Question re: Diamox

[jaydub624]

Has anyone taken Diamox before going from sea level to high elevation in the matter of a day or two (14K+)? Does it help? Do you need a prescription to get Diamox?

 

I am asking in the context of someone taking it proactively to help with acclimatization rather than someone battling altitude sickness.

 

Thanks for any advice.

[Drederek]

yep it helped me and yes you do need a scrip.

[MarkMcJizzy]

yep it helped me and yes you do need a scrip.

 

Ditto

[ivan]

from experience though, its shockingly easy to get the scrip, plus a wealth of other expedition drugs (including morphine!)

[wayne]

2nd the "it helped me" add, "many times" to it.

[jaydub624]

Thanks for all the endorsements. I'm definitely going to try to get some Diamox before I leave this weekend. I just moved to Seattle so I don't have a primary care doc (or any doc for that matter). Any referrals on a Seattle doc who treats climbers well or is a climber himself who I can see to get the scrip?

[Bug]

The key is proactive use. Much more effective that way.

If you cannot get it that quickly, some people find that Ginka biloba works. Again, proactive use is most effective.

[Le Piston]

One cautionary note. It is an osmotic diuretic, so it is important to stay up on the hydration (you piss like the proverbial racehorse) and can cause blurry vision (as I experienced once or twice) It isn't a total replacement for acclimatization...but can help. There are other herbal supplements that have shown to be helpful (Ginko, etc)

[catbirdseat]

Also, you should know that you have a choice of dosages. The long standing preferred dose has been 250 mg twice a day, but studies have shown that 125 mg twice a day is also effective.

 

Why would you want to take less? -possibly fewer side-effects. The side effects include water loss as mentioned and also tingling in the finger tips and, curiously, you'll get a metallic taste in your mouth if you drink anything carbonated.

[ivan]

it feels like heresy coming from me, but might i suggest simply skipping the drugs? i didn't need/use them on denali (well, at least not diamox ) and if you're just trying to use them as a crutch and skipping acclimatizing, you're creating a potentially dangerous siutation for yourself.

[iluka]

A few bits on information regarding information/points made in this thread:

 

1) Diamox is not an "osmotic" diuretic. It is a diuretic but it is not working by affecting osmotic forces. It causes bicarbonate diuresis in the kidney. It's diuretic effects are not as powerful as lasix but staying hydrated while taking it is important.

 

2) Don't rely on Ginkgo Biloba. While a few studies have shown it may work vs. AMS, several other studies have shown it is no better than placebo for this purpose. There is no consensus in the research literature. The likely problem is that, not being an FDA-regulated product, when you buy Ginkgo at the store, you have no idea if you're getting the real deal or junk

 

3) Standard prophylactic doses for diamox: 125 mg or 250 mg twice a day

 

4) Rather than relying on acetazolamide (diamox) to go to 14K in a day, perhaps not unreasonable to change the ascent plans, going with a slower ascent profile. Even if you take diamox, you can still get sick from the altitude if you go too high, too fast.

[Off_White]

Finding out that all you guys use Diamox is akin to uncovering rampant Viagra usage.

[KaskadskyjKozak]

 

Diamox is aid.

[catbirdseat]

Finding out that all you guys use Diamox is akin to uncovering rampant Viagra usage.

Well, it just so happens that Viagra is also supposed to aid performance at altitude, so the comparison is most appropriate (or was it deliberate?).

[Pete_H]

Mountain Goats watch out!

[sobo]

Finding out that all you guys use Diamox is akin to uncovering rampant Viagra usage.

What, doesn't everyone?

 

ooops...

[Coldfinger]

Just remember that diamox is best while you are acclimatizing AND gaining altitude, many folks discontinue once a reasonable acclimatization period and after you have arrived at a target elevation.

[mneagle]

A few bits on information regarding information/points made in this thread:

 

1) Diamox is not an "osmotic" diuretic. It is a diuretic but it is not working by affecting osmotic forces. It causes bicarbonate diuresis in the kidney. It's diuretic effects are not as powerful as lasix but staying hydrated while taking it is important.

 

2) Don't rely on Ginkgo Biloba. While a few studies have shown it may work vs. AMS, several other studies have shown it is no better than placebo for this purpose. There is no consensus in the research literature. The likely problem is that, not being an FDA-regulated product, when you buy Ginkgo at the store, you have no idea if you're getting the real deal or junk

 

3) Standard prophylactic doses for diamox: 125 mg or 250 mg twice a day

 

4) Rather than relying on acetazolamide (diamox) to go to 14K in a day, perhaps not unreasonable to change the ascent plans, going with a slower ascent profile. Even if you take diamox, you can still get sick from the altitude if you go too high, too fast.

 

 

Andy, you beat me to the punch again. I will add a couple of things and an anecdote:

 

1) Diamox has a sulfa component, so don't use it if you are allergic to sulfa drugs.

 

2) It will make all carbonated beverages taste flat, which is a disappointment while enjoying your celebratory base camp brew.

 

 

Story: Although Diamox does have some evidense concerning prevention of HAPE, on my last trip to Bolivia I developed HAPE despite being on it. We flew into 12,000 feet, went to 15,000 foot base camp 2 days later and then went to 17,000 on recon the next day. The next morning I couldn't walk more than 15 feet without taking a knee and had audible crackles and blue fingers. After a few days at Lake Titicaca I healed up and we ended up summiting 3 more peaks without too much difficulty (including Sajama at ~21,500 feet). The morale to the story is that Diamox and youthful enthusiasm are no substitute for acclimatization.

[Le Piston]

A few bits on information regarding information/points made in this thread:

 

1) Diamox is not an "osmotic" diuretic. It is a diuretic but it is not working by affecting osmotic forces. It causes bicarbonate diuresis in the kidney. It's diuretic effects are not as powerful as lasix but staying hydrated while taking it is important.

 

2) Don't rely on Ginkgo Biloba. While a few studies have shown it may work vs. AMS, several other studies have shown it is no better than placebo for this purpose. There is no consensus in the research literature. The likely problem is that, not being an FDA-regulated product, when you buy Ginkgo at the store, you have no idea if you're getting the real deal or junk

 

3) Standard prophylactic doses for diamox: 125 mg or 250 mg twice a day

 

4) Rather than relying on acetazolamide (diamox) to go to 14K in a day, perhaps not unreasonable to change the ascent plans, going with a slower ascent profile. Even if you take diamox, you can still get sick from the altitude if you go too high, too fast.

Thank you for the correction...but I guess talking about Carbonic Anhydrase inhibition wouldn't interest most people, but you are correct. I echo your point about acclimatizing...it is safer and better to take your time and do it right (besides usually more enjoyable)

[thoth]

Diamox isn't a HAPE drug, try Nifedipine, oxygen, descent, Gamow bag, etc.

 

Gingko - garbage, but a great product for snake oil salesmen, look here - http://nccam.nih.gov/health/ginkgo/ (a generically good site for real data on alternative medicine)

 

Diamox- helped me tremendously when it came to being able to sleep above 15k, the tingling and carbonation side effects were well worth it.

 

+1 on the taking longer to go higher suggestion, if you get sick your trip is probably over.

Edited June 17, 2009 by thoth

[iluka]

The story with Diamox and HAPE is a bit more involved than what's come across in some of the previous posts.

 

Diamox was never thought to play a role in HAPE prevention or treatment. In the past several years, however, there have been some studies in animals showing that diamox can block the rise in pulmonary artery pressures that occurs with exposure to hypoxia. Since it is a marked rise in pulmonary artery pressure that leads to HAPE in susceptible individuals, one possible conclusion from these studies was that it might be useful for preventing HAPE in humans.

 

The studies done in humans looking at this question have not provided any good support for the hypothesis yet. One study showed a small effect on pulmonary artery pressure at altitude but the clinical significance of that change is unclear. Another study from Nepal showed no benefit in preventing HAPE but it was such a poorly designed study that it is basically of no use at all on this question.

 

Interesting, there is a phenomenon known as "reentry HAPE" in which some people (often kids) who live at high altitude in Colorado travel to a lower altitude for a bit then develop HAPE following a rapid trip back to their home town. Anecdotally, some physicians have used diamox in these kids during their reascent to home and it has prevented further occurrences of the problem. This has never been formally studied.

 

In the end, the jury is still out on whether Diamox has a role in HAPE prevention Nifedipine remains the standard preventive medication for use in people with a prior history of the problem who are going back up to high altitude. Tadalafil (cialis) and sildenafil (viagra) are probably effective as well (but may have other unintended effects on intra-team dynamics in basecamp... )

[Dechristo]

Finding out that all you guys use Diamox is akin to uncovering rampant Viagra usage.

Well, it just so happens that Viagra is also supposed to aid performance at altitude, so the comparison is most appropriate (or was it deliberate?).

 

Effective in self-arrest when sliding head first. Well, I guess every situation would be head first.

[mneagle]

The story with Diamox and HAPE is a bit more involved than what's come across in some of the previous posts.

 

Diamox was never thought to play a role in HAPE prevention or treatment. In the past several years, however, there have been some studies in animals showing that diamox can block the rise in pulmonary artery pressures that occurs with exposure to hypoxia. Since it is a marked rise in pulmonary artery pressure that leads to HAPE in susceptible individuals, one possible conclusion from these studies was that it might be useful for preventing HAPE in humans.

 

The studies done in humans looking at this question have not provided any good support for the hypothesis yet. One study showed a small effect on pulmonary artery pressure at altitude but the clinical significance of that change is unclear. Another study from Nepal showed no benefit in preventing HAPE but it was such a poorly designed study that it is basically of no use at all on this question.

 

Interesting, there is a phenomenon known as "reentry HAPE" in which some people (often kids) who live at high altitude in Colorado travel to a lower altitude for a bit then develop HAPE following a rapid trip back to their home town. Anecdotally, some physicians have used diamox in these kids during their reascent to home and it has prevented further occurrences of the problem. This has never been formally studied.

 

In the end, the jury is still out on whether Diamox has a role in HAPE prevention Nifedipine remains the standard preventive medication for use in people with a prior history of the problem who are going back up to high altitude. Tadalafil (cialis) and sildenafil (viagra) are probably effective as well (but may have other unintended effects on intra-team dynamics in basecamp... )

 

When I had my HAPE experience, I had nifedipine with me but I was nervous about dropping my blood pressure, as I was pretty volume depleted from nausea. I was also in denial (see below). Instead I used an albuterol inhaler and it really helped. I wasn't too surprised when that NEJM article was published about HAPE prevention with salmeterol. I've only taken care of 2 people with HAPE in Colorado so far but both were mid-westerners who came down from Estes Park and Summit County on ventilators. They both wanted to know how to prevent problems on future trips and I recommended salmeterol, Diamox and not being stupid (emphasizing the not being stupid part, of course).

 

An important aside:

Perhaps the most interesting (and troubling) aspect of the experience was my degree of denial. I could barely walk but I still had my crampons on and tried to make the climb with my partners. It was pretty apparent to everyone else how bad things were before I was able to admit I didn't just have some mild bronchitis (and I'm supposed to be the lung doctor). Colin Grissom told me a similar story on the Cassin Ridge of Denali. Basically, the same thing happened except the denial was shared by everyone in the party. Everyone kept taking gear from the sick guy and just kept going. It wasn't until the guy was gearless and turning blue that they admitted the obvious and got the hell out of there. Were these cases of thin air affecting judgement, recklessness or summit fever? It's hard to say, but I definitely learned something about myself that trip and I have to believe I wouldn't make the same mistake again...or would I?

 

Forget the drugs and this whole discussion...we should all just pick up golf.

[Off_White]

Finding out that all you guys use Diamox is akin to uncovering rampant Viagra usage.

Well, it just so happens that Viagra is also supposed to aid performance at altitude, so the comparison is most appropriate (or was it deliberate?).

 

Effective in self-arrest when sliding head first. Well, I guess every situation would be head first.

 

OMG, you guys should chill and just drop it, or Porter's going to scold me for spraying.