Significant CNS effects (psychiatric symptoms, psychomotor slowing, fatigue, somnolence), may occur. May cause metabolic acidosis (predisposing conditions/therapies include renal disease, severe respiratory disease, diarrhea, surgery, ketogenic diet, and other medications). Pediatric patients may also be at increased risk and may have more severe metabolic acidosis. Discontinue therapy in patients who develop acute renal failure or significant sustained increase in creatinine/BUN concentration (kidney stones reported). Rare, but potentially fatal sulfonamide reactions (including Stevens-Johnson syndrome and toxic epidermal necrolysis) occurred following use. Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in sulfonamide allergy contraindicated (risk of cross-reaction). Use with caution in hepatic and renal impairment. Effects with other sedative drugs or ethanol may be potentiated. Decreased sweating (oligohidrosis) and hyperthermia requiring hospitalization reported in children. Anticonvulsants should not be discontinued abruptly.