An update on drug interaction considerations in the therapeutic use of carbonic anhydrase inhibitors

Introduction: Carbonic anhydrase inhibitors (CAIs) have been in clinical use for decades for the management of various disorders. An update on their drug-drug interactions is presented here considering these main therapeutic areas and drugs: glaucoma (acetazolamide, methazolamide, dichlorophenamide, dorzolamide, and brinzolamide); epilepsy/obesity (sulthiame, topiramate, and zonisamide); arthritis/inflammation (celecoxib and polmacoxib) and hypoxic tumors (SLC-0111). Areas covered: Drug interactions reported between CAIs with various other pharmacological agents are reviewed in publications after 2016, when the previous review was published. Most reported interactions concern the antiepileptics sulthiame, topiramate, and zonisamide, as they are part of complex regimens in which drugs controlling this disorder are administered. Fewer interactions were reported for the anti-glaucoma agents, whereas synergistic combinations of celecoxib with antibiotics or SLC-0111 with various antitumor drugs were extensively investigated. Expert opinion: Drug interactions involving CAIs may be used both for monitoring the clinical efficacy of these agents when co-administered with other drugs but also for better controlling some diseases, such as hypoxic tumors, case for which the combination of CAIs with other anticancer agents (histone deacetylase inhibitors, alkylating agents, antimetabolite nucleosides, angiogenesis inhibitors, and immune checkpoint inhibitors) proved to be synergistic.