Offer people written advice on taking the medication. Unless medical help is available, moderate to severe symptoms should be assumed to be due to mountain sickness, and anyone with these symptoms needs to act accordingly (see Lake Louise score and information in resources). Less common side effects of nausea, headache, and dizziness have an overlap with symptoms of acute mountain sickness. This may also help altitude related sleep disturbance. If reducing the dose, we recommend 125 mg at night. Symptoms may be improved by moving the evening dose to several hours before bed. Parasthesia can be particularly uncomfortable at night. If these side effects are not tolerated, the dose can be reduced or discontinued. What are the side effects of acetazolamide?Ĭommon dose-dependent side effects include altered taste, paraesthesia, and polyuria. Two common examples where there is a high risk of developing mountain sickness are flying to Cusco (Machu Picchu) in Peru at 3400 m and taking a bus to Lake Titicaca at 3812 m, or flying directly to Colorado ski resorts at over 3000 m. 4 5 Starting at a lower altitude allows more time to adapt to gradual changes in hypoxia.īy contrast, physical exertion directly after being transported to high altitude increases the risk of mountain sickness. Guidelines suggest ascending no more than 500 m/day, with a rest day (no increase in altitude) every third day. 5 Rate of exposure to hypoxia dictates risk: the faster and more energetic the ascent (above 2500 m), the greater the likelihood of developing altitude illnesses. Suggested approach: strongly consider acetazolamide 125 mg bd.īeing young and fit does not reduce the risk of developing mountain sickness, 4 so travel plans are a more reliable indicator of risk or whether to prescribe prophylaxis. Very rapid ascents (eg, ascent of Mt Kilimanjaro in less than 7 days) Those with a history of high altitude cerebral oedemaĬlimbers ascending to >3500 m in one day and those ascending >500 m/day (increase in sleeping height) above 3000 m without extra days for acclimatisation People with a history of acute mountain sickness who are ascending to above 2800 m in one day This article is an approach to discussing travel and activity at high altitude, prevention of sickness, and acetazolamide prescription for non-specialists. Some GPs may decide not to prescribe acetazolamide on this basis, or because they feel it is outside the scope of their practice. In the UK, prescribing acetazolamide for travel is an optional service, not included in the general practitioner’s contract. 2 3 4 5 Acetazolamide causes mild diuresis and increases renal excretion of bicarbonate, causing a mild metabolic acidosis which in turn increases respiratory rate (improving oxygenation). Acetazolamide can help to prevent acute mountain sickness developing and has fewer side effects than alternative drugs such as dexamethasone, which can mask symptoms and therefore carries greater risks. If this natural adaptation is surpassed by the rate of exposure to altitude, acute mountain sickness can occur. 2 Acclimatisation to altitude involves multiple physiological changes, occurring over days to weeks, which enable individuals to function better in these hypoxic environments. It is estimated that more than 100 million people per year travel to the hypoxic environments found at altitudes above 2500 m, 1 and at least 10% to 20% of unacclimatised individuals develop acute mountain sickness at this height. He asks you for a prescription of acetazolamide to prevent mountain sickness.įor most people, mountain sickness is a self limiting illness, but it can become life threatening. The most important treatment for altitude sickness is descent to a lower, more oxygen-rich environmentĪcetazolamide 125 mg twice daily can be prescribed as prophylaxis for those at risk of developing acute mountain sicknessĪ 25 year old man plans to trek to Everest Base Camp (5545 m) in Nepal for charity. Help prevent mountain sickness by slow ascents ≤500 m/day, rest days every third day, and avoid over-exertion
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