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: 1.58). 09/2012; 19(5):298-307. DOI: 10.1111/j.1708-8305.2012.00629.x
Source: PubMed


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 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.

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Available from: Neil Ritchie, Nov 20, 2014
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    • "Compared to the obstructive apneas observed at baseline in OSAS patients, central apneas induced by an ascent to altitude are characterized by the intermittent absence of the drive to breathe [17] and are generated by the brainstem respiratory center as a response to changes in blood gas concentrations [18]. One treatment for central apneas at altitude is acetazolamide, a carbonic anhydrase inhibitor frequently used in the treatment of acute mountain sickness [19], [20]. Acetazolamide prevents central apneas at altitude through metabolic acidosis by its diuretic effects [21]. "
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    ABSTRACT: 1) To investigate the impact of acetazolamide, a drug commonly prescribed for altitude sickness, on cortical oscillations in patients with obstructive sleep apnea syndrome (OSAS). 2) To examine alterations in the sleep EEG after short-term discontinuation of continuous positive airway pressure (CPAP) therapy. Data from two double-blind, placebo-controlled randomized cross-over design studies were analyzed. Polysomnographic recordings in sleep laboratory at 490 m and at moderate altitudes in the Swiss Alps: 1630 or 1860 m and 2590 m. Study 1: 39 OSAS patients. Study 2: 41 OSAS patients. Study 1: OSAS patients withdrawn from treatment with CPAP. Study 2: OSAS patients treated with autoCPAP. Treatment with acetazolamide (500-750 mg) or placebo at moderate altitudes. An evening dose of 500 mg acetazolamide reduced slow-wave activity (SWA; approximately 10%) and increased spindle activity (approximately 10%) during non-REM sleep. In addition, alpha activity during wake after lights out was increased. An evening dose of 250 mg did not affect these cortical oscillations. Discontinuation of CPAP therapy revealed a reduction in SWA (5-10%) and increase in beta activity (approximately 25%). The higher evening dose of 500 mg acetazolamide showed the "spectral fingerprint" of Benzodiazepines, while 250 mg acetazolamide had no impact on cortical oscillations. However, both doses had beneficial effects on oxygen saturation and sleep quality.
    PLoS ONE 04/2014; 9(4):e93931. DOI:10.1371/journal.pone.0093931 · 3.23 Impact Factor
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    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 (
    High altitude medicine & biology 10/2010; 11(3):217-22. DOI:10.1089/ham.2010.1003 · 1.28 Impact Factor
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    Journal of Travel Medicine 09/2012; 19(5):281-3. DOI:10.1111/j.1708-8305.2012.00646.x · 1.58 Impact Factor
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