Diamox

Anyone have experience taking it?  Got some for an upcoming trip.  Good idea doing a home trial before taking it in a foreign country?

Some of the side effects mimic those of AMS, so you may want to try it out if you're concerned.   I didn't bother when I went to Bolivia, but also didn't have any major issues.  It's a diuretic, so make sure you drink extra liquids.  This is a fairly comprehensive article on AMS, HAPE and HACE written by several high altitude medical researchers and based on current literature.

According to prior research for this article it's only 60-80% effective for AMS and the authors didn't find a difference between outcome in the Diamox versus control group, but they said it was difficult to determine some of the AMS symptoms from side effects. Note that the participants were also not randomized and volunteers who took Diamox were more likely to be susceptible to AMS.

Adding that on my trip I also brought, but did not take dexamethasone for HAP/CE.

I have found that is is helpful for me in small doses (half a pill, forget the dosage I have) when sleeping. Placebo or not, I felt it helps me get better sleep above 13-14k, which was infinitely more useful for daytime aerobic activities than trying to take it directly for that. I experience the tingling extremities side effect pretty strongly, hence the half dose, and it's a good balance. 

Definitely test it out and try drinking a beer after trying it.

Alex Caillat wrote: I have found that is is helpful for me in small doses (half a pill, forget the dosage I have) when sleeping. Placebo or not, I felt it helps me get better sleep above 13-14k, which was infinitely more useful for daytime aerobic activities than trying to take it directly for that. I experience the tingling extremities side effect pretty strongly, hence the half dose, and it's a good balance. 

Diphenhydramine (Benadryl) is another option for the sleep issue.

A friend and I tried diamox this summer when going from sea level straight into the evolution traverse. We both experienced significant altitude sickness when we got over Lamarck Col (13k) and down to Darwin Bench (11500 or so). Our plan due to tight timing had been to climb straight into the traverse that day (ie. Heading back up over 13k), but our AMS made that unthinkable. Our itinerary was too aggressive no matter how you slice it, but Diamox certainly wasn't a wonder drug for us.

Regarding how it felt, I was drinking and peeing at least 2x what I ordinarily would have, and felt totally parched. That alone was significantly negative from a climbing perspective, since we would have needed to double our water budget and were planning to carry water for 12+ hours between refills. I didn't notice a significant difference in the quality of my sleep at 11500 (again, coming straight from sea level); I tossed and turned but still slept, which is normal for me at elevation.

Personally, I'm going back to ibuprofen, which I've used successfully in the past to improve altitude performance. I've felt at least as good when using it, and it doesn't make my kidneys run wild the way Diamox did.

Makes ya piss like a race horse ...

My experience is similar to above...little to no difference acclimating with a partner who wasn’t taking it, aside from the peeing every g’damn hour thing.

Lower dose or time release may help, but I’m unlikely to use again.

Been using it for years for when I go over 13,000 feet. And only on those days; not for the whole trip. So two or three times each summer, I'll take it.

For me, it eliminates the headache and nausea that come with altitude. Still get short or breath. Still don't sleep well (other meds for that!)

But it helps.  I think it's a good idea to try it out at home first, so you don't ruin a trip with side effects.

I used it in Nepal and it helped, but it gave me very odd dreams. Very odd; so odd I stopped takeing it.  

I used it on a very aggressive acclimatization plan and had high success-

Day 0: 0ft
Day 1: 9,300ft
Day 2: 15,100ft; summit to 16,800ft
Day 3: 15,100ft; summit to 17,200ft
(I continued going higher for the next 10 days)

My best advice is the remember that Diamox dehydrates you like crazy and does hurt your performance. Plan accordingly!

A dry run could be a good idea as well. It gives my girlfriend a terribly bad stomach and basically offsets its value to her. Not something you want to discover in a tent! 

Got the popcorn ready... 

Maureen Maguire wrote: Got the popcorn ready... 

For this? 

Did I miss a racial slur somewhere?

my wife is knowledgeable about this stuff and she mentioned to me and some friends recently that ibuprofen has been shown to be "not inferior" (presumably meaning roughly as effective?) to acetazolamide and dexamethasone for preventing High Altitude Headaches. Here's a related article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478153/

A quick search turns up some suggestion that it is also moderately effective for AMS, but I that seems to be less clear and I don't have good data to point to. 

Dave Alie wrote: my wife is knowledgeable about this stuff and she mentioned to me and some friends recently that ibuprofen has been shown to be "not inferior" (presumably meaning roughly as effective?) to acetazolamide and dexamethasone for preventing High Altitude Headaches. Here's a related article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478153/

A quick search turns up some suggestion that it is also moderately effective for AMS, but I that seems to be less clear and I don't have good data to point to. 

I’m curious about this. If ibuprofen just masks the headache while acetazolamide helps prevent the causes of the headache, that’s not the same thing at all. 

Acetazolamide’s action is complicated, but by causing your body to excrete bicarbonate, you are likely to increase your rate of respirations to blow off carbonic acid/CO2.

Diamox won't improve your alpine performance; you'll still suck wind if you're not acclimatized.  In some cases it will help with AMS symptoms.

I used it several times on a 1.5 week trip to Cayambe and Cotopaxi last summer.  I would wake up with headaches and nausea when sleeping over 15k ft unless I took it before going to bed.  I did not experience any diuretic effect, but it did make my fingers tingle.  I never needed it when I was up and moving.

If your high-altitude is going to be in the Andes I'd highly recommend the native remedy over Diamox.

fossana wrote: This is a fairly comprehensive article on AMS, HAPE and HACE written by several high altitude medical researchers and based on current literature.

And that article specifically recommends that people known to have altitude problems (such as me) consider taking Acetazolamide in advance.

fossana wrote:
> "According to prior research for this article it's only 60-80% effective for AMS and the authors didn't find a
> difference between outcome in the Diamox versus control group, but they said it was difficult to determine
> some of the AMS symptoms from side effects."

But acetazolamide versus altitude has been studied and studied for like fifty years now. That single article acknowledges that many previous studies did indeed find Acetazolamide to be effective.

I notice that a couple of parameters for which that study reported measurements are not things that acetazolamide is intended to address anyway.

Ken

Brian Abram wrote:

Acetazolamide’s action is complicated

Well anyway acclimatization to altitude is more complicated than most people think.
And it's different for different altitudes and different time periods. And
like with most physiological effects of any complexity, different persons react very differently. And
like with any worthwhile pharmaceutical, different persons react differently.

So it's pretty tricky to learn from anecdotal reports on MountainProject.
. . . (also tricky to learn from a single research study, if you're not expert in the field).

My experience from conversations with people hiking near the summit of Mt Whitney is that a large percentage do not follow the instructions for taking Acetazolamide for altitude. Which makes assessing anecdotal reports even more tricky.

Brian Abram wrote:
>  "... by causing your body to excrete bicarbonate, you are likely to increase your rate of respirations to blow off carbonic acid/CO2".

Actually Acetazolamide works by _reducing_ the amount of CO2 that gets "blown off" into the high-altitude atmosphere. Its critical function in preventing AMS is to help your blood to better retain dissolved CO2 / Carbonic acid (and thus prevent alkalosis).

. . . (Note that acetazolamide has nothing to do with building Red Blood Cells or increasing the amount or effectiveness of Hemoglobin).

Ken

kenr wrote:

... a large percentage do not follow the instructions for taking Acetazolamide for altitude. Which makes assessing anecdotal reports even more tricky.

For my single data point, I can confirm that my partner and I followed the instructions to a T: we took diamox every 12 hours, starting before we got up high, and only stopped after achieving our high point.

If you're considering using it, I do think water consumption is something important to consider. Starting very hydrated, I typically drink 1-2 liters (or less) if heading uphill for 2 hours in cool weather. On diamox, I drank 3-4L in that timeframe, and was very thirsty and eager to find a water source. No mystery where the fluid went; I was stopping to pee constantly (and numerous times over night). If you're in a moist climate and hanging out near water, perhaps that'd be fine, but if you're heading up a technical route without access to water (here's looking at you, Harding Route on Keeler Needle), needing to carry that much extra could be a real liability.