UKC

During my last trip to Elbrus we met a doctor who said that the diamox is a very strong medicine and we should not be using it.

So when would one use Diamox?

Presumably if one is planning on taking proper time to acclimatise diamox would not be needed. However it can generally reduce the acclimatisation time so is it worth taking diamox under 5000m altitudes where the acclimatisation can generally be a day or two? 

Yes I've been using acetazolamide / Diamox successfully as a prophylactic for under 5000m especially on holiday trips where losing two days counts a lot. Multiple trips up from sea-level each year, for like thirty years now.

Lots of other people do that to speed acclimatization -- been well-studied for like 50 years.

Yes it's strong, yes it has side effects. You should consult with a medical doctor before using it.

Notes:

* the dosage protocol for altitude acclimatization is different from that for its normal label use. Many medical doctors do not know this, and prescribe it with the normal label dosage protocol. Some climbers then find themselves understandably dissatisfied with the their experience.

* its action is on your body's use of Carbon Dioxide (CO2) - (not Oxygen). It does _not_ stimulate hemoglobin or red blood cells. Instead it helps prevent "respiratory alkalosis" (due to low carbonic acid in the blood), which is a key cause of Acute Mountain Sickness symptoms at altitudes below 4500m.

* the protocol for acclimatization is to start it _before_ you go to altitude. An advantage (or disadvantage?) of this is that its diuretic side effect (frequent urgent urination) is experienced mostly _before_ you're actually up on your climb - (but might cause disruption with business meetings or commuting travel).

* There is another chemical "trick" protocal for the key CO2 / alkalosis acclimatization below 4500m which is not well-known.

Ken

In reply to Getoiu:

Just to add an alternative opinion – I've climbed at altitude several times and never even considered using Diamox. I've always considered it a rescue tool rather than a general preventative.

As with the use of oxygen or dex there's so much debate and strong feeling on the subject. I think in certain circles (commercial guided groups?) its considered the norm and so many people do it... but then a bit of Googling turns up plenty of leading alpinists that frown upon it or consider it doping.

E.g:

Reinhold Messner, who famously took nothing more than aspirin when setting records on the world’s highest peaks in the '70s and '80s, compares using drugs in general, and dex in particular, to placing bolts in the rock. “It’s not possible anymore to tell who is doing great things in the Himalayas and who is using drugs and cheating,” he told me. “It’s a form of cheating, clearly. You cheat yourself and you cheat others by using drugs.”

https://www.outsideonline.com/1914501/climbings-little-helper

In reply to Getoiu: I used diamonds when trekking in Ethiopia, generally at the 4000m level. I had chronic stomach ache after a day and didn't make the highest mountain and had to have a jeep ride out, missing a 1200m walk over a pass. I would have been much better off without it. Save it for the high mountains.

In reply to Getoiu:

I've used it once, when we did the Annapurna circuit (tops out at 5416m), to speed up acclimatisation due to time constraints - I'd never been to that altitude before and didn't want to risk it.

We were taking the minimum dose, 1/2 a tablet twice a day, which I believe is fairly standard practice - only side effect I noticed was a vague feeling of tingling, like all my skin was fizzy. One of our party did it clean, but had done it before and was more used to the altitude - another of our party took it and still suffered a bit of altitude sickness.

Stopped taking it as soon as we crossed the pass and started descending.

It's readily available over the counter in Kathmandu for pennies, without prescription.

In reply to Getoiu:

I used Diamox when climbing in the Himalaya in the 1980s. The side effects included increased peeing, diarrhoea and vivid dreams at night. At that time I was also suffering from bouts of Delhi Belly ( not nice when living in a tent at altitude), so it was difficult to pinpoint the causes just to the Diamox.

Following retinal eye surgery 4 months ago my eye pressures went sky high as a reaction to the steroids and antibiotics which were prescribed to me immediately post op. To control/reduce this unexpected rise in eye pressure I have been on a cocktail of eye drops and Diamox for the last 4 months. The reaction to the Diamox has not been pleasant and the side effects have included diarrhoea (controlled to some extent by Imodium), feeling depressed and irritable, difficulty in sleeping, and when I did sleep, very disturbing and unpleasant dreams, very dry mouth, and pins and needles in both lower arms and fingers, and sometimes my feet, and weight loss*.  Finally about two weeks ago the eye pressures lowered to a more acceptable level, and I have now been taken off the Diamox, but am continuing with the various eye drops. The relief from the side effects has been marked and I am now feeling so much better - normal bowl motions, no pins and needles, better, generally dream free  sleep, and  no longer feeling depressed and low.

It is indeed a strange drug, and not one I would be happy to be on again. I would go along with the advice given above, to seek professional medical and try it at home for a week or so before going to the mountains.

* on reading the notes that come with Diamox I see that weight loss is a common side effect, but also it states the it should NOT be used with the objective of achieving weight loss.

In reply to Getoiu:

I've never been above 5000m, but I wouldn't even consider using it; I just don't like the idea of chemicals tinkering with my body.

In reply to McHeath:

Never taken a painkiller?

In reply to McHeath:

"Damn H2O interacting with my intestines and kidneys"

A similar line is used for the damaging Clean Eating cult. And similar again for GM foods.

In reply to kenr:

Stay at the hut, and drink as much beer as you can piss?

CB

In reply to knighty:

Do I really have to clarify which chemicals I mean? 

And sure, I'll take stuff if it's medically necessary. But not in advance, with side effects, to save a couple of days acclimatisation. Each to their own.

In reply to Getoiu:

I'm I planning to use Diamox this summer for the first as I need to trek over a 5000m pass on day 3 in order to reach our BC on day 5, which will actually be lower. I think it's best for the welfare of the porters that we'll be hiring if we just get on with it and cross the pass at their preferred pace. 

Otherwise I think it's good to know what my body generally can and can't cope with before using Diamox, otherwise it could be being used needlessly.

Yes Diamox is actually a banned substance with WADA, obviously hypothetically speaking. 

In reply to Takein:

I don't think that's the case. For example, our company doctors (Jagged Globe) do not advise taking Diamox as a prophylactic on our trips as the itineraries are designed to give most people time to acclimatise. 

We carry it in our medical kits and there are instances where I'd use it (e.g. as Big Lee describes above).

In reply to Getoiu:

I've used it in the Alps to help with acclimatization, though only to make what I know from experience I could manage without it a lot less unpleasant. It definitely seems to help. At higher altitudes, where I have less experience of what I can cope with, I've only ever taken it when already feeling ill (and therefore to descend) rather than to try to speed up acclimatization.

In reply to Mr. Lee:

My best guess it that acetazolamide is banned by the drug-testing authority WADA for competitive sports _not_ because it has any effect on oxygen-utililization or hemoglobin or red blood cells, but rather because ...

it's a cheap diuretic

So athletes using _other_ illegal chemicals might take acetazolamide / diamox soon before a WADA drug test in order to try to purge their urine of the WADA-illegal chemicals.

Therefore the detection of acetazolamide / diamox in a WADA test is regarded as strong evidence that the athlete is cheating.

. . . (I know or care little about competitive sports -- just my educated guess).

Ken

In reply to Tom Briggs:

That makes sense when leaders are taking responsibility for a larger group of climbers who will have widely varying adaptive responses and side-effects from Diamox, and where doctors might want to hold it "in reserve" for maximum effectiveness in emergency use at really high altitudes (above 4500m).

With a larger group, there's little gain if a couple of people acclimatize two days faster, but still need to wait for others who got less helpful effect.

On a 21-28 day Himalayan trip, saving two days isn't such a big gain. And the leaders come up with other useful things to do with the extra days.

But a climber hopping over to the Alps for a 6-day holiday for just their own personal trip might feel differently about the proportional gain of two days. Especially if the only two days of stable dry weather are the first two.
. . . (I come from living at sea-level and "normally" get AMS symptoms at 2500m)
. . . (Sometimes my best achievements in the Alps have been in my first two days after arrival -- would have missed those without Diamox and my other protocol trick).

Ken

In reply to Getoiu:

DIamox is a diuretic so if one is not adequately hydrated, it can hasten the onset of illness at altitude. I suspect that's what the doctor's concern is. That said, if sufficiently hydrated, it helps the transition to altitude by causing acidosis, which increases your breathing and gets more oxygen into the blood.

In reply to Getoiu:

I used Diamox in the Himalayas in 2004.  I had got as far as Gorak Shep by following the usual acclimatisation schedule, with nothing worse than a few mild headaches.  However at our camp at 5100m I was sleeping very badly - bad dreams, trouble breathing, it felt like I was having panic attacks.  Really horrible. I went onto Diamox and then slept much better, and I didn't notice any side effects.  On the other hand it didn't help me to get very much higher, I really struggled and had to bale out at 5710m.

In reply to Tom G:

The point of using Diamox is not primarily getting more oxygen into the blood, the body achieves this by simply increasing breathing rate and volume.

Increased breathing, however, automatically means that you also exhale more CO2, in turn causing blood alkalosis and AMS symptoms. 

The primary response of the body to restore pH balance in the blood is to excrete hydrogen carbonate (the main buffer ion in the blood), which the body can only achieve if the kidneys are busy. This is in turn helped by drinking a lot and, of course, the point where diuretics act in altitude adaptation.

In proper high altitude mountaineering diuretics can also reduce overall fluid levels, which can help against edema (in parallel to corticosteroids) but there is a tradeoff with increased stroke risk.

CB

In reply to cb294:

maybe you'd find this useful :https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/al...

You should avoid taking any medication at all. They all have side effects. Acclimatise properly. By taking Diamox you risk severe dehydration if you don't drink enough to compensate for the countless trips to the bathroom. You also risk of masking the AMS symptoms.

I only carry Diamox in my first aid kit to be used in conjunction with Dex for HACE treatment. 

In reply to alex.serban:

I notice that web page linked contains this phrase:

"Acetazolamide prophylaxis strongly recommended."

I am not any sort of medical expert, but I sort of thought that "acetazolomide" was the technical word for Diamox; and that

"prophylaxis" meant Prevention: like take it even before notice any symptoms.

Which by remarkable coincidence, I've been doing for over a hundred holiday mountaineering trips from sea-level up to low/moderate altitude.

With obvious consistent success.

. . . (Yes I did experience the diuretic side effect each time; and Yes drinking more liquids did seem to solve that).

Ken

In reply to alex.serban:

I absolutely agree with you that hydrating properly and acclimatizing slowly is much better, but did you even read your link? It is actually recommending Diamox use as a precaution against developing AMS already at reasonably low levels (see table 2 in particular). Actually, this makes sense if you sit in a hotel in Cuzco after flying in from sea level, much better in any case than simply taking some pills against the headache.

Anyway, I am a biologist and have a very clear idea about the mechanisms of acclimatization, and merely posted a simplified explanation to correct the post above who had the physiology a bit backwards.

The first aid diamox use you refer to is also what I had in my last sentence, using diuretics in combination with dexamethasone (a corticosteroid) to quickly reduce overall liquid volume to combat lung or brain edema (swellings caused by liquid influx into the tissue).

CB

In reply to Getoiu:

Hi all,

Just noticed the thread and gonna throw in my very limited experience that may be of interest...

I am a 47 year old Physiotherapist who has been making short alpine rock climbing trips to mainly Chamonix for over 20 years. By short, I mean that I often had a 5/6 day window to fly out, get up to a hut and climb several days on the trot and fly home. This was interspersed with longer family stays in the valley with not the same urgency.

I am well aware of all the medical pros/cons/advice, etc... here is what I found for me personally - several times with a planned/booked stay at either Cosmiques (3613m) or Torino (3375m) huts - when we went straight up on our day of arrival to stay for several nights, I suffered mild to moderate AMS.

I then tried Diamox as per prophylactic guidelines when I next went a few times - and it helped greatly - I had no similar signs & symptoms.

So, in short - it worked for me in this very specific scenario.

I fully consulted before and after with my GP who provided the prescription for me.

To be fair - I've only done that 3/4 times - it is possible I could have been ok without it, but that is my simple experience. 

It was never needed or used for anywhere lower, eg the Envers Refuge.

Planning, training & dreaming through the year of a few routes in a short window of opportunity - I tried to maximise my chances of enjoyment  - and it definitely worked for me.

That is of course in no way a recommendation for others to follow, etc, etc, etc..

Enjoy!