Diamox for Altitude Sickness?

“i think you will be ok. that first night at 6400 will be key. the ginko prolly won't hurt. make sure you get a formulation from a company you trust. a lot of these herbal companies skimp on the active ingredient. consumer report did a big article on this a while back.”

“Anyone happen to know what brands Consumer Reports liked, if any, in herbal meds?”

“anyone know how sunny did with the trip?

i did a lot of reading on ams and diamox. i thought i would share some of what i found.

the best link i found on the web was:

http://www.ismmed.org/np_altitude_tutorial.htm

sorry for all the cut and paste. i know you can read the web page for yourself... :) these were the bits i found most interesting.

The diagnosis of AMS is made when a headache, with any one or more of the following symptoms is present after a recent ascent above 2500 meters (8000 feet):

- Loss of appetite, nausea, or vomiting
- Fatigue or weakness
- Dizziness or light-headedness
- Difficulty sleeping

GOLDEN RULE I
If you feel unwell at altitude it is altitude illness until proven otherwise.

GOLDEN RULE II
Never ascend with symptoms of AMS.

GOLDEN RULE III
If you are getting worse (or have HACE or HAPE), go down at once.

There is a lot of mythology about acetazolamide [Diamox]:

MYTH: acetazolamide hides symptoms
Acetazolamide accelerates acclimatization. As acclimatization occurs, symptoms resolve, directly reflecting improving health. Acetazolamide does not cover up anything - if you are still sick, you will still have symptoms. If you feel well, you are well.

MYTH: acetazolamide will prevent AMS from worsening during ascent
Acetazolamide DOES NOT PROTECT AGAINST WORSENING AMS WITH CONTINUED ASCENT. It does not change Golden Rule II. Plenty of people have developed HAPE and HACE who believed this myth.

MYTH: acetazolamide will prevent AMS during rapid ascent
This is actually not a myth, but rather a misused partial truth. Acetazolamide does lessen the risk of AMS, that's why we recommend it for people on forced ascents. This protection is not absolute, however, and it is foolish to believe that a rapid ascent on acetazolamide is without serious risk. Even on acetazolamide, it is still possible to ascend so rapidly that when illness strikes, it may be sudden, severe, and possibly fatal.

MYTH: If acetazolamide is stopped, symptoms will worsen
There is no rebound effect. If acetazolamide is stopped, acclimatization slows down to your own intrinsic rate. If AMS is still present, it will take somewhat longer to resolve; if not - well, you don't need to accelerate acclimatization if you ARE acclimatized. You won't become ill simply by stopping acetazolamide.”

“I had great success with ditching the diamox and changing my diet. Went with high complex carbs and not as much protein, and started ginko biloba and ginseng 10 days before going out, also stayed very well hydrated. I only went on a 2 nighter, so the protein wasn't that important--but I guess on a longer hike it would be easier to acclimate before you really needed much protein. Now, I was only up at 8-9000 ft, but before I got sick on the same hike so I was really happy. Had not one symptom where before I had been by myself and had been really slowed down and was a bit worried at how weak and nauseous I got.”

“Did you have a headache on your last trip?”

“i only ask because i may give GB a try. it certainly can't hurt, although i would hardly call it a controlled experiment. i am just trying to get an idea of the before/after here.”

“I personally had a good experience taking Diamox and recommend it highly. Everyone reacts differently to all drugs so that's my disclaimer. There are a few odd side affects but at 15k ft who cares. It did a number on my taste buds but they returned to normal within a few days.”

“I had a headache, but it went away with ibuprofen. No headache this last time. Nausea and weakness are my most troubling symptoms. Diamox has worked some, but not a complete cure. It also makes my hands, feet, and mouth really tingly and it's distractng. I agree that acclimating is the best way, but next time I go from sea level to 8000+ in the same day I will be taking GB before hand, staying hydrated, eating high complexz carbs and not too much protein, AND bringing the Diamox in case, but won't automatically take it.”

“i bought some gb... i am taking 120mg 2x/day. is that the dosage you used?”

“i think it gives me a somewhat "warm" sensation when i take it. weird.”

“Yeah, the biggest drawback to Diamox I have found is that it makes beer taste like crap!

I was up at 8,500' over the weekend. Maybe a little lethargy (which could easily have just been being a little tired from the hike), but that was it. I was sucking wind some on the ascents.

Sunny, what's the deal with complex carbs vs. protein? Starting this weekend, I'm hopping from sea level up to 9,500' for one night and then the next day, going over a 12,000' pass, but then descending back to about 9K. Want to avoid getting sick at the top. Why would complex carbs help with this?”

“just stick to crappy beer.

on second thought life is too short to drink crappy beer.

i read once that someone asked an elite runner if beer was good for training. he replied, "only when the other guy is drinking it." lol!”

“Animal protein (that includes milk products) make your blood ph more acidic and you want it more alkaline--veggie protein and complex carbs increase the alkalinity.”

“hey sunny!

what dosage did you use for gb... :)”

“I used Nature's Way Ginkgo Standardized extract 60 mg with 24% ginkgo flavone glycosides and 6% terpene lactones (whatever they are!) It was priced middle of the road in the health food store I go to, and the label lookes comprable to the more expensive stuff as far as saying it was standardized and the pecentages and milligrams.”

“i got the same stuff. walgreens i bet?

...but what dosage did you take? 120mg/day? the studies i read said 120mg 2x/day. just wondering 'cause what's on the bottle and what might be good towards ams prevention might not be the same thing.”

“ok so here is my diamox story.

i started taking gb, 120mg 2x per day about a week before my trip. i was planning on bagging a 14er later in the week, so i needed to acclimate enough for a day of climbing to 14k.

... never did make it up that mountain. that's another story.

so i gave up the gb about two days before the trip because i am more a chemist than a botanist. i started taking acetazolamide (generic diamox) instead. 120 tablets cost me 10 bucks. i took a pill in the morning (125mg i think) and a pill in the evening... 12 hours apart basically... two days prior to the trip and the entire time i was in colorado.

first i had zero issues with altitude, but below 8000 feet that's expected.

the first two days i had a strange metallic taste in my mouth and i think my eyesight was slightly altered (for the worse). it was not a great feeling. by the second day i still had the same side effects. i had to pee a LOT. on the third day (in colorado) these had vanished and i was peeing about the same as usual.

i chose to take a dose at night when i went to bed because, as i understand, it works by causing your kidneys to excrete bicarbonate and since most of your acclimation is done when sleeping i figured this was the time to take the pill... also because i was sleeping i wouldn't be bothered with side effects (of which there were none by the third day).

what i DID experience were a series of migraine headaches. i suffered a massive headache last year when the trip had me go from the airport to a camp at 10k feet the same day. i didn't have my migraine medicine with me (imitrex) and lost a day of climbing as a result. well this time these were smaller headaches but i brought my meds with me... i took 4 doses during the course of the week... months supply in a week. so i am pretty confident these altitude changes are a trigger for my migraines.

thing is, the symptoms of a bad headache/migraine are very similar to AMS... bad frontal headache that does not go away when you drink water, nausea, sensitivity to light, lack of appetite, insomnia... so i think it would be very easy to confuse a migraine attack for AMS... but the golden rule is that unless you can prove it's not AMS then you have to assume it's AMS. so my not climbing last year and returning to a lower elevation was the right call.

the generic acetazolamide did NOT make beer taste funny nor did it give soda pop a metallic taste. it did give me a metallic taste in my mouth for the first two days i took it, but this went away by the third day.

obviously i don't know if acetazolamide worked for me or not since weather killed our plans to climb longs peak, but i did learn something about diamox and my reaction to migraines and altitude changes. while i didn't climb as high as last year, i come from 700 feet above sea level and went well about that during this trip. i felt a lot stronger a lot sooner taking acetazolamide and by the 5th day the approaches were a lot easier... not sure if that's the acetazolamide or just getting used to the rigors of extended activity.

i did wonder if the diamox triggered the migraine, but i didn't have one the two days prior to arriving in denver. also, denver has much drier air than illinois, so this might have been a trigger as well. who knows, but i have a huge bottle of generic diamox and plan to use it in the future.

anyway, good luck no matter what you decide to do!
last edited: 9/15/09 6:41:31 PM”

“I'd say next time stick with the ginko and skip the diamox.”

“I am happy to report I stayed between 10K and 12K on my most recent jaunt and had zero problems with altitude aside from some slight head pressure periodically and reduced thirst/hunger. When I felt headachey, it was usually the result of dehydration. Spending one night at 10K before starting the hike did wonders though I exhibited normal symptoms of being at altitude, such as shortness of breath when climbing. The high point was about 13K with no symptoms.”

“yeah. i suspect the last bad experience was just a migraine. i'll prolly skip the ginko as well. i'll just remember to never forget a good supply of my migraine medicine. still, in theory the acetazolamide should halve the time to acclimate and that in itself might make using it worthwhile. so we'll see. like i said, i had no real problems taking it other than some annoying effects the first two days.”

“Thats' the right prescription rosey.”