Diamox

[backpackerchick]

Any bad experiences?

[Lori P]

If you're allergic to sulfa antibiotics like me, then you would probably have a bad experience. I have never tried Diamox and never will.

[Kimberly Wersal]

I've taken it numerous times with no problem- and it does help. If I hike at over 13,000 feet for more than an hour or two I get killer headaches/nausea, which kind of spoils the fun. The Diamox saves me the misery.

[backpackerchick]

Yeah Lori, that's an excellent point. If you get anything more than just a rash from sulfa drugs, Diamox probably might not a good idea. I think I get a bit of photosensitivity from Celebrex — another sulfa drug. I will keep this in mind.

Had it around for years, just never bothered. Mechanisms involved are very intriguing. Think I will finally mess with it this winter — ski trip to a resort or something — controlled setting. Interested in going to some more serious elevations eventually and would like to see how it effects me.

[Brian Barnes]

I've used Diamox when I'm ascending faster than i'd prefer. Definitely can cross react to those allergic to sulfonamides. Tolerated it ok, seemed to work, but consistently have some annoying paresthesias on my cheeks (ahem… facial cheeks) and bottom of my feet. Such ADRs are a fairly common complaint amongst our ICU patients.

You may enjoy this site. I've listen to Hackett speak at SCCM a year or so ago… neat guy http://www.altitudemedicine.org/

[Diane “Piper” Soini]

I get a rash from Sulfa drugs. I don't recall getting a rash from Diamox.

The bad thing about my experience with diamox was that I spent the money for it and it was not necessary. It also makes my fingers tingle.

[backpackerchick]

It's light on the sulfonomides. Not necessary? How does one know whether it affected the rate of acclimatization?

[Nate Meinzer]

Wow…this one keeps coming up.

I've taken it with great success. You certainly can't know for sure if it's helping you because you don't have an identical control of yourself along for the trip, Although, I've experienced altitude sickness regularly, and at even moderately low altitudes (7-9k ft), and was able to ascend from sea level to nearly 11000 feet in one day with not so much as a headache. I did have tingly hands, peed a bit more often. Also, soft drinks and beer tasted flat for a few days.

There are a lot of factors that contribute to AMS–hydration, rest, fitness, exertion, underlying illness–but Diamox can help you acclimate, and has been shown to reduce AMS in double-blind control studies.

It's important to say that if you have any symptoms of HAPE or HACE, Diamox won't do anything to cure that, and you should descend immediately and get medical attention.

Poke around on google and you can find a lot of information about it (percentage of people who suffer side effects, its effectiveness, etc.).

[Hikin’ Jim]

I took a wilderness first aid class 2 years ago. They said that one of Diamox's most helpful aspects was in preventing altitude related sleep disruption. I believe the "by the book" course is regular doses at a given interval. Per the WFA class, they said that taking diamox before bed was quite beneficial. I'm not a doc (not even close), so DO NOT take my word for it, but maybe the taking it at night thing is worth investigating.

I've also heard alka-seltzer has some amelioritve qualities WRT altitude, but that's completely anecdotal.

[backpackerchick]

Cialis is gaining a following. Dilates the pulmonary vessels as well as those other vessels.

[Laurence Beck]

Plus, it provides a handle with which to drag you out of the wilderness if a rescue is needed…

[Anonymous]

"They said that one of Diamox's most helpful aspects was in preventing altitude related sleep disruption. I believe the "by the book" course is regular doses at a given interval. Per the WFA class, they said that taking diamox before bed was quite beneficial. I'm not a doc (not even close), so DO NOT take my word for it, but maybe the taking it at night thing is worth investigating."

I know a doc who takes it regularly, at altitudes 18-20,000', for Cheyne Stokes Syndrome. He says it is very effective, something to do with retaining more CO2 in the blood. The hypothesis is based on the premise that CO2 buildup in the blood is what triggers the breathing reflex; When at high altitude, the partial pressure of CO2 in the atmosphere being less than that in the blood, there is a tendency for CO2 in the blood to flare off and drop to levels below that required to trigger the breathing reflex. The result is long delays between breaths which in turn triggers a series of gasps to make up for the oxygen deficit that ensues. I'm not a doc either, but his explanation makes sense to a layman.

Comments from any medical professionals would be appreciated.

[Anonymous]

"Plus, it provides a handle with which to drag you out of the wilderness if a rescue is needed…"

Assuming it takes longer than 4 hours to drag you out of the wilderness, your original injury is likely to be the least of your concerns. ;}

[backpackerchick]

Larry and Tom — LMAO.

Re: Diamox. Altitude –> hyperventilation –> blow off too much CO2 –> respiratory alkalosis.

Diamox works on the kidney to cause a metabolic acidosis. Theoretically, these processes should offset each other. Start a few days prior to ascent. Various dosing regimens. Not a large body of evidence. Also a mild diuretic. Not completely understood. Not a tx. Prophylaxis. Tx dex and down fast.

Bpl not phone friendly.

[Walter Carrington]

Interesting stuff.
A quick google yields:
http://en.wikipedia.org/wiki/Sildenafil has some references for the use of viagra for hypoxia and HAPE (High Altitude Pulmonary Edema).

http://www.annals.org/cgi/content/abstract/145/7/497
In this study they took 29 adults with previous HAPE from 490 meters to 4559 m (~15000 ft) in 24 hours, treating with placebo, diamox and tadafil (cialis). " High-altitude pulmonary edema developed in 7 of 9 participants receiving placebo and 1 of the remaining 8 participants receiving tadalafil but in none of the 10 participants receiving dexamethasone"
In particular note that 7 of 9 developed HAPE, which is life threatening!! Presumably there was ample medical care on site.

A link to a picture of the mountain:
http://www.melotti.net/ricordi_di_viaggio/capanna_margherita_2/capanna-margherita.jpg

[Roger Caffin]

> the premise that CO2 buildup in the blood is what triggers the breathing reflex;

I don't think that is a 'premise'; I believe it is a very well-established fact.
To bring people out of anaesthetic quickly they sometimes give them what is called 'carboxygen'.A high oxygen concentration, plus a solid dose of carbon dioxide. The breathing is strongly stimulated to flush the anaesthetic out of your bloodstream.

Cheers

[Tohru Ohnuki]

"Assuming it takes longer than 4 hours to drag you out of the wilderness, your original injury is likely to be the least of your concerns. ;}"

Won't take that long if you girth hitch it with a sling to the helicopter cable for short-haul…

[backpackerchick]

ALL study participants had PREVIOUS HAPE! That is extremely significant here — a very select group. I did a double take on this one. What? ONLY 15,000 ft and all these people with HAPE — but we already knew they were especially prone — that is why they were selected! In giving dex, they were sort of treating the problem before it occurred.

Prophylactic dexamethasone is becoming popular on very high altitude expeditions. If taken for an extended period of time, dex can have some significant consequences. Even when used briefly can cause agitation and insomnia among other things. Medex, a UK group, does a lot of work on the topic of high altitude physiology. You can download a free book on the topic from their site. Much of the physiology is not well understood.

[backpackerchick]

Don't believe Diamox causes CO2 retention (which would be a respiratory acidosis) but rather HCO3- and K+ wasting via the renal system. K+ loss is balanced by H+ retention. The result being higher H+ levels in the blood and thus a metabolic acidosis. The idea being to offset the expected respiratory alkalosis caused by CO2 loss via the lungs. Buffering. More based on theory than evidence. Can no doubt find LOTS of info re: acid-base physiology on the web.

Wonder how much of any beneficial effect is related to the diuretic effect of Diamox which after all is a diuretic.

[Diplomatic Mike]

Viagra has a valuable safety function when used on multi-day climbs. It can stop you rolling off narrow ledges on big face routes when you are sleeping.

[David Ure]

Mike – is this what I often hear as 'self arresting?'

[Diplomatic Mike]

"Mike – is this what I often hear as 'self arresting?'"

I believe it may result in an arrest Dave. :)

[Anonymous]

"Not a tx. Prophylaxis. Tx dex and down fast.Bpl not phone friendly."

Meaning?

[Anonymous]

"I don't think that is a 'premise'; I believe it is a very well-established fact."

That's what I suspected but I always use "premise", or its equivalent, if I'm not 100% certain. I've been burned a few times.

[Anonymous]

"Don't believe Diamox causes CO2 retention (which would be a respiratory acidosis) but rather HCO3".

Yup. I should have been more precise. CO2 in solution -> H2CO3 -> H + HCO3, although H2CO3 is a weak acid and does not completely dissociate, IIRC(it's been a long time now). I guess a follow on question would be whether all of the CO2 in the blood combines with H2O to form H2CO3. Anybody know?

[Author]

Posts