/ Diamox

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mypyrex - on 07 Oct 2017
Not wanting to re-open the debate on the ethics of using Diamox to stave off altitude problems but I'm just curious to know from those who have used it as a prophylactic what dosage you used. I can't honestly remember how many I took when I was in Nepal.

I ask because I'm currently on a three day course of three per day to relieve pressure in my eye.

Just curious.
ben b - on 09 Oct 2017
In reply to mypyrex:

250mg daily is the usual dose (much argument about this as previous studies showed 750 worked but 500 didn't).

http://www.bmj.com/content/345/bmj.e7077

cheers

b
damowilk on 09 Oct 2017
In reply to ben b:

Apparently 125mg twice daily is fine for altitude use. This was my recollection from the Dipl Mountain Med, and seems to agree with the recent UIAA paper on drug use and misuse in the mountains:
http://theuiaa.org/documents/mountainmedicine/English_UIAA-MedCom-Rec-No-22a-Drug-misuse-2014-V1-1.p...

Basnyat B, Gertsch JH, Holck PS et al “Acetazolamide 125mg bd is not significantly different from 375mg bd in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficiency (PACE) trial.” HAM&B 7, 17-27. 2006.
1
Axel Smeets - on 09 Oct 2017
In reply to mypyrex:

125mg first thing in the morning and the same dosage just before bed.
ben b - on 09 Oct 2017
In reply to damowilk:

Thanks for the link to that article - it is quite entertaining (Hillebrandt for sure) even if it has some very obvious factual errors (e.g. "Many authorities prefer to use benzodiazepines with short half lives such as Zopidem or Zopliclone" would be more convincing if either drug was spelt correctly, or indeed were benzodiazepines).

The BMJ paper looks at a variety of studies - 125mg twice daily or 250mg once daily included. I can send you a pdf if it's behind the paywall.

Cheers

b

damowilk on 09 Oct 2017
In reply to ben b:

Sure, would be good to read it, I can only see the summary this side of the paywall. Just spotted it’s written by Chris Imray, he was/is DiMM faculty.
I can’t say I’d ever use or recommend Dex for prophylaxis though, it’s side effects and disadvantages seem to far outweigh its usefulness.
splat2million on 10 Oct 2017
In reply to damowilk:

The other useful paper is the WMS guidelines published in Wilderness and Environmental Medicine:
Luks AM, McIntosh SE, Grissom CK, et al. Wilderness medical society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med 2014;25:S4–14. doi:10.1016/j.wem.2014.06.017

Also agrees with 125mg twice daily as the preventative dose. Some tablets are modified release so would be 250mg once daily - I prefer the normal release one though because in case it needs to be used for treatment it seems like it would act faster.

I've don't recommend to anyone to use it prophylactically but have worked with some people who decide to take it and have sometimes advised people who've already decided to take it to not go higher than this dose (the dose prescribed from travel clinics seems to vary very widely). Side effects can be troublesome for some but most people seem to tolerate it pretty well at 125mg twice daily (for me the biggest problem when I've tried it for myself is that it makes beer taste flat).

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