Diamox vs Ibprofin for AMS?

The fact that ibuprofen is equivalent with acetazolamide in preventing signs of altitude sickness–depending on how the study is designed, just may mean that both of them do a minor or slight improvement, compared with nothing at all. Does the study compare them against proper acclimatization?

No, they don't. It is assumed that taking 3 weeks to acclimatize would clearly be superior. :) And, like getting cancer from smoking, this is a statistical phenomenon. You can certainly find some anecdote along the lines of "my uncle took a gram of Motrin eight times a day for twenty years and never had a problem", just as you can find cases of "my dad smoked three packs a day since he was 13 and died at the ripe old age of 101." I.e., nonetheless, it's still stupid to smoke, just as it is stupid to take 4800mg of ibuprofen a day if you don't have to. And the converse is true, of course- some people are more susceptible, for various reasons, and get ulcers with even very trivial courses of NSAIDs. And if you're already dehydrated a big dose of ibuprofen can push you into acute renal failure. Etc. And, of course, one can certainly read the warning label, though it's silent on dosing and duration: http://www.drugs.com/sfx/ibuprofen-side-effects.html I'd like to note that I'm not trying to scaremonger about ibuprofen. I take it quite a lot (I get headaches); adverse reactions are rare in healthy well-hydrated adults at the rule-of-thumb doses. I'm just trying to warn someone that 800mg every 4 hours is a very high/dangerous dose, and that I strongly suspect that someone got their dosing wrong somewhere. Period. End transmission. If you want to try 600mg every 6 hours, I'll support you. It's worth noting that I cannot find a study that quotes that larger dose.

Thanks Dean. My concern is around a few injuries I have had as of late. Relatively high dosages over a short period of time (3-4 days) dramatically reduced the swelling in the area. But of course, I am concerned about side effects.

"And, of course, one can certainly read the warning label, though it's silent on dosing and duration: http://www.drugs.com/sfx/ibuprofen-side-effects.html I'd like to note that I'm not trying to scaremonger about ibuprofen. I take it quite a lot (I get headaches); adverse reactions are rare in healthy well-hydrated adults at the rule-of-thumb doses. I'm just trying to warn someone that 800mg every 4 hours is a very high/dangerous dose, and that I strongly suspect that someone got their dosing wrong somewhere. Period. End transmission. If you want to try 600mg every 6 hours, I'll support you. It's worth noting that I cannot find a study that quotes that larger dose." To everybody monitoring this thread, listen up: This is as solid advice as you are going to get, so put aside your instinctive urge to argue and listen up. This guy knows what he's talking about more than anybody on this website. I don't have a dog in this fight, so consider this a public service comment. And don't bother to argue with me, as I am not monitoring this thread.

Jennifer, if you had to pay $100 for Diamox, you were pretty much cheated. Why would a Doctor prescribe Diamox Sequels, when you could have taken generic Acetazolamide for a fraction the cost and equal effectiveness? Yikes! Too bad the pharmacy didn't steer you in that direction. By the way, I use Acetazolamide if I am going to be over 12,000 for any length of time over a few hours, and it is quite effective for me.

Dave- I'm not saying that I haven't popped 800mg now and then. I may do so very shortly, as a matter of fact, because I have over-done some squats and I can barely walk… I prescribe 800mg every 8 hours prn x 10 days for many of my postop patients. Just be sure you're hydrated and so long as you're young (by medical standards) and aren't otherwise predisposed to problems (the list is vast and protean) you should be okay with a short course at that dose- though of course my lawyer advises me to quibble that I can't say with any certainty without knowing your medical history. Ibuprofen is nowhere near as dangerous as acetaminophen, but there's a reason that the over-the-counter dose is 200-400mg every 6 hours… To reiterate- my only objection is to that excessive dosage, i.e. 800mg every 4 hours. That's too much, especially without running it past your doc first. (Though, of course, the OP did exactly that.) You just want them to give your history a once-over to be sure you're ok at prescription doses, because a bleeding ulcer or acute renal failure at 10,000 feet and 3 days' hike from a road is no joke. Could there be some obscure use for that scary dose of which I am unaware? Yes, I guess there could, but "obscure" would be the relevant word, there, and I'll bet it's *very* short duration. P.S.- Tom, I'm touched. And where did Jen go? If anyone is going to prove me wrong it would be the other person with a PubMed account.

She did not specifically prescribe Diamox Sequels…I was just referring to the previous poster's reference that you can no longer get just plain acetazolamide in the US any longer – I thought that might have been a reason for the ridiculous price I paid. I have absolutely no idea why CVS charged more than $120 for 60 tabs of generic acetazolamide, nor do I know why my insurance charged me a $100 copay when all my generic co-pays are 0/$10/$150 (the $150 is my specialty pharmacy copay for Humira, an injectable biologic drug that actually costs more than $2000/month that I take). CVS did not know either but said it was common for insurance companies to not pay for it. I have a Blue Cross/Blue Shield PPO, by the way; they simply said it was a non-formulary drug. I always take Diamox when I go above 10,000' because I have a terrible time acclimating no matter what, and FOR ME the drug really helps

Sorry Dean, I'm not going to disagree with you here…you are spot on. I also couldn't really find much that was any different in terms of prolonged IB vs any other NSAID use. Your standard renal complications, GI ulceration, etc.

"P.S.- Tom, I'm touched." Do I get a big hug? :0)

BIG hug. I can always wash afterwards. :) PS– for those who are wondering about this, Tom and I have a history of very, er, prolonged and frank foreign policy discussions on these forums.

Thanks to all for the great info. I had read about the Vit I vs Diamox before I did a run up and down Mt Fuji, wondering if it could help me. As an aside, I'm kind of surprised at the dosages/mg. I see here. In Japan ibuprofen pills are often 50, 100 or max 150mg. Perhaps it has to do with the average height/weight being different from the U.S. (though I'm 184cm myself). I think the ibuprofen route would throw me into the heavyweight backpacking category.

From the Stanford press release: "Of the 44 participants who received ibuprofen, 19 (43 percent) suffered symptoms of altitude sickness, whereas 29 of the 42 participants (69 percent) receiving placebo had symptoms, according to the study. In other words, ibuprofen reduced the incidence of the illness by 26 percent. The researchers also noted less severe symptoms overall in those who took the drug compared with those in the placebo group. But this reduction in severity did not meet the researchers' predetermined statistical significance based on the self-reporting questionnaire that was used." A common symptom caused by altitude is headache, Ibuprofen is a common headache pill, this alone could account for the results of the study, maybe someone just fancied some time off in the mountains? I find Benedetti's "gossip" altitude study much more interesting; if one of your peers warns you about altitude headaches, you're more likely to suffer them. The first rule of altitude club is… Dave

I think Ibuprofen just masks the symptoms by treating the headache. Dexamethasone is thought to mask symptoms by its euphoric effect. My thoughts only…

"BIG hug. I can always wash afterwards. :)" I didn't say it should be on a backpacking trip. Or a mud wrestling match. ;0)) "PS– for those who are wondering about this, Tom and I have a history of very, er, prolonged and frank foreign policy discussions on these forums." Which is what made me think of mud wrestling. But hey, I'll take my hugs where I can get 'em. ;0)