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Acetazolamide opens the muscular K  Ca 2+ channel: A novel mechanism of action that may explain the therapeutic effect of the drug in hypokalemic periodic paralysis

Acetazolamide is a thiazide derivative clinically used in skeletal muscle disorders related to altered K+ homeostasis such as the periodic paralyses. The mechanism of action responsible for the therapeutic effects of the drug is still unknown, however. In the present work, we investigated the mechanism of action of acetazolamide in the K–deficient diet rat, an animal model of human hypokalemic periodic paralysis (hypoPP). The in vivo administration of 2.8‐ and 5.6‐mg/kg−1/day−1 concentrations of acetazolamide to K–deficient diet rats prevented paralysis and depolarization of the fibers induced by insulin. In the acetazolamide‐treated animals, intense sarcolemma Ca2+‐activated K+ channel (K  Ca 2+ ) activity was recorded. Acetazolamide also restored the serum K+ levels to control values. The concentrations of acetazolamide needed to enhance the K  Ca 2+ current by 50% in vitro were 6.17 and 4.01 × 10−6 M at −60 and +30 mV of membrane potentials, respectively. In normokalemic animals, the thiazide derivative enhanced the K  Ca 2+ current with similar efficacy. Our data demonstrate that the therapeutic effects of acetazolamide in the K–deficient diet rats and possibly in human hypokalemic periodic paralysis patients can be mediated by activation of the K  Ca 2+ channel. Ann Neurol 2000;48:304–312