From the Guidelines
The best treatment for altitude sickness is to descend to a lower elevation and allow your body time to acclimate. For prevention, gradual ascent is key—climb no more than 1,000-1,500 feet (300-500 meters) per day when above 8,000 feet, with a rest day every 3,000 feet. Acetazolamide (Diamox) is the most effective medication for prevention, typically taken at 125mg twice daily starting 1-2 days before ascent and continuing for 2-3 days at maximum altitude 1. For treatment of mild symptoms, rest, hydration, and over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen can help with headaches. Dexamethasone (4mg every 6 hours) may be prescribed for more severe cases, as suggested by studies on high-altitude pulmonary edema (HAPE) 1. Supplemental oxygen can provide immediate relief when available. Avoid alcohol and sleeping pills, which can worsen symptoms by depressing respiration. Altitude sickness occurs because lower oxygen pressure at high elevations leads to hypoxia, causing the body to compensate through increased breathing rate and heart rate. These medications work by improving oxygenation (acetazolamide increases respiratory rate) or reducing inflammation (dexamethasone). If symptoms worsen despite treatment, especially with confusion, difficulty walking, or shortness of breath at rest, immediate descent is necessary as severe altitude sickness can be life-threatening. Some individuals, such as those with heart failure, may need to take extra precautions when traveling to high-altitude locations, as they are more susceptible to the physiological changes induced by high altitude exposure 1. It's also important to note that sex differences may play a role in responses to hypoxia, and women may need to take extra precautions when engaging in mountain sports or hypoxia training 1. However, more research is needed to fully understand these differences and to develop sex-specific recommendations for preventing and treating altitude sickness. In general, the key to preventing and treating altitude sickness is to ascend gradually, stay hydrated, and seek medical attention if symptoms worsen or persist. By taking these precautions, individuals can minimize their risk of developing altitude sickness and ensure a safe and enjoyable trip to high-altitude locations.
From the Research
Treatment for Altitude Sickness
- Acetazolamide is used to prevent acute mountain sickness (AMS) by inhibition of carbonic anhydrase 2
- Descent to a lower altitude is the primary treatment for serious altitude illnesses, with oxygen therapy and medications such as nifedipine, sildenafil, and dexamethasone used as adjuncts 3, 4
- Calcium channel blockers and phosphodiesterase inhibitors are used to manage high-altitude pulmonary edema 3
- Dexamethasone is reserved for the treatment of more severe cases of altitude illnesses such as cerebral edema 3
Prevention of Altitude Sickness
- Slow ascent is the primary prevention strategy for altitude sickness 5, 3, 6
- Acetazolamide is the drug of choice for prophylaxis of acute mountain sickness, with reduced dosage schemes compared to current recommendations being warranted 3
- Individuals with preexisting illnesses, particularly of the heart and lungs, should be cautious when traveling to high altitudes and seek medical advice before doing so 5
Management of High-Altitude Pulmonary Edema
- Descent to a lower altitude and oxygen therapy are the primary treatments for high-altitude pulmonary edema 4
- Nifedipine and sildenafil are commonly used to manage high-altitude pulmonary edema, with dexamethasone and acetazolamide also being used in some cases 4
- The use of multiple medications for high-altitude pulmonary edema is not supported by current evidence and should not be widely adopted without further study 4