From the Guidelines
The primary treatment for altitude sickness is descent to lower elevation, which is the most effective intervention, as it directly addresses the underlying cause of hypoxia and helps prevent further complications, as noted in the context of high-altitude retinopathy and other altitude-related illnesses 1. When managing altitude sickness, it's essential to consider the severity of symptoms and the individual's overall health. For mild cases, rest, hydration, and over-the-counter pain relievers like acetaminophen or ibuprofen can help manage symptoms.
- Acetazolamide (Diamox) is a commonly prescribed medication for altitude sickness, typically given at 125-250mg twice daily, which helps speed acclimatization by increasing breathing rate and reducing alkalosis, as mentioned in the context of preventing high-altitude illnesses 1.
- In moderate to severe cases, dexamethasone (4mg every 6 hours) can reduce brain swelling and inflammation, while supplemental oxygen, when available, provides immediate relief by increasing oxygen levels in the blood. Some key points to consider in the management and prevention of altitude sickness include:
- Gradual ascent, with no more than 1,000-1,500 feet per day above 8,000 feet, to allow for proper acclimatization, as emphasized in the guidelines for preventing high-altitude illnesses 1.
- Staying hydrated and avoiding alcohol and sedatives, which can exacerbate symptoms of altitude sickness.
- Considering prophylactic acetazolamide (125mg twice daily) starting 24 hours before ascent for those with previous altitude sickness, as a preventive measure to reduce the risk of recurrence 1. It's also important to note that sex differences may play a role in the risk and severity of altitude sickness, with some studies suggesting that women may be more susceptible to high-altitude pulmonary edema, although the mechanisms underlying these differences are not yet fully understood 1.
From the Research
Treatment Options for Altitude Sickness
- Descent to lower altitude is considered the treatment of choice for altitude sickness, including acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE) 2, 3, 4, 5.
- Acetazolamide is the drug of choice for prevention of AMS and probably HAPE, with lower dosages offering adequate protection with fewer side effects 2, 3, 6.
- Oxygen effectively treats HAPE and mild AMS, but is not as useful for cerebral edema 2.
- Dexamethasone is effective for treatment of AMS, including early cerebral edema, but not for advanced cerebral edema, and should be reserved for more severe cases of altitude illnesses 2, 3, 4.
Prevention Strategies
- Slow ascent is the primary prevention strategy for altitude sickness, with rapid descent for the management of serious altitude illnesses 3, 4, 5.
- Pharmacological agents, such as acetazolamide, can be helpful when rapid ascent cannot be avoided or when rapid descent is not possible 3, 6.
- Calcium channel blockers and phosphodiesterase inhibitors are used for the management of high-altitude pulmonary edema 3.
Dosage and Regimen
- The optimal dosage of acetazolamide for prophylaxis and treatment of AMS is still being researched, with studies suggesting doses of 500-750 mg/day within 24 hours of altitude exposure may be the most effective for minimizing symptoms of AMS 6.
- Reduced dosage schemes compared to current recommendations may be warranted for acetazolamide 3.