July 13, 2012
Preventing Acute Mountain Sickness With Acetazolamide
Although acetazolamide is widely prescribed to prevent and treat acute mountain sickness (AMS), the appropriate dose at which it is effective and safe has not been clearly defined. A comprehensive review and meta-analysis of 24 studies comparing the efficacy and risks associated with increasing doses of acetazolamide is published in High Altitude Medicine & Biology, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers (http://www.liebertpub.com). The article is available free online at the High Altitude Medicine & Biology (http://www.liebertpub.com/ham) website.
Bengt Kayser and colleagues, University of Geneva, Switzerland, reviewed the data compiled on more than 1,000 subjects and describe the relationship between efficacy in preventing and treating AMS, risk of side effects, and increasing drug dosages. They discuss their findings in the article "Reappraisal of Acetazolamide for the Prevention of Acute Mountain Sickness: A Systematic Review and Meta-Analysis (http://online.liebertpub.com/doi/full/10.1089/ham.2011.1084)."
Unless the baseline risk of AMS is high, as with rapid transport to high altitude (as opposed to a slow ascent), acetazolamide has limited effectiveness. Some side effects occur with even the lowest doses of the drug, whereas others appear to be dose-dependent. The authors suggest that treatment be tailored for the individual depending on AMS risk and acceptability of the most common side effects such as increased urination, numbness and tingling, and taste disturbance.
"This is a valuable contribution on the pros and cons of using the most important medication for preventing and treating acute mountain sickness," says John B. West, MD, PhD, Editor-in-Chief of High Altitude Medicine & Biology and Professor of Medicine at the University of California, San Diego School of Medicine.
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