{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:58:38Z","timestamp":1783490318760,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T00:00:00Z","timestamp":1704326400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Heart failure (HF) patients often experience persistent fluid overload despite standard diuretic therapy. The adjunctive use of acetazolamide, a carbonic anhydrase inhibitor, in combination with loop diuretics has shown promise in improving decongestion and diuretic efficacy. This literature review aims to analyze six studies evaluating the effectiveness of acetazolamide as an additive treatment for acute decompensated heart failure (ADHF) and its impact on various outcomes. Methods: We searched the PubMed database using the terms \u201cacetazolamide heart failure\u201d. We refined our search with specific filters (as shown our PRISMA flow diagram) and exclusion criteria, narrowing down our results to five studies. We included an extra study via expert recommendation, ultimately including six studies for comprehensive analysis. Results: The review highlights the positive effects of acetazolamide on decongestion, natriuresis, and diuresis in HF patients. However, it also showcases the limitations of these trials. Discussion: While the reviewed studies demonstrate the potential benefits of acetazolamide in enhancing decongestion and diuretic efficiency, there are limitations to consider, including small sample sizes, lack of blinding, and limited external validity. Further research is needed to confirm these findings, compare acetazolamide with other diuretic combinations, and explore its effects in a broader population of heart failure patients, including those in the United States. The use of acetazolamide in HF management warrants continued investigation to optimize its role in improving decongestion and patient outcomes.<\/jats:p>","DOI":"10.3390\/jcm13010288","type":"journal-article","created":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T04:05:38Z","timestamp":1704341138000},"page":"288","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Unlocking the Potential of Acetazolamide: A Literature Review of an Adjunctive Approach in Heart Failure Management"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2041-623X","authenticated-orcid":false,"given":"Michael","family":"Sabina","sequence":"first","affiliation":[{"name":"Lakeland Regional Health Medical Center, Lakeland 33805-4500, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zein","family":"Barakat","sequence":"additional","affiliation":[{"name":"Lakeland Regional Health Medical Center, Lakeland 33805-4500, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Feliciano","sequence":"additional","affiliation":[{"name":"Lakeland Regional Health Medical Center, Lakeland 33805-4500, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Lamb","sequence":"additional","affiliation":[{"name":"Lakeland Regional Health Medical Center, Lakeland 33805-4500, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Mrhaf","family":"Alsamman","sequence":"additional","affiliation":[{"name":"Lakeland Regional Health Medical Center, Lakeland 33805-4500, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,4]]},"reference":[{"key":"ref_1","first-page":"e895","article-title":"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","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1258\/acb.2011.011281","article-title":"Diuretics: A review","volume":"49","author":"Wile","year":"2012","journal-title":"Ann. Clin. Biochem."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1056\/NEJM195405062501803","article-title":"Oral administration of a potent carbonic anhydrase inhibitor (\u201cDiamox\u201d). I. Changes in electrolyte and acid-base balance","volume":"250","author":"Leaf","year":"1954","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1042\/cs0940287","article-title":"Mild metabolic alkalosis impairs the natriuretic response to bumetanide in normal human subjects","volume":"94","author":"Loon","year":"1998","journal-title":"Clin. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e003180","DOI":"10.1161\/CIRCHEARTFAILURE.116.003180","article-title":"Hypochloremia and Diuretic Resistance in Heart Failure: Mechanistic Insights","volume":"9","author":"Hanberg","year":"2016","journal-title":"Circ. Heart Fail."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1177\/10600280231154603","article-title":"Intravenous or Oral Acetazolamide for Treatment of Diuretic-Induced Alkalosis in Patients with Heart Failure","volume":"57","author":"Addison","year":"2023","journal-title":"Ann. Pharmacother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1161\/HYPERTENSIONAHA.120.15205","article-title":"Pathophysiology of Diuretic Resistance and Its Implications for the Management of Chronic Heart Failure","volume":"76","author":"Wilcox","year":"2020","journal-title":"Hypertension"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1681\/ASN.V3121878","article-title":"A volume-independent component to postdiuretic sodium retention in humans","volume":"3","author":"Almeshari","year":"1993","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"F958","DOI":"10.1152\/ajprenal.00476.2015","article-title":"Everything we always wanted to know about furosemide but were afraid to ask","volume":"310","author":"Huang","year":"2016","journal-title":"Am. J. Physiol. Ren. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100465","DOI":"10.1016\/j.xkme.2022.100465","article-title":"Renin-Angiotensin-Aldosterone System activation and diuretic response in ambulatory patients with heart failure","volume":"4","author":"Amatruda","year":"2022","journal-title":"Kidney Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1093\/eurheartj\/ehac689","article-title":"Combining loop with thiazide diuretics for decompensated heart failure: The CLOROTIC trial","volume":"44","author":"Casado","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e009149","DOI":"10.1161\/JAHA.118.009149","article-title":"Outcomes Associated with a Strategy of Adjuvant Metolazone or High-Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis","volume":"7","author":"Houser","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1001\/jamacardio.2017.2198","article-title":"Efficacy and safety of spironolactone in acute heart failure: The ATHENA-HF randomized clinical trial","volume":"2","author":"Butler","year":"2017","journal-title":"JAMA Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1001\/jama.291.16.1963","article-title":"Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: A randomized controlled trial","volume":"291","author":"Gheorghiade","year":"2004","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1016\/j.jacc.2016.09.004","article-title":"Efficacy and Safety of Tolvaptan in Patients Hospitalized with Acute Heart Failure","volume":"69","author":"Felker","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1007\/s40261-017-0577-1","article-title":"Acetazolamide as Add-on Diuretic Therapy in Exacerbations of Chronic Heart Failure: A Pilot Study","volume":"37","author":"Imiela","year":"2017","journal-title":"Clin. Drug Investig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e12465","DOI":"10.1111\/1755-5922.12465","article-title":"Use of acetazolamide in the treatment of patients with refractory congestive heart failure","volume":"36","author":"Heredia","year":"2018","journal-title":"Cardiovasc. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1002\/ejhf.1478","article-title":"Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance","volume":"21","author":"Verbrugge","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1056\/NEJMoa2203094","article-title":"Acetazolamide in acute decompensated heart failure with volume overload","volume":"387","author":"Mullens","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3672","DOI":"10.1093\/eurheartj\/ehad557","article-title":"Renal function and decongestion with acetazolamide in acute decompensated heart failure: The ADVOR trial","volume":"44","author":"Meekers","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3683","DOI":"10.1093\/eurheartj\/ehad560","article-title":"Acetazolamide for acute heart failure: Is ADVOR a riddle wrapped in a mystery inside an enigma?","volume":"44","author":"Bueno","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_22","first-page":"473","article-title":"CANDI: Chlorthalidone versus acetazolamide in patients with diuretic resistance and acute heart failure [CANDI: Clortalidona frente a acetazolamida en pacientes con resistencia diur\u00e9tica e insuficiencia cardiaca aguda]","volume":"76","author":"Royuela","year":"2023","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_23","first-page":"16526","article-title":"Diuretic, natriuretic, and chloride-regaining effects of oral acetazolamide as an add-on therapy for acute heart failure with volume overload: A single-center, prospective, randomized study","volume":"133","author":"Kosiorek","year":"2023","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_24","first-page":"e37792","article-title":"Effect of acetazolamide as add-on diuretic therapy in patients with heart failure: A meta-analysis","volume":"15","author":"Malik","year":"2023","journal-title":"Cureus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1093\/ehjacc\/zuac006","article-title":"Comparison of chlorthalidone and spironolactone as additional diuretic therapy in patients with acute heart failure and preserved ejection fraction","volume":"11","author":"Ruiz","year":"2022","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1038\/s41591-021-01659-1","article-title":"The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: A multinational randomized trial","volume":"28","author":"Voors","year":"2022","journal-title":"Nat. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1161\/CIRCULATIONAHA.122.059038","article-title":"Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients with Acute Decompensated Heart Failure (EMPAG-HF)","volume":"146","author":"Schulze","year":"2022","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1002\/ejhf.1713","article-title":"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)","volume":"22","author":"Damman","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s40119-020-00172-9","article-title":"Proposal for New Classification and Practical Use of Diuretics According to Their Effects on the Serum Chloride Concentration: Rationale Based on the \u201cChloride Theory\u201d","volume":"9","author":"Kataoka","year":"2020","journal-title":"Cardiol. Ther."},{"key":"ref_30","first-page":"904","article-title":"Chloride in Heart Failure: The Neglected Electrolyte","volume":"9","author":"Sepehrvand","year":"2021","journal-title":"JACC Heart Fail."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/1\/288\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:39:49Z","timestamp":1760103589000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/1\/288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,4]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["jcm13010288"],"URL":"https:\/\/doi.org\/10.3390\/jcm13010288","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,4]]}}}