Carbonic anhydrase inhibitors: “Old” drugs with new potential in unexpected areas

Abstract

Claudiu T. Supuran (2025) provides an in-depth examination of the intricate and diverse pharmacologic functions of carbonic anhydrase (CA) inhibitors (CAIs). CAs have been recognized for several decades and are highly abundant in vertebrates and many other organisms, and theirinhibitors have been a staplein both pharmacology and clinicalmedicine for a long time (Berliner and Orloff,1956;Maren, 1967). In particular, acetazolamide, the CAI par excellence, was the first modern diuretic to be introduced clinically in 1954 and was also the lead molecule that afforded the development of many classes of diuretics like thiazides, thiazide-like agents (indapamide, chlorthalidone, quinethazone, metholazone, etc) and high-ceiling diuretics, all of which are widely used by millions of patients worldwide (Maren, 1967; Tsikas, 2024). Despite being perceived as outdated and poorly effective, recent studies demonstrate the usefulness of acetazolamide in combinationwith loop diuretics in patients with acute heart failure (Milbradt et al, 2024). These and other novel findings related to CAIs are discussed in Supuran’s piece (2025).