Article

Acetazolamide for the Prevention of Acute Mountain Sickness-A Systematic Review and Meta-analysis

Institute of Infection, Immunity and Inflammation, Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, UK.
Journal of Travel Medicine (Impact Factor: 1.53). 09/2012; 19(5):298-307. DOI: 10.1111/j.1708-8305.2012.00629.x
Source: PubMed

ABSTRACT Acetazolamide has been reported to be effective in the prevention of acute mountain sickness (AMS). Our aim was to conduct a systematic review of randomized, placebo-controlled trials of acetazolamide in the prevention of AMS.
Studies were identified by searching the MEDLINE, Embase, Cochrane Clinical Trials Register, and ClinicalTrials.gov databases. Primary end point was difference in incidence of AMS between acetazolamide and placebo groups.
Acetazolamide prophylaxis was associated with a 48% relative-risk reduction compared to placebo. There was no evidence of an association between efficacy and dose of acetazolamide. Adverse effects were often not systematically reported but appeared to be common but generally mild. One study found that adverse effects of acetazolamide were dose related.
Acetazolamide is effective prophylaxis for the prevention of symptoms of AMS in those going to high altitude. A dose of 250 mg/day has similar efficacy to higher doses and may have a favorable side-effect profile.

Download full-text

Full-text

Available from: Neil Ritchie, Nov 20, 2014
0 Followers
 · 
173 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We investigated the incidence of AMS amongst a general population of trekkers on Mount Kilimanjaro, using the Lake Louise consensus scoring system (LLS). Additionally we examined the effect of prophylactic acetazolamide and different ascent profiles. Climbers on 3 different ascent itineraries were recruited. At 2743 m we recruited 177 participants (mean age 31, range [18-71]) who completed LLS together with an epidemiological questionnaire. At 4730 m participants (n=189, male=108, female=68, mean age 33, range [1871]) completed LLS, 136 of whom had been followed up from 2730 m. At 2743 m, 3% (5/177) of climbers were AMS positive, and 47% (89/189) of climbers from all itineraries were AMS positive at 4730 m. Of climbers attempting the Marangu itineraries, 33% (45/136) were taking acetazolamide. This group had a similar rate of AMS and no statistical difference in severity of LLS when compared with those not taking prophylactic drugs. We also did not demonstrate a difference between the incidence of AMS in climbers who did or did not take a rest day at 3700  m. However, there was a significant reduction in the incidence of AMS amongst pre-acclimatized subjects. Consistent with previous work, we found that the rate of AMS on Mount Kilimanjaro is high. Furthermore, at these fast ascent rates, there was no evidence of a protective effect of acetazolamide or a single rest day. There is a need to increase public awareness of the risks of altitude sickness and we advocate a pragmatic "golden rules" approach (http://www.altitude.org/altitude_sickness.php).
    High altitude medicine & biology 10/2010; 11(3):217-22. DOI:10.1089/ham.2010.1003 · 1.82 Impact Factor
  • Source
    Journal of Travel Medicine 09/2012; 19(5):281-3. DOI:10.1111/j.1708-8305.2012.00646.x · 1.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: High altitude illness – Acute Mountain Sickness (AMS), High Altitude Cerebral Edema (HACE and High Altitude Pulmonary Edema (HAPE) - can be prevented or limited in severity by gradual ascent and by pharmacologic methods. The decision whether to use pharmacologic prophylaxis depends on the ascent rate and an individual’s previous history of altitude illness. This review discusses risk stratification to determine whether to use pharmacologic prophylaxis and recommends specific drugs, especially acetazolamide, dexamethasone and nifedipine. This review also evaluates non-recommended drugs. In addition, this review suggests nonpharmacologic methods of decreasing the risk of severe altitude illness. There are also brief sections on how to decrease sleep disturbance at high altitude, travel to high altitude for patients with pre-existing illness and advice for travelers ascending to high altitude
    Travel Medicine and Infectious Disease 01/2013; 12(1). DOI:10.1016/j.tmaid.2013.12.002 · 1.54 Impact Factor
Show more