Schneiderhan Mark E, Marvin Robert
Colleges of Pharmacy and Medicine, University of Illinois at Chicago, Chicago, IL 60612-7230, USA.
Am J Ther. 2007 Nov-Dec;14(6):581-4. doi: 10.1097/MJT.0b013e31813e65b7.
Acetazolamide (AZD), a sulfa-like moiety, is a potent, nonspecific inhibitor of carbonic anhydrase (CA) enzymes and has been demonstrated to decrease lipogenesis in adipose cells in in vitro cell culture studies. In contrast, topiramate (a sulfamate moiety) appears to inhibit specific (CA) enzymes II and V. Four placebo-controlled trials with topiramate have demonstrated positive results in weight loss. There is only anecdotal evidence that AZD may cause weight loss. The following case is of a 49-year-old African-American woman with a long history of schizoaffective disorder, hypertension, diabetes type II, stress incontinence, and obesity (body mass index, 45.5 kg/m2). Previous trials of topiramate demonstrated temporary but significant weight loss before AZD use. A 4 week washout period occurred before starting AZD, 250 mg twice daily. Significant weight loss of 11.5 lbs was seen over 4 weeks. During washout periods of either topiramate or AZD, her total mean weight was approximately 2 to 7 lbs higher than when she was treated with AZD. Although tolerance and side effects may limit the use of AZD as a safe and effective strategy for medication-related weight gain, the pharmacology may provide research insights into the causes and treatments of obesity.
乙酰唑胺（AZD），一种类似磺胺的部分，是碳酸酐酶（CA）酶的强效非特异性抑制剂，并且在体外细胞培养研究中已被证明可减少脂肪细胞中的脂肪生成。相比之下，托吡酯（一种氨基磺酸酯部分）似乎抑制特定的（CA）酶II和V。四项托吡酯的安慰剂对照试验已证明在体重减轻方面有积极结果。仅有轶事证据表明AZD可能导致体重减轻。以下病例是一位49岁的非裔美国女性，有精神分裂症性情感障碍、高血压、II型糖尿病、压力性尿失禁和肥胖症（体重指数，45.5kg/m²）的长期病史。先前托吡酯试验表明在使用AZD之前有暂时但显著的体重减轻。在开始每日两次服用250mg AZD之前有4周的洗脱期。在4周内体重显著减轻了11.5磅。在托吡酯或AZD的洗脱期，她的总体平均体重比接受AZD治疗时高约2至7磅。尽管耐受性和副作用可能限制将AZD用作药物相关体重增加的安全有效策略，但药理学可能为肥胖症的病因和治疗提供研究见解。
