Acetazolamide and thiamine combination lowers cortisol

[haidut]

Human study in mental health patients. It looks like the drugs in combination have properties that neither one has alone.

http://www.invenzone.com/research_paper ... -423699970

"...Several recent reports indicate that A + T administration may be beneficial for schizophrenia and tardive
dyskinesia, and also lowers blood cholesterol. As thiamine (T) alone lacks these actions, it is important to
see if they are due to A alone. The differential effects of placebo (P), A + P, and A + T on blood cortisol
we~ ~ determined on normal males as cortisol is synthesized from freshly synthesized cholesterol, has a
shc:~ half-life in plasma, and is accurately measurable. All nine healthy subjects had 9 AM and noon blood
cortisol levels determined on each of 3 days 1 week apart. Immediately after the AM phlebotomy, they
received P alone, 750 mg A + P, or 750 mg A + 500 mg T, in a double-blind randomized order. There
were no significant differences in the pretreatment morning cortisols, or between the noon levels after P
alone or A+P. All showed a considerable decrease in cortisol after A +T administration (p < 0.01 by paired t test). It appears that the combination of A with T has properties not seen when they are administered separately."

 

[Mr Joe]

Hey @haidut, I thought you might want to have a read (that might explain why acetazolamide reduce cortisol) :

DEFINE_ME

. Major clinical states are associated with metabolic alkalosis, including vomiting, aldosterone or cortisol excess, licorice ingestion, chloruretic diuretics, excess calcium alkali ingestion, and genetic diseases such as Bartter syndrome, Gitelman syndrome, and cystic fibrosis.


"The other major category of metabolic alkalosis with increased mineralocorticoids encompasses patients with normal or expanded vascular volume such as in primary aldosteronism. The role of mineralocorticoid excess in the generation and or the maintenance of metabolic alkalosis in volume-depleted or volume-expanded states will be discussed in the following sections."

They mentionned that there might be a link between alkalosis and hypokalemia induced loss of potassium (another reason to increase orange juice when you are in that state, especially if you start acetazolamide for the electrolyts) :

"In brief, hypokalemia is a critical contributor to the worsening of metabolic alkalosis, specifically in volumedepleted states, by (1) enhancing ammoniagenesis in proximal tubule cells, leading to new HCO3 − generation; (2) increasing proximal tubular reabsorption of filtered HCO3 − ; (3) increasing HCO3 − generation and absorption in the collecting duct A-intercalated cells; and (4) decreasing HCO3 − secretion in the collecting duct B-intercalated cells."

One thing I couldn't understand is : "These factors include volume contraction, low glomerular filtration rate, potassium deficiency, hypochloremia, aldosterone excess, and elevated arterial carbon dioxide."
How could elevated arterial CO2 could happen while alkalosis is a state of Low CO2 and hyperventilation.