Diamox vs Ibprofin for AMS?

A) I'm impressed with your MD for knowing about these studies.

B) there seemed to be no significant difference between the groups (those who took IB and those who took Diamox) in terms of AMS and other symptoms of altitude sickness.

However, IB can have some relatively serious gastrointestinal side effects – so if you get those or if you have ulcers/history of ulcers than IB is not for you. On a trip to the Winds a few years ago several of my friends went this route but 1 had stomach troubles taking so much and another still had loss of appetite, headache and general malaise.

I can't take IB because of some other drugs I take, so I can't comment personally. But I am familiar with the study.

EDIT: here is the link to the most recent review article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4185145/

My wife and I both took Diamox before our first trip to the Andes in Peru. I stopped after a few days, because I didn't think it was doing anything for me. She continued, but also felt that her symptoms may have been due as much to the side-effects of Diamox as to any AMS.

So on our second trip to Peru, neither one of us took Diamox. Top elevation was 15,700, and we were fine. But we also acclimated and took the hiking slow and steady

Be aware that Ibuprofen is an NSAID, and that some people can have an allergic reaction to any NSAID. This reaction can range from swellings and rashes to going into toxic shock, with massive swelling of the airways and difficulties breathing. It can even be fatal if not handled quickly.

Also be aware that you can develop this sensitivity after safely taking NSAIDs for years.

Cheers

Jennifer- My hero. Thanks for the paper. I'm with ya on the gastro issues but based on your reminder I'll be sure to eat them with tortilla shells. And yes my doc is awesome. Out of the 30 plus old doctors on the practice webpage, she was the only one who listed an active sport (rock climbing) as her professional bio : ) Sold right there.

Paul- I've heard like 40-60% of people might not be affected by severe ams at that altitude. How long did you acclimate for? 15,700 sounds amazing though. Was it one of the volcanos? What was the name if you don't mind me asking? : )

Roger- Thanks for your replies as always appreciated. And thank you for the caution on allergies. I'm not anticipating this but if it does happen I'll be sure to discontinue to the AIs quickly. I could see that being counter intuitive for a swelling issue so thanks for mentioning.

Hey Jennifer: how'd the new Rab do?

Now back to the actual thread.

We spent two days and nights in Huaraz, at 10,000 feet, before taking the hike. And then the first day climbed to about 12K, the second day to 13.5K, and the third day took us over the pass at 15,700.

There a trip report on it in the forum…check out trip reports for April of this year…

Or we've got a lot on our website: backpackthesierra.com

> s always appreciated. And thank you for the caution on allergies. I'm not
> anticipating this but if it does happen I'll be sure to discontinue to the AIs
> quickly.
If airways constriction does happen (and it is quite common!), you will need either a Ventolin inhaler or an ambulance service with a nebuliser. The ambos are quite familiar with it.

Read the warning on the packet. Yes, the warning is there! (At least in Australia.)

Cheers

why in the world would you want to take 6-800mg of IB every 4 hours when you only need to take 1 Diamox pill 2 times a day ??
and many people can get away with 125mg Diamox rather than the more standard 250mg.

IB is just plain not good for you.

easy decision on my part.

>> IB is just plain not good for you.

+1 on the above!

It has become "fashionable" among a lot of endurance athletes (runners, hikers, climbers etc)
to take Vitamin I (their term for Ibuprofen) during and after intense efforts.

Mostly they are taking it for the anti-inflammatory effect of Ibuprofen, which requires
a pretty high dose taken over multiple days.

High dose usage or extended use of Ibuprofen over hours/days may cause
undue burden on kidneys or worse yet kidney damage; this can get magnified with potential dehydration or with muscle breakdown, both common among endurance athletes.
This can potentially lead to kidney damage even in an otherwise healthy young person!

Ibuprofen is also known to cause platelet aggregation potentially leading to blood clots.
Not a great thing to happen during intense activity. (Think heart attack or stroke). While
the likelihood is small in most people, for some populations it might be the worst thing
to take! (Think somewhat undertrained, out of shape 55+ year old males…..out for a few nights; know anybody like that? ;) )

That said Ibuprofen HAS been demonstrated to prevent AMS symptoms.

And I'm NOT advocating Diamox which has its own issues. But at least it requires a prescription; hopefully the prescribing doctor understands the risks well enough and counsels the patient accordingly.

800mg every 4 hours is a METRIC CRAPTON of Ibuprofen. In fact, it is twice what has traditionally been considered the high end of safe. I will point out that the studies in that meta-analysis did NOT use this dosing! (Thanks for the link Jen- this was news to me.) Rather, the highest dose used was 600mg every 6 hours, which is correct. Perhaps you're mis-remembering the dosing?

The rule of thumb for maximum *prescription* dose is: mg Ibuprofen / 100 = schedule in hours.

So 800mg is every 8 hours, 600mg is every 6 hours, etc. Doses this high are at risk for ulcers, GI bleeding, and nausea. Take with food, by which I mean a sandwich, not a cracker.

But, as was mentioned above, why would you want to do this in lieu of twice-a-day dosing of Diamox? The only benefit I see is that you can get Ibuprofen over-the-counter, but even then you SHOULDN'T take such high doses without talking to a doctor first, for all of the reasons mentioned above. These are prescription doses.

"you SHOULDN'T take such high doses without talking to a doctor first"

Dean, you sound like you know what you're talking about but please calm down. OP says paragraph 2, that the Doc recommended IBprofin over Diamox. Using this forum as a sounding board to double check the Doc, with people with real world experience.

Regarding the dosing, yeah the doc said 600-800 mg, The study said 600mg. I'm not a doc or a toxicologist but I understand that dosing is recommended as mg (drug) per kg (bodyweight. aka mg/kg.

Regarding the general advice here. Thanks everyone I agree with the logic 2 pills are better than 12 with ulcers. I have the pre-trip jitters right now so I'm questioning everything and running it over in my head.

Edit: I think maybe the doc was advocating under the general logic: "why prescribe a prescription when OTCs are effective." She has been really helpful as far as warning me off other expensive drugs. If Diamox is better though, I have no issues grabbing it.

Agree with Dean's warnings. He is a medical doctor also. Taking prescription doses (more than recommended on bottle) of OTC meds is dangerous unless your personal physician has approved it for you.

Don't correct dosages depend on the weight of the individual? Overall health? Age? Lean body mass? Litigious USA? I would have more faith in the OP's Doctor who would have a history with the OP.

And the other point is that even with good insurance my Diamox script cost me a $100 copay.

so if your MD says it's OK for you to take that level of IB in lieu of such an expensive yet generic diuretic, then by all means go ahead. But by NO means should you just figure out for yourself that you should load up that kind of IB into your system.

I have always payed $2-$5 co pay for diamox with my insurance.

The generic version Acetazolamide is price reasonably.

http://www.drugs.com/price-guide/acetazolamide

Example
Qty 15 per pill $1.17 total $17.62

The above is the total price not copay; of course YMMV.

BTW Diamox is no longer sold in the US; only Diamox Sequels – see below.

"Acetazolamide is a diuretic, and it is available as a generic drug in the United States. Diamox is now available as Diamox Sequels in the United States since the original product is no longer made or sold there."

from Wikipedia….

https://en.wikipedia.org/wiki/Acetazolamide

I'm not hyperventilating or any such thing, Craig. I just have no way to lend emphasis other than caps. :)

But 800mg of ibuprofen every 4 hours is a scary dose. No kidding. And ulcers are the least scary thing I can think of, albeit the most likely. Would it harm you short term? *Probably* not. (There, no caps- have I assuaged your anxiety?) But I don't know- I don't know you. Long term, yes, that dose would likely lead to some sort of issues. 4800mg/day… ouch. The more aggressive folks try to max at 3200mg/day in adults.

So, how old are you? Do you have young kidneys? Yes, the most accurate dosing is based on lean body mass, but that's logistically challenging to figure out, so we use conservative rules of thumb for most common drugs. Have you ever had GERD, or an ulcer? Have you had bariatric surgery or any other foregut procedures?

Most dosing really isn't rocket science, and I hesitate to say something like "consult your doctor before taking Motrin!" because that's a bit extreme. But I'm also not willing to try to sit here before the interwebs and enumerate all the finer points of whether or not one can safely take high-dose ibuprofen. It's so easy to just ask your doc. S/he knows you.

Plus there's the issue that I pointed out- that the studies in question did *not* use such high dosing. That kind of stands out, brother. Presumably there was some other study with higher dosing, but if the (reasonably diligent) meta-analysis shows that 600mg q6 hours works, why take a higher (scary) dose and risk acute renal failure?

EDIT– I did some reading to try to find out if someone was recommending 4800mg/day, and found other stuff…

In the Gertsch study they found a statistically significant difference in the intent to treat group, but *not* among all who completed the trial. This could imply that there were people in the placebo group who dropped out of the study, which really plays hell with analysis. (In fact, he sort of mis-uses the phrase 'intent-to-treat.') He had a 38% attrition rate! Ahem. One is tempted to assume that these folks in the placebo groups dropped out because they got sick and wanted treatment, of course, but we really don't know. If that happened why then didn't they just list them as a failure of placebo? This all seems very shady. There have been quite a lot of similar studies based in the Everest region, and almost all of them have the same problem.

That said, the most common complaint from people with AMS is headache, so it would certainly *make sense* if ibuprofen helped with this somehow. It turns out that most of these studies use headache as a proxy for AMS, but a high-altitude headache (HAH) alone is not diagnostic of AMS! In fact several critics of this treatment have claimed that ibuprofen only treats a symptom, rather than being a treatment for AMS per se. And in a letter to the editor in response Gertsch does admit that he only found statistical difference regarding headache but *not* for any other factor in the Lake Louise Acute Mountain Sickness Questionaire (andalso gives a mea culpa for his misleading labels). Probably a moot point for most climbers, though. They just want to get rid of their headaches. Well, and they want a decent night of sleep, but evidence that ibuprofen helps with that is thin. Frex, Lipman's study is better-designed, and does show differences in other than just headache (and he is very defensive of it), but though adequately powered it is nonetheless much smaller.

"But 800mg of ibuprofen every 4 hours is a scary dose. No kidding. And ulcers are the least scary thing I can think of, albeit the most likely."

I agree that is sounds scary. But for how long? For two days? 10 days? etc.

Has there been any long term studies and if so, what were the dosages?

Thanks Dean.

The current thoughts from the WMS are

http://www.wemjournal.org/article/S1080-6032%2814%2900257-9/fulltext

"Ibuprofen

Two trials have demonstrated that ibuprofen (600 mg 3 times a day) is more effective than placebo at preventing AMS(27, 28); however, these trials did not include a comparison with acetazolamide. That comparison has been made in only a single other trial, which found equal incidence of high altitude headache and AMS between the 2 groups.(29) No studies have compared ibuprofen with dexamethasone. Clinical experience with ibuprofen to prevent AMS is not extensively documented, so at this time ibuprofen cannot be recommended over acetazolamide and dexamethasone for AMS prevention."

AHA!!! so that's why an old diuretic costs so damned much in the US. Even look at the coupon prices here…

http://www.goodrx.com/diamox-sequels

Walgreens, Walmart, Rite-Aid, CVS, etc – even with the coupons the cash prices are more than $100 (without they are more than $250). My insurance paid very little and my copay was $100 for 60 tabs.

I hate pharmaceutical companies, I really do. They do great work, but are such greedy bastards……

politicians love pharmaceutical companies – they make nice donations : )

When I last looked Pharmaceuticals were the most profitable industry in the U.S.–more than oil companies.

Other western governments have determined that in the case of pharmaceuticals the bottom line doesn't trump the public good of affordable medications. Pharma can still make a profit, just not an obscene profit. Seems so…civilized. Maybe we'll become civilized here in the States one day…

edit: maybe 'decent' would be a better word than 'civilized'.

Pharmaceutical companies do great things.

We just need to change the rules so they don't make such huge profits, and the profits should be based on improving health.

Currently, the business model is to make huge profits off a blockbuster drug, like Lipitor. Create test data that says it's more effective (even though it's not significantly better). Make lots of political donations that are coincident with the FDA rules allowing this.

But antibiotics don't make money because they're only used for a short time. So all the companies have stopped developing them, and now there are bacteria resistant to all antibiotics. Pharmaceutical should make more profit off this.

"Other western governments have determined that in the case of pharmaceuticals the bottom line doesn't trump the public good of affordable medications. Pharma can still make a profit, just not an obscene profit."

Regulate them like utilities.