Efficacy and harm of pharmacological prevention of acute mountain sickness: quantitative systematic review

Abstract

Objective To quantify efficacy and harm of pharmacological prevention of acute mountain sickness. Data sources Systematic search (Medline, Embase, Cochrane Library, internet, bibliographies, authors) in any language, up to October 1999. Study selection Randomised placebo controlled trials. Data extraction Dichotomous data on efficacy and harm from 33 trials (523 subjects received 13 different interventions, 519 a placebo). Data synthesis At above 4000 m the mean incidence of acute mountain sickness with placebo was 67% (range 25% to 100%); incidence depended on the rate of ascent, but not on the altitude or the mode of ascent. Across all ascent rates, dexamethasone 8-16 mg prevented acute mountain sickness (relative risk 2.50 (95% confidence interval 1.71 to 3.66); number needed to treat (NNT) 2.8 (2.0 to 4.6)), without evidence of dose responsiveness. Acetazolamide 750 mg was also efficacious (2.18 (1.52 to 3.15); NNT 2.9 (2.0 to 5.2)), but 500 mg was not. In two trials, adverse reaction (including depression) occurred after dexamethasone was stopped abruptly (4.45 (1.08 to 18); NNT 3.7 (2.5 to 6.9)). With acetazolamide, paraesthesia (4.02 (1.71 to 9.43); NNT 3.0 (2.0 to 6.0)) and polyuria (4.24 (1.92 to 9.37); NNT 3.6 (2.5 to 6.2)) were reported. Data were sparse on nifedipine, frusemide (furosemide), dihydroxyaluminium-sodium, spironolactone, phenytoin, codeine, phenformin, antidiuretic hormone, and ginkgo biloba. Conclusions At above 4000 m, with a high ascent rate, fewer than three subjects need to be treated with prophylactic dexamethasone 8-16 mg or acetazolamide 750 mg for one subject not to experience acute mountain sickness who would have done so had they all received a placebo. Acetazolamide 500 mg does not work.

Acute high-altitude sickness

“…While there has been debate about the appropriate dosage for prophylaxis [117], the bulk of the evidence suggests 125 mg twice daily is sufficient for most climbs [102,118], but may be inadequate for overly rapid ascents and/or ascents to very high final altitudes [119]. The medication is typically started the night before the planned ascent and continued until descent is initiated or until the individual has been at the target elevation for 2-3 days.…”

Acute mountain sickness

“…can be prevented by using pharmacological prophylactics. The use of various pharmaceuticals for prevention of AMS was studied by Dumont et al The drugs analysed included dexamethasone, acetazolamide and Ginkgo biloba extract [18].…”

Treatment of Acute Mountain Sickness and High Altitude Pulmonary Oedema

“…Acetazolamide is the preferred drug [8]. Prophylactic aspirin can be used for prevention of headache [2].…”