Review of Acetazolamide and Novel Medical Paradigms for Idiopathic Intracranial Hypertension Treatment.

Objective: To summarize recent emerging treatments for idiopathic intracranial hypertension (IIH) as an adjunct to surgical repair of cerebrospinal fluid leak by rhinology and skull base surgeons.

Data sources: PubMed and Embase databases.

Review methods: A literature review of aforementioned databases was performed on August 23, 2024, to identify studies from the past 5 years of acetazolamide alternatives and on September 16, 2024, for acetazolamide for the medical management of IIH. Data collected from studies included author, publication year, type of evidence, main findings, dosage, reported adverse effects, and medication studied.

Results: Ten articles met screening criteria, and medications studied included the following: acetazolamide, topiramate, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and 11-beta hydroxysteroid dehydrogenase type 1 (11β-HSD1) inhibitors. There were 4 randomized control trials, 1 pilot single-center study, 2 retrospective cohort studies, 1 retrospective case-control study, and 2 murine model basic science studies. There were significant findings supporting the case for increased research into their respective medications with hopeful clinical translation.

Conclusion: Topiramate, GLP-1RAs, and 11β-HSD1 inhibitors are promising adjuncts or alternatives to acetazolamide and should be further investigated as effective IIH treatments.