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geordie

Altitude drugs

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Hoping to head to bolivia this spring.

 

I've had some success with Diamox in the past (and some nasty AMS without it).

 

Wondering if people have had success with Viagra or other drugs/herbs?

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Geordie - I'm allergic to sulfa drugs, so can't take diamox to help acclimate. I've found that giving myself a couple more days to get used to altitude and drinking copious amounts of fluids (about 1.5 gallons a day during my Ecuador trip) worked for me. No AMS.

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Rumor is viagra is real good for altitude adjustment.

 

Diamox is useful I suppose if you take it as prescribed and drink a lot of water. My buddy was pissing up a storm a few days back after taking it so one could assume you have to hydrate a lot..

 

It is my understanding that diamox is more for adjusting to the current symptons and not necessarily made for making MS go away if you travel higher. But then again I was just listening to my good friend and never took any.

 

I am convinced that to thwart it best drink WAY more water than you want and eat a lot - or more than you think at elevations above 12k.

 

 

Latah

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The traditional dose of acetazolamide has been 250 mg b.i.d. More recently, some doctors have been recommending 125 mg b.i.d. Supposedly, it works almost as well at that dose with fewer side effects, such as metallic taste, tingling in the fingers, and of course, diuresis. At this dose it makes sleeping much easier for me on Rainier.

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There is data to support that 125mg twice daily is equally effective as 250mg or more.

 

Diamox is both a prophylactic as well as a treatment for AMS and cerebral edema.

 

Diamox speeds acclimatization and can be stopped without worry for rebound. Dexamethazone (Decadron) however does not and therefore if started for AMS/cerebral edema at altitude you should not stop it until you are back at lower altitude.

 

The only treatments for pulmonary edema are descent, supplemental oxygen, or nifedipine. Why they chose to treat edema with "dex" in Vertical Limit I cannot explain, but it is completely wrong just the same.

 

If you don't know what you are doing with nifedipine you could easily kill yourself.

 

Your best bet is to take it slow. Spend 3-4 days in La Paz at ~11,000 feet. Then go to Condoriri base camp at ~15,000 for another 3-4 days. Ilusioncita at a little over 16,000 feet is a good first climb to test your acclimatization. The weather in Bolivia is very good and stable, so don't let your Washington instincts to not let good weather pass by. If you push it you may be very sorry.

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Here is a nice meta-analysis on the topic; it compares the data from a few dozen different trials. (if that link doesn't work, try this one.)

 

Regarding daily dosage for acetazolamide (trade name=Diamox), their analysis indicated that 250mg or 500mg per day is ineffective:

 

"Acetazolamide was tested in nine trials with exposure above 4000 m (mean 4478 m (range 4000-5356 m)) and acute mountain sickness as an end point. Across all ascent rates, acetazolamide 750 mg was more efficacious than placebo (NNT 2-3). Acetazolamide 500 mg was not significantly different from placebo (NNT 7) (table 2).

 

A recent article in the Lancet, however, addressed this point:

 

"In one systematic review, acetazolamide was judged ineffective as a prophylactic at daily doses lower than 750 mg. [71] This claim runs contrary to clinical experience, and probably reflects the strict criteria for inclusion of studies in the review, and the fact that studies with different ascent rates were compared. Trials directly comparing different doses of acetazolamide in people at similar rates of ascent are needed to clarify this issue."

 

This same article also addressed the limited research that has been done on Gingko:

 

"Preliminary evidence shows that Gingko biloba has some prophylactic activity against AMS. During an ascent from 1800 m to 5200 m over 10 days, no person taking gingko extract at a dose of 80 mg twice daily experienced AMS, compared with 41% of people taking placebo.[77] Gingko 120 mg twice daily taken for 5 days before exposure reduced the incidence and severity of AMS during ascent from 1400 m to 4300 m over 2 h. [78] In a third study, gingko 60 mg three times daily, started 1 day before rapid ascent from sea level to 4205 m, compared with placebo, reduced the severity but not rate of AMS. [79] By contrast, gingko was no better than placebo in preventing AMS in trekkers ascending from 4248 m (BB, unpublished data). Gingko's effects may be due to its antioxidant activity. This concept is supported by data suggesting that ingestion of antioxidant vitamins may reduce the incidence and severity of AMS."

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There is data to support that 125mg twice daily is equally effective as 250mg or more.

These results are for a group of people. Individual results can vary. I started off taking 125mg twice a day, which helps, but doesn't prevent AMS. 250 mg twice a day is more effective for me.

 

The individual needs to figure out what works best for them, and starting off at the 125mg dosage is reasonable.

 

One advantage of Diamox over Viagra is that it is much cheaper. Also your tentmate might prefer you peeing in the bottle at night.

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Coca leaf tea is nice for relieving headaches and nausea. I doubt you will find medical studies about it though. It's easy to get in South America. Maybe if you have to pee in a cup for your job you should avoid it though.

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-I've used Ginkgo before, started taking it two weeks before leaving for Denali and kept taking it while on the mountain. Figured that it couldn't hurt giving it a shot, and I didn't need diamox while I was climbing so maybe it helped.

here's a link showing a study that was done:

http://www.high-altitude-medicine.com/hot-topics.html

 

I also took ginkgo before going to Denali and did not have any AMS problems. Anecdotal, but that's two of us. One of my partners got AMS at 14K and took Diamox and was fit-as-a-fiddle within 12hrs. However, I think he was taking Ginkgo too, so I guess it didn't work for him.

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I'v ebeen on two trips to Alaska and one trip to Ecuador. I did not take any altitude meds on those trips and encountered no problems with altitude.

 

On the other hand, during a winter attempt on the Gibralter Ledges I had a mild case of pulmonary edema.

 

As Caveman pointed out above, proper hydration (to the point of being overly-hydrated) is the key. This is based on personal experience though and may not translate to others.

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The traditional dose of acetazolamide has been 250 mg b.i.d. More recently, some doctors have been recommending 125 mg b.i.d. Supposedly, it works almost as well at that dose with fewer side effects, such as metallic taste, tingling in the fingers, and of course, diuresis. At this dose it makes sleeping much easier for me on Rainier.

 

mushsmile.gif Drugs are aid. Except... bigdrink.gif

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Personal experience and professional (MD) suggested amount of 60 mg. from a high altitude medicine conference held in CO last week.

 

Good book on the subject is Charles Houston, Going Higher- Oxygen, Man and Mountains. Covers all dat shite.

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I used it on Denali. There were three of us. I used Ginko, the others used nothing. One got HAPE at 17000 which we reached in 9 days. The other guy and I were feeling fine. Because of a long list of problems, we bailed so I don't know if I would have been fine on a sustained basis. But I certainly did better than an east Indian who had been at 22K the year before without problems.

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try ginkgo, and if it works, great. Try viagra, and if it works, everyone else will know it.

 

But it would be a good idea to take some diamox along. The thing that bugs me the most at altitude is periodic breathing during sleep when I ascend quickly to a new altitute. This is common in places like Ecuador and Bolivia where you can fly high and drive even higher. Periodic breathing means your blood is becoming alkalotic (your blood pH is too high). Diamox is a carbonic anhydrase inhibitor. It induces acidosis, and indirectly causes you to pee a lot more (you are pissing out loads of bicarbonate) and breath a lot more (you are breathing out CO2). I take Diamox at my first night at a new altitude if I suspect that it is going to be a difficult night of sleep. Periodic breathing sucks, and if you are sharing a tent with someone, they won't be able to sleep either. Take 125mg an hour before bed (or even in the middle of the night if you are getting frustrated) and it will last about 8-12 hours - long enough to get you through the night and into your excercise regime for the next day.

Diamox is a diuretic, so take a pee bottle in your tent. And drink a ton! Avoid caffeinated beverages if you can. Drink over a gallon a day if you can. More if you are excercising. Drinking fluids is by far the best prevention and treatment for AMS besides carefully moderated ascent and rest. Enjoy Bolivia! Cruise to Isla del sol for a couple of days to acclimatize, or take your rock shoes and go cragging at that chossy crag near Zona Sur. It's less than 10,000 feet there.

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Last year I couldn't sleep a wink in Muir Hut, so finally at 2 am I took a Diamox and was sound asleep within 10 minutes.

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