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Acetazolamide + furosemide is a combination of two diuretic agents used together to enhance diuresis, particularly in cases of volume overload resistant to single-agent therapy. Acetazolamide is a carbonic anhydrase inhibitor that acts primarily in the proximal tubule, reducing bicarbonate reabsorption and promoting mild natriuresis and diuresis. Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the thick ascending limb of the loop of Henle, resulting in potent natriuresis and fluid loss. The combination leverages their complementary mechanisms to overcome diuretic resistance seen in conditions such as acute decompensated heart failure or nephrotic syndrome with volume overload[1][2][4]. Clinical studies (e.g., ADVOR trial) have shown that adding acetazolamide to standard furosemide therapy increases the rate of successful decongestion compared with furosemide alone[2][4]. This approach may be especially beneficial for patients with persistent congestion despite high-dose loop diuretics.
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