Azosemide, a sulfonamide loop diuretic, has been investigated in vitro as inhibitor of human Carbonic Anhydrases (hCAs, EC 4.2.1.1). The inhibition profile shows the same high potency as the structural analog loop diuretic furosemide towards the most abundant isoforms hCA I and hCA II. On the other hand, replacement of the carboxylic group of furosemide with the tetrazole bioisostere in azosemide leads to important differences in activity for other isoforms such as hCA XII and in particular against hCA IV and XIV, thus explaining possible differences of potency in vivo. The higher inhibitory potency of azosemide compared to furosemide and bumetamide against hCA VII might also explain its efficacy in the management of epilepsy. By means of X-ray crystallographic studies we elucidated the binding mode of azosemide to hCA I and hCA II, which is rather different from that of furosemide when considering the thienylmethylamino and furanylmethylamino fragments present in the two diuretics.