Worked well for me going from sea level to Wheeler's summit in less than 24 hours.
Next time around I woke up early, took it on an empty stomach, had some cheap Dunkin' Donuts "breakfast" and boarded an early morning flight to Phoenix - on which I almost passed out. Figured it had to be the Diamox and haven't gone back to it since. My doc thought that was a good idea (the staying away from it part).
Your results may vary, I'm not a doctor, yaddyadya.
I've been to higher altitudes many times but have only used it a few times. The latest was just last week. Since I have had severe food poisioning from the Houston Airport for three days I missed all our acclimatization climbs except for one, so I took Diamox before climbing Cotopaxi as a preventative measure.
Personally I don't like the side effects. It makes you tingle as if your hands or feet are asleep and also makes you pee a lot. Sicne I already have a small bladder that side effect is not pleasant.
If you don't have to use it, I wouldn't, but I would always take some along. It is both a preventative and a treatment just in case. It should never be used to ascend to a higher altitude if you already have AMS.
Where did the food poisoning come from? Ugh! I've had endless problems with GI bugs, presumably from contaminated food or drink, in many 3d World countries (as well as Corsica) despite taking the usual precautions--for a start, they don't have screens just those plastic tubes hanging in the doors, so you can't keep the damned flies off your food--but I wouldn't have expected it at IAH. (oddly, I had very few problems in Egypt, Tunisia or Peru, while I had gastroenteritis every 3 days in Turkey or Morocco).
Used diamox a few times climbing, usually only on peaks that are substantially higher than 14,000', and with colder tempatures in the minus number. I have only once taken the fully perscript dose, with a slight tingling of the lips and fingers. Since then I found that taking a half or a quarter dose above 14,000' and usually only at night (it helps me sleep better). then on summit morning I'll take another half. With the lower doses I have never had any tingling from the diamox, I was afraid with the full dose that I wouldn't be able to tell the differents between cold and the effects of the diamox.
On climbing 14,000' I have gotten hit ill acouple time. I was living at sea level and the next day or the following day be standing on top. Over time I learned to super hydrate myself on the drive to the mountains the day before, and no I am not talking about BEER, to go high you need to be hydrated.
I have never used it. I do not consider it cheating. If it keeps you from getting AMS (or something worse) so you can enjoy a big mountain, use it. We all have spent alot of time and $ to climb/hike. I'd hate for somebody to get sick and not be able to enjoy a trip b/c they felt like it was "cheating". Go hike and enjoy. ps, I have been accused of being a dr.
"Diamox is NOT a preventive medication. It only works to treat AMS, not to prevent its occurrence."
Actually this is not correct.
Diamox is both a preventative and a treatment. Diamox works because it stimulates breathing and prevents hypopoxemia during sleep, thus is a preventative medication.
Notes: Although minor, as stated in my previous message, the side effects are unpleasant to some. It can help prevent altitude sickness, but it's better to go without medication if you can do so. Diamox should never be used to ascend higher if you alraedy have AMS.
I used it when I attempted Mount McKinley in 2003. Diamox is NOT a preventive medication. It only works to treat AMS, not to prevent its occurrence. If I were to attempt McKinley again, I would take some along "just in case." I don't consider it cheating in any sense of the word.
I was under the impression that Diamox was exactly that - preventative. You're supposed to start taking it several days before being exposed to altitude (says the guy who had a problem using it).
Isn't there another medication that's used as a treatment? Injection, I believe? Or have I watched "Vertical Limit" one too many times?
For AMS use some Phenergan, fluids, Ibuprofen; and if not better descend. For HAPE ( High Altitude Pulmonary Edema) and HACE (High Altitude Cerebral Edema) descent is treatment of choice. Injectible steroid (Dexamethasone) can be stopgap for HACE and Procardia for HAPE.
Have fun. Remember what Nancy Reagan said; "Hugs are better than drugs, but if you can't get a hug then drug away!"
Seems to be Diamox isn't something that was developed for AMS, but it's utility in that regard has been "discovered," and so now you can get a perscription for that purpose. So I guess that it wasn't developed to be a treatment or a prophylactic for AMS.
As with any medication, there are side effects that you may get. The bottle I got had three warnings:
1) May cause drowsiness or dizziness
2) This drug may impair the ability to drive or operate machinery. Use care until you become familiar with it's effects. (How about an ice ax?!?!)
3) You should avoid prolonged or excessive exposure to direct and/or artificial sunlight while taking this medication. (You mean like on a glacier?!?!)
For what it's worth, I'm glad I started taking it a couple of days before. I stuck to the regimen better the first time around (Wheeler) and had no problems - and it worked. Plus, if you start taking it down low and you have a problem, presumably you can stop taking it, recover and acclimatize the old fashioned way. I let a climbing partner do the driving from Phoenix to Flagstaff, but could easily have climbed the next day; the adverse effects had passed by then.
The drug for AMS or "la siroche" used to be Aldactone (spironolactone). Not sure if it was to be taken to prevent or treat it. My bottle carries warnings about "may cause dizziness" as well as "check with your physician before using salt substitutes" and possible stomach upsets (take snacks or a small meal). 25-mg tablets, take 1 every morning.
I was prescribed it as a diuretic; don't remember having any of these problems. It was stopped because my K+ (potassium) got too high; now I take Lasix (furosemide; don't confuse with the Lasik laser eye surgery) and they halved that to 10 mg each morning. Haven't tried Diamox and not sure what it does.
Aldactone (Spironalactone) is a Potassium sparing diuretic. Keeps you from pissing out so much Potassium.
Diamox (Acetazolamide) Carbonic Anhydrase inhibitor diuretic, makes you piss.
Lasix (Furosemide) Loop diuretic. Makes you piss alot. You lose Potassium.
Many times prescribe Aldactone in addition to Lasix to prevent Hypokalemia (low Potassium level in blood) Or use Potassium supplement.
Diamox helps by essentially stimulating breathing. This is a simple answer to a complex explanation involving partial pressures of O2, metabolic acidosis, the Loop of Henle, respiratory drive, central chemoreceptors, the carotid body, etc ad nauseum.
Although the Int Society Mountain Med does not recommend Diamox for AMS, I wonder who the "we" in the opening sentence of this statement (We do not recommend...)
In e-medicine Thomas Dietz MD of ISMM writes Diamox is, "Not indicated for general prophylaxis of AMS" but then later states
"Acetazolamide prophylaxis is indicated for persons with an unavoidable rapid ascent, such as flying in to a high city (eg, Lhasa, Tibet; La Paz, Bolivia), or with a past history of recurrent AMS."
In the CDC Yellow book for 2005-06 "Acetazolamide (Diamox) can prevent AMS when taken before ascent."
"Comparing acetazolamide with placebo, the authors report the following: “We found one systematic review (search date 1999, 9 RCTs, 295 people) and one subsequent RCT. The systematic review compared acetazolamide (500 mg or 750 mg daily) versus placebo at altitudes above 4000 metres.It found that acetazolamide significantly increased the proportion of people who remained free of acute mountain sickness compared with placebo (AR for freedom from acute mountain sickness: 67% of people with acetazolamide v 42% with placebo; RR 1.58, 95% CI 1.27 to 1.96; see comment below). The subsequent RCT (197 trekkers in Nepal) compared acetazolamide (125 mg twice daily) versus placebo at altitudes between 4243 and 4937 metres.It found that acetazolamide significantly reduced the incidence of acute mountain sickness compared with placebo (acute mountain sickness: 20/81 [25%] with placebo v 9/74 [12%] with acetazolamide; P = 0.043).”
I don't know what the right answer would be I guess it depends on one past experience and concern for future occurance. I guess the axiom about physicians would be appropriate here; Most opinions are like A**holes, everybody has one.
Although i am not a frequent high-altitude mountaineer, I take care of many and always ask them how things worked on their latest climbs.
With respect to Diamox, I have found the ismmed information to be most accurate, particulary with respect to using it "or persons on forced rapid ascents ". The largest benefit appears to be reduction of "periodic breathing" at night and the sleep disturbance caused by waking up gasping for air. Personally, I found this less disturbing than waking up to pee repeatedly. Also, hydration is hard enough at altitude and even more important to prevent symptoms of AMS and the rare events of venous thrombosis. One should decide for themselves on the trade-offs. I tend to recommend smaller doses (e.g 125mg at night) at first, with increases in porportion to overall altitude (particularly above 15,000') and speed of ascent.
Advil is frequently helpful for simple High Altitude Headache that is not related to AMS of HACE.
Viagra is now frequently used for treatment of pulmonary hypertension in hospitals and anecdotally for HAPE with good reports. It makes sense, since it is easier to dose than nifedipine, with less orthostatic symptoms. If you don't use it for medical needs, it may come in handy for "administrative good will" (a.k.a. bribes) in some foreign countries.
I am not a fan of Steroids at altitude for prophylaxis, as discussed in the following article:
I was the base camp physician for the 1999 National Geographic / North Face Everest expedition and remember sitting in the same tent with Ken Kamler and Pete Athans while helping treat a climber who took prophylactic "dex" on summit day. I wrote a letter in response to that article which appeared on page 18 in the October edition of National Geographic Adventure. My point was that taking "dex" as a preventive may reduce the effectiveness of it as a treatment. Additionally, it can "mess" with other medications one is taking or block the action of other important hormones, like thyroid hormone (whether you are taking it or making it).
Basically, the best ways to avoid grief at altitude are to ascend at a proper pace, hydrate well, treat small symptoms and wait before ascending so they don't become big ones. Anything you can do to prevent inflammation (before you have to treat it) in either the lungs or at the blood-brain barrier will be helpful. Some things that may prove helpful are:
-Omega-3 fatty acids (e.g. "fish oil")
-Maybe Ginkgo Biloba
Though I have yet to write it up, Singulair (a leukotriene inhibitor) was extremely helpful in cases of "Khumbu Cough" and I'm sure would have helped any HAPE victims, which I did not see at basecamp. I have also had considerable success with this medication in my climbers and athletes with asthma.
There is interest the use of Salmeterol, a.k.a. Serevent (a long-acting bronchodilator) at altitude, but I would be careful. There are several cases and lawsuits in progress concerning Serevent-related deaths. However, these are in asthmatics who may have O.D.'ed on the drug while trying to use it as a short-acting "rescue" inhaler. I do remember receiving an e-mail in 1998 from a Himalayan guide who found one of his clients dead in her tent with a Serevent inhaler by her head (she did not report having asthma in her medical form). Sadly, she was on the trek to scatter the ashes of her brother who had also died in the mountains. Use with caution, and only with the advice of a good physician.
My 0.02
Remember to take time to enjoy the ascent, and you will.
Thanks for that outstanding response Rich and thanks to everyone for all the great information and experiences. This certainly turned out to be an educational thread for me. As someone who lives near sea-level, I'm inclined to try out the Diamox and see how annoying the side effects actually are. The only "forced-ascent" here is me trying to get to 13 or 14K in two days instead of four. We'll see how it goes, we'll see how I like it and I won't take it on an airplane!!
Thanks for the responses so far. When I posted originally, I was thinking of it more as a preventative measure, but the below site (which at least seems credible) suggests that it can be used for both prevention and treatment:
The blurb on Diamox is toward the bottom. Anyway, it sounds like a good thing to have in either event. This year, it took me about 4 days to feel good out west (including a turn-around on Wheeler on Day 2). I'd love to cut that time in half. Vacation days are precious, ya know.
"Acetazolamide (Diamox) is the drug of choice for prophylaxis of AMS.... numerous dosage regimens have been effective Smaller doses (125-250 mg a day) started 24 hours before ascent work as well as higher doses started earlier. A 500 mg sustained action capsule of Diamox taken every 24 hors is probably equally effective and results in fewer side effects because of the lower peak serum level. Most authors recommend continuing for the first day or two at high altitude...."
source Wilderness Medicine by Paul Auerbach 4th edition.
I've never used. I have subcribed a few times and people seem to tolerate well. I have talked to hikers who have used without problems.
On Denali I felt great during the day but at 14K had Cheyne-Stokes breathing (like sleep apnea), which is apparently pretty common at altitude and not bad, but disconcerting and makes for a bad nights sleep. So I ended up using a low dose at night for sleep. Haven't felt the need in the lower 48. Getting started aclimatizing as soon as you can on your trip and staying well hydrated are important to help with altitude.
Coming from Michigan I usually get headaches and have trouble sleeping if I go above 8000-9000' the first day or so. I took Diomox on Denali in 1999, 500mg sustained release daily. I don't know if it helped or not , but it was my fourth time on the mountain trying for the summit so what the hell. You get thirsty and pee alot or was it just me hydrating and working hard at altitude?
I say try it, It may prevent symtoms if you are a flat lander. Usually I'm ok the longer I'm at altitude over 7 days and finally find my self feeling good about the time the trip is over.
(Sorry for the double post; my other one is out of place slightly).
"Diamox is NOT a preventive medication. It only works to treat AMS, not to prevent its occurrence."
Actually this is not correct.
Diamox is both a preventative and a treatment. Diamox works because it stimulates breathing and prevents hypopoxemia during sleep, thus is a preventative medication.
Notes: Although minor, as stated in my previous message, the side effects are unpleasant to some. It can help prevent altitude sickness, but it's better to go without medication if you can do so. Diamox should never be used to ascend higher if you alraedy have AMS.
I read somewhere that taking one or two aspirin seven to ten days before going to altitude will help you from getting headaches by thinning your blood a bit. I live at 250 ft and am prone to headaches the first couple of days above 6,000 ft. I took one aspirin a day for ten days before doing Kings Peak. I landed in Salt Lake in the afternoon, hiked to just below Gunsight Pass the next day, then on up to 13,528 the next morning with out ever having a headache. Made a believer out of me.
I used diamox on Kilimanjaro, 1/2 tablet at the 15,500 ft level for the summit day to 19,300. I ended up a bit dehydrated as it is a powerful diuretic, so if you use it, take an extra quart of water with you. I did summit so I suppose it did help, but I would probably not use it again. I had it with me 20 years ago on Denali but did not use it.
I suspect dehydration from your dose was a combination of Diamox and increased insensible loss from altitude. If you want powerful try an Edecrin drip. It will make a rock pee.
My wife and I climbed to the summit of Kili on February 11 of this year with 8 other climbers. Here are some interesting observations (at least to me):
1. Of the party of 10 climbers, 6 used Diamox (we did not, nor did two other women).
2. Those who did not use Diamox were generally stronger and healthier the entire climb, though we were also the most experienced hikers/climbers.
3. The 6 who used it came from Toronto, Ottawa, and Boston. Those who did not were from Denver and Lincoln, NE.
4. Those who did not use it suffered from headaches and mild sleep disturbances. Those who used it suffered nausea, loss of appetite, headaches, sleep disturbances, and low energy.
5. We all reached the summit, though the 4 who did not use it had an easier time of it.
All I can surmise from this is that experience appears to count for a lot more than medication. I suppose one can say that since those who used Diamox had a rough time of it, they may not have reached the summit without it. Then again, they were peeing so much from it that I wonder if hydration was an issue.
Thanks for sharing. Interesting facts but there are too many confounding variables to draw any conclusions; age, health status (ie: cardiac, kidney, and lung function, previous illnesses), current medications, +/- experience, physical conditioning, +/- baseline living altitude. Glad you may it.
I used Diamox last year while hiking up Kilimanjaro. Took it for 2-3 days, got annoyed at the many nighttime pees and STOPPED taking it (at 12,000 feet). I got altitude sickness above Kibo at 17,000 during summit attempt and had to descend. Although there are many factors here, medical friends have concluded that starting AND then stopping Diamox at altitude was much worse on me than if I had never started.
Until the summit attempt I was feeling strong, eating well and drinking plenty of water (and Cytomax).
When planning for Whitney, I asked my doctor for Diamox scrip and he freaked over my intentions. "You can't do that!" he said - climb to 14K+ feet, that is. I assured him that, yes, I could and he relented. Once in Lone Pine I asked the local drug store pharmacist for his input. He said the side effects could surpass the actual effects of altitude (so how would you know the difference?). I decide to forego using the stuff but chose aspirin instead. Though mushrooms, reishi in particular, are supposedly a good thing, I never hear any talk of their use by high-up venturers.
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