Brinzolamide (trade names Azopt, Alcon Laboratories, Befardin, Fardi Medicals, ) is a carbonic anhydrase inhibitor used to lower intraocular pressure in patients with open-angle glaucoma or ocular hypertension. Brinzolamide was approved as a generic medication in the United States in November 2020. Chemistry
Brinzolamide is a carbonic anhydrase inhibitor (specifically, carbonic anhydrase II). Carbonic anhydrase is found primarily in erythrocytes (but also in other tissues including the eye). It exists as a number of isoenzymes, the most active of which is carbonic anhydrase II (CA-II). Indications
Use for the treatment of open-angle glaucoma and raised intraocular pressure due to either excess aqueous humor production or inadequate drainage of the humor via the trabecular meshwork. Pharmacodynamics
Inhibition of carbonic anhydrase in the ciliary processes of the eye decreases aqueous humor secretion and thus lowers the intraocular pressure in the anterior chamber, presumably by reducing the rate of formation of bicarbonate ions with subsequent reduction in sodium and fluid transport; this may alleviate the effects of open-angle glaucoma. Pharmacokinetics
Absorption
The recommended frequency for topical application is two times per day. Following ocular instillation, the suspension is systemically absorbed to some degree; however the plasma concentrations are low and generally below the limits of detection (less than 10 ng/mL) due to extensive binding by tissues and erythrocytes. Oral administration is less-favored due to variable absorption from the stomach mucosa and an increased side-effect profile versus ophthalmic administration. Distribution
The compound is fairly well protein-bound (60%), but adheres extensively to the carbonic anhydrase-containing erythrocytes.
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Malingering
Pneumoperitoneum secondary to abdominal trauma
Septic miscarriage (See Miscarriage)

Laboratory findings
Complete blood count (CBC)
Blood urea nitrogen (BUN)/creatinine
Liver function tests (LFTs)
Glucose
Amylase/lipase
Urine culture
Urinalysis
Beta-human chorionic gonadotropin (beta-hCG)
Cervical cultures are recommended to diagnose pelvic inflammatory disease

Electrolyte and biomarker studies
Electrolytes

MRI and CT
CT diagnoses:
Organ contusion
Organ laceration
Aneurysm
Diverticulitis
Appendicitis

Echocardiography or ultrasound
Pelvic, abdominal and/or transvaginal ultrasound diagnoses:
Peritonitis
Ectopic pregnancy
Ovarian cysts
Fluid/blood secondary to trauma
Appendicitis
Aneurysm

Other imaging findings
KUB x-ray imaging (kidney, ureter, bladder) could reveal nephrolithiasis and bowel gas pattern

Other diagnostic studies
Symptomatic relief may be provided by paracentesis, which may also diagnose spontaneous bacterial peritonitis (SBP)
Gastrointestinal endoscopy may be used or patients with suspected peptic ulcer disease
Helicobacter pylori testing may also be used
Trial medications may be beneficial for the diagnosis and treatment of:
GERD/dyspepsia: Proton pump inhibitors or H2 blockers
Abdominal wall strain: Nonsteriodal anti-inflammatory drugs (NSAIDs)
Anxiety: Lorazepam
Zoster: Acyclovir

Treatment
Specific conditions need direct treatment
Hemodynamic status and life-threatening disease require immediate attention
Volume replacement with a possible blood transfusion, and with normal saline
For obstruction and persistent vomiting, place nasogastric (NG) tube

Pharmacotherapy
If perforated viscus or intra-abdominal infection suspected, administer broad-spectrum empiric antibiotics

Surgery and device-based therapy
Early sepsis, or evidence of hemorrhage may require surgery (likely to be life-threatening emergency)

References
Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3