Lund L.H.; ESC-EORP-HFA Heart Failure Long-Term Registry Investigators. Acute heart failure congestion and perfusion status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry. Eur. J. Heart Fail. 2019; 21 (11): 1338–1352.

  15. Lala A., McNulty S.E., Mentz R.J., Dunlay S.M., Vader J.M., AbouEzzeddine O.F., DeVore A.D., Khazanie P., Redfield M.M., Goldsmith S.R., Bart B.A., Anstrom K.J., Felker G.M., Hernandez A.F., Stevenson L.W. Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF). Circ. Heart Fail. 2015; 8 (4): 741–748.

  16. Bilgeri V., Spitaler P., Puelacher C., Messner M., Adukauskaite A., Barbieri F., Bauer A., Senoner T., Dichtl W. Decongestion in Acute Heart Failure-Time to Rethink and Standardize Current Clinical Practice? J. Clin. Med. 2024; 13 (2): 311.

  17. Бойко А.Н., Гусев Е.И., Быкова О.В., Кузенкова Л.М., Маслова О.И. Ацетозоламид в детской неврологической практике: история и перспективы практического применения. Вопросы современной педиатрии. 2006; 5 (3): 40–45.

  18. Белоусов Ю.Б., Кукес В.Г., Лепахин В.К., Петров В.И., ред. Клиническая фармакология: национальное руководство. М.: ГЭОТАР-Медиа; 2014. 976.

  19. Kassamali R., Sica D.A. Acetazolamide: a forgotten diuretic agent. Cardiol. Rev. 2011; 19 (6): 276–278.

  20. Loon N.R., Wilcox C.S. Mild metabolic alkalosis impairs the natriuretic response to bumetanide in normal human subjects. Clin. Sci. 1998, 94: 287–292.

  21. Arrigo M., Jessup M., Mullens W., Reza N., Shah A.M., Sliwa K., Mebazaa A. Acute heart failure. Nat. Rev. Dis. Primers. 2020; 6 (1): 16.

  22. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M., Burri H., Butler J., Čelutkienė J., Chioncel O., Cleland J.G.F., Coats A.J.S., Crespo-Leiro M.G., Farmakis D., Gilard M., Heymans S., Hoes A.W., Jaarsma T., Jankowska E.A., Lainscak M., Lam C.S.P., Lyon A.R., McMurray J.J.V., Mebazaa A., Mindham R., Muneretto C., Francesco Piepoli M., Price S., Rosano G.M.C., Ruschitzka F., Kathrine Skibelund A.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. J. Heart Fail. 2022; 24 (1): 4–131.

  23. Wilcox C.S., Testani J.M., Pitt B. Pathophysiology of Diuretic Resistance and Its Implications for the Management of Chronic Heart Failure. Hypertension. 2020; 76 (4): 1045–1054.

  24. Cuthbert J.J., Cleland J.G.F., Clark A.L. Diuretic Treatment in Patients with Heart Failure: Current Evidence and Future Directions-Part II: Combination Therapy. Curr. Heart Fail. Rep. 2024; 21 (2): 115–130.

  25. Trullàs J.C., Morales-Rull J.L., Casado J., Carrera-Izquierdo M., Sánchez-Marteles M., Conde-Martel A., Dávila-Ramos M.F., Llácer P., Salamanca-Bautista P., Pérez-Silvestre J., Plasín M.Á., Cerqueiro J.M., Gil P., Formiga F., Manzano L.; CLOROTIC trial investigators. Combining loop with thiazide for decompensated heart failure: the CLOROTIC trial. Eur. Heart J. 2023; 44 (5): 411–421.

  26. Sánchez-Marteles M., Garcés-Horna V., Morales-Rull J.L., Casado J., Carrera-Izquierdo M., Conde-Martel A., Dávila-Ramos M.F., Llácer P., Salamanca-Bautista  P., Ruiz  R., Aramburu-Bodas  O., Formiga F., Manzano L.,  Trullàs J.C. Combining Loop and Thiazide Diuretics Across the Left Ventricular Ejection Fraction Spectrum: The CLOROTIC Trial. JACC Heart Fail. 2024; 12 (10): 1719–1730.

  27. Conde-MartelThis email address is being protected from spambots. You need JavaScript enabled to view it.."> A., Trullàs J.C., Morales-Rull J.L., Casado J., Carrera-Izquierdo M., Sánchez-Marteles M., Llácer P., Salamanca-Bautista P., Manzano L., Formiga F. Sex differences in clinical characteristics and outcomes in the CLOROTIC (combining loop with thiazide diuretics for decompensated heart failure) trial. Rev. Clin. Esp. (Barc.). 2024; 224 (2): 67–76.

  28. Mullens W., Dauw J., Martens P., Verbrugge F.H., Nijst P., Meekers E., Tartaglia K., Chenot F., Moubayed S., Dierckx R., Blouard P., Troisfontaines P., Derthoo D., Smolders W., Bruckers L., Droogne W., Ter Maaten J.M., Damman K., Lassus J., Mebazaa A., Filippatos G., Ruschitzka F., Dupont M.; ADVOR Study Group. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload. N. Engl. J. Med. 2022; 387 (13): 1185–1195.

  29. Verbrugge F.H., Martens P., Dauw J., Nijst P., Meekers E., Augusto S.N. Jr., Ter Maaten J.M., Damman K., Filippatos G., Lassus J., Mebazaa A., Ruschitzka F., Dupont M., Mullens W. Natriuretic Response to Acetazolamide in Patients With Acute Heart Failure and Volume Overload. J. Am. Coll. Cardiol. 2023; 81 (20): 2013–2024.

  30. Meekers E., Dauw J., Martens P., Dhont S., Verbrugge F.H., Nijst P., Ter Maaten J.M., Damman K., Mebazaa A., Filippatos G., Ruschitzka F., Tang W.H.W., Dupont M., Mullens W. Renal function and decongestion with acetazolamide in acute decompensated heart failure: the ADVOR trial. Eur. Heart J. 2023; 44 (37): 3672–3682.

  31. Ефремова Е.В., Шутов А.М., Бородулина Е.О. Проблема коморбидности при хронической сердечной недостаточности. Ульяновский медико-биологический журнал. 2015; 4: 46–52.

  32. Greene S.J., Felker G.M. Considering Addition of Acetazolamide to Loop Diuretics as Treatment for Acute Heart Failure: ADVOR Reappraisal. JACC Heart Fail. 2023; 11 (3): 365–367.

  33. Ge Y. Acetazolamide As A Valuable Addition to Acute Heart Failure? J. Am. Board. Fam. Med. 2024; 37 (2): 351–353.

  34. Biegus J., Voors A.A., Collins S.P., Kosiborod M.N., Teerlink J.R., Angermann C.E., Tromp J., Ferreira J.P., Nassif M.E., Psotka M.A., Brueckmann M., Salsali A., Blatchford J.P., Ponikowski P. Impact of empagliflozin on decongestion in acute heart failure: the EMPULSE trial. Eur. Heart J. 2023; 44 (1): 41–50.

  35. Voors A.A., Angermann C.E., Teerlink J.R., Collins S.P., Kosiborod M., Biegus J., Ferreira J.P., Nassif M.E., Psotka M.A., Tromp J., Borleffs C.J.W., Ma C., Comin-Colet J., Fu M., Janssens S.P., Kiss R.G., Mentz R.J., Sakata Y., Schirmer H., Schou M., Schulze P.C., Spinarova L., Volterrani M., Wranicz J.K., Zeymer U., Zieroth S., Brueckmann M., Blatchford J.P., Salsali A., Ponikowski P. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat. Med. 2022; 28 (3): 568–574.

  36. Schulze P.C., Bogoviku J., Westphal J., Aftanski P., Haertel F., Grund S., von Haehling S., Schumacher U., Möbius-Winkler S., Busch M. Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF). Circulation. 2022; 146 (4): 289–298.

  37. Damman K., Beusekamp J.C., Boorsma E.M., Swart H.P., Smilde T.D.J., Elvan A., van Eck J.W.M., Heerspink H.J.L., Voors A.A. Randomized, double-blind, placebo-controlled, multicentre pilot study on the effects of empagliflozin on clinical outcomes in patients with acute decompensated heart failure (EMPA-RESPONSE-AHF). Eur. J. Heart Fail. 2020; 22 (4): 713–722.

  38. Felker G.M., Lee K.L., Bull D.A., Redfield M.M., Stevenson L.W., Goldsmith S.R., LeWinter M.M., Deswal A., Rouleau J.L., Ofili E.O., Anstrom K.J., Hernandez A.F., McNulty S.E., Velazquez E.J., Kfoury A.G., Chen H.H., Givertz M.M., Semigran M.J., Bart B.A., Mascette A.M., Braunwald E., O'Connor C.M.; NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N. Engl. J. Med. 2011; 364 (9): 797–805.

  39. Martín V.P., Munoz M.A., Ortiz S.D., Domínguez F., Royuela A., Marcos C.M. CANDI: Chlorthalidone versus acetazolamide in patients with diuretic resistance and acute heart failure. Rev. Esp. Cardiol. 2023; 76: 473–485.

  40. Malik B.A., Nnodebe I., Fayaz A., Inayat H., Murtaza S.F., Umer M., Zaidi S.A.T., Amin A. Effect of Acetazolamide as Add-On Diuretic Therapy in Patients With Heart Failure: A Meta-Analysis. Cureus. 2023; 15 (4): e37792.

  41. Галявич А.С., Терещенко С.Н., Ускач Т.М., Агеев Ф.Т., Аронов Д.М., Арутюнов Г.П., Беграмбекова Ю.Л., Беленков Ю.Н., Бойцов С.А., Бубнова М.Г., Васюк Ю.А., Виллевальде С.В., Виноградова Н.Г., Гарганеева А.А., Гендлин Г.Е., Гиляревский С.Р., Глезер М.Г., Готье С.В., Гринштейн Ю.И., Довженко Т.В., Драпкина О.М., Дупляков Д.В., Жиров И.В., Затейщиков Д.А., Звартау Н.Э., Иртюга О.Б., Кобалава Ж.Д., Козиолова Н.А., Коротеев А.В., Либис Р.А., Лопатин Ю.М., Мареев В.Ю., Мареев Ю.В., Мацкеплишвили С.Т., Михайлов Е.Н., Насонова С.Н., Нарусов О.Ю., Недогода С.В., Недошивин А.О., Овчинников А.Г., Орлова Я.А., Перепеч Н.Б., Погосова Н.В., Римская Е.М., Самко А.Н., Саидова М.А., Сапельников О.В., Сафиуллина А.А., Ситникова М.Ю., Скворцов А.А., Скибицкий В.В., Стукалова О.В., Тарловская Е.И., Терещенко А.С., Чесникова А.И., Федотов П.А., Фомин И.В., Хасанов Н.Р., Шевченко А.О., Шапошник И.И., Шария М.А., Шляхто Е.В., Явелов И.С., Якушин С.С. Хроническая сердечная недостаточность. Клинические рекомендации 2024. Российский кардиологический журнал. 2024; 29 (11): 251–349.

  42. Сорокина К.В., Полтавская М.Г., Пальман А.Д., Куклина М.Д., Харкевич К.Ю., Андреев А.Д., Куликов В.М., Седов В.П. Ацетозоламид в терапии дыхания Чейна-Стокса у больных с хронической сердечной недостаточностью: рандомизированное исследование. Физиология человека. 2022; 48 (1): 97–105.

  43. Siddiqi A.K., Maniya M.T., Alam M.T., Ambrosy A.P., Fudim M., Greene S.J., Khan M.S. Acetazolamide as an Adjunctive Diuretic Therapy for Patients with Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis. Am. J. Cardiovasc. Drugs. 2024; 24 (2): 273–284.

  44. Рубаненко О.А., Рубаненко А.О., Виллевальде С.В., Дупляков Д.В. Эффективность и безопасность применения ацетазоламида у пациентов с декомпенсированной хронической сердечной недостаточностью II-IV функционального класса NYHA: протокол открытого проспективного рандомизированного многоцентрового исследования (ОРИОН-А). Российский кардиологический журнал. 2023; 28 (3S): 14–21.

  45. Bavandpour Karvane H., Ashraf H., Aghakouchakzadeh M., Navid H., Bozorgi A. Efficacy of Oral Acetazolamide as Add-on Diuretic Therapy in Decongestion in Patients with Heart Failure: A Study Protocol for a Randomized Controlled Trial. J. Tehran. Heart Cent. 2024; 19 (1): 47–53.

  46. Giamello J.D., Savioli G., Longhitano Y., Ferrari F., D'Agnano S., Esposito C., Tesauro M., Zanza C. The role of acetazolamide in critical care and emergency medicine. J. Geriatr. Cardiol. 2024; 21 (11): 1085–1095.

  47. Schmickl C.N., Owens R.L., Orr J.E., Edwards B.A., Malhotra A. Side effects of acetazolamide: a systematic review and meta-analysis assessing overall risk and dose dependence. BMJ Open Respir. Res. 2020; 7 (1): e000557.

  48. Wallace T.R., Fraunfelder F.T., Petursson G.J., Epstein D.L. Decreased libido – a side effect of carbonic anhydrase inhibitor. Ann. Ophthalmol. 1979; 11 (10): 1563–1566.

  49. Epstein R.J., Allen R.C., Lunde M.W. Organic impotence associated with anhydrase inhibitor therapy for glaucoma. Ann. Ophthalmol. 1987; 19 (2): 48–50.

  50. Ten Hove M.W., Friedman D.I., Patel A.D., Irrcher I., Wall M., McDermott M.P.; NORDIC Idiopathic Intracranial Hypertension Study Group. Safety and Tolerability of Acetazolamide in the Idiopathic Intracranial Hypertension Treatment Trial. J. Neuroophthalmol. 2016; 36 (1): 13–19.

  51. Sosa Mercado I., Putot S., Fertu E., Putot A. Acetazolamide Tolerance in Acute Decompensated Heart Failure: An Observational Study. J. Clin. Med. 2024; 13 (12): 3421.

  52. Kazory A., Ronco C. Tackling Congestion in Acute Heart Failure: Is It the Primetime for "Combo Diuretic Therapy?". Cardiorenal Med. 2023; 13 (1): 184–188.

  53. Verbrugge F.H., Dupont M., Steels P., Grieten L., Swennen Q., Tang W.H., Mullens W. The kidney in congestive heart failure: 'are natriuresis, sodium, and diuretics really the good, the bad and the ugly?'. Eur. J. Heart Fail. 2014; 16: 133–142.

  54. Verbrugge F.H., Martens P., Mullens W. SGLT-2 Inhibitors in Heart Failure: Implications for the Kidneys. Curr. Heart Fail. Rep. 2017; 14 (4): 331–337.

  55. An Y., Zhang J.Z., Han J., Yang H.P., Tie L., Yang X.Y., Xiaokaiti Y., Pan Y., Li X.J. Hypoxia-inducible factor-1α dependent pathways mediate the renoprotective role of acetazolamide against renal ischemia-reperfusion injury. Cell Physiol. Biochem. 2013; 32 (5): 1151–1166.

  56. Shimoda L.A., Suresh K., Undem C., Jiang H., Yun X., Sylvester J.T., Swenson E.R. Acetazolamide prevents hypoxia-induced reactive oxygen species generation and calcium release in pulmonary arterial smooth muscle. Pulm. Circ. 2021; 11 (4): 1–12.

  57. Ослякова А.О., Петроченко Е.П. Влияние гиперкапнии и окиси азота на реологические свойства крови. Тромбоз, гемостаз и реология. 2016; 68 (4): 72–77.

  58. Misaka T., Sato Y., Sugawara Y., Ogawara R., Ichimura S., Tomita Y., Anzai F., Yokokawa T., Sato A., Shimizu T., Sato T., Oikawa M., Kobayashi A., Yoshihisa A., Takeishi Y. Elevated blood bicarbonate levels and long-term adverse outcomes in patients with chronic heart failure. ESC Heart Fail. 2024; 11 (6): 4420–4426.

  59. Milbradt T.L., Sudo R.Y.U., Gobbo MODS, Akinfenwa S., Moura B. Acetazolamide therapy in patients with acute heart failure: a systematic review and meta-analysis of randomized controlled trials. Heart Fail. Rev. 2024; 29 (5): 1039–1047.

Поступила в редакцию 07.04.2025; принята 18.06.2025.

Авторский коллектив

Серов Валерий Анатольевич – доктор медицинских наук, профессор кафедры терапии и профессиональных болезней, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: http://orcid.org/0000-0002-8262-8816

Ширяевская Диана Валерьевна – кандидат медицинских наук, доцент кафедры терапии и профессиональных болезней, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: http://orcid.org/0000-0001-7729-552X

Ширяевский Олег Александрович – ассистент кафедры терапии и профессиональных болезней, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: Ostap This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: http://orcid.org/0009-0009-5395-7950

Ефремова Елена Владимировна – доктор медицинских наук, профессор кафедры терапии и профессиональных болезней, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: http://orcid.org/0000-0002-7579-4824

 

Образец цитирования

Серов В.А., Ширяевская Д.В., Ширяевский О.А., Ефремова Е.В. Применение ацетазоламида при лечении сердечной недостаточности: прошлое или будущее? Ульяновский медико-биологический журнал. 2025; 3: 41–59. DOI: 10.34014/2227-1848-2025-3-41-59.