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catmandu
9th October 2006, 09:26 PM
Dear readers,
can somebody plz explain when sud i start to take diamox, one tab. is 250mg, is there any specific height dat u need to start taking it,e.g. frm 2500m+, if so do i take it two tab. twice a day??

yakshaver
9th October 2006, 10:55 PM
Dear readers,
can somebody plz explain when sud i start to take diamox, one tab. is 250mg, is there any specific height dat u need to start taking it,e.g. frm 2500m+, if so do i take it two tab. twice a day??

I take diamox from about 3000m altitude, or just before. I take half a tablet in the morning, and half in late afternoon or evening with food.

This is to spread the effect more evenly over the 24 hours.

Of course I stop taking it as I start to go down.

With diamox, because it is a diuretic, make sure you drink lots of fluids, and be prepared to pee often.

Harry
9th October 2006, 11:27 PM
Hi,

There has been a lot of discussions on the dutch website nepal.pagina.nl about the use of diamox. Actualy diamox hides all symptons of high altitude sickness, in other words, taking diamox is fooling yourself with even the risk of death. Better listen to your body, go on slowly take time to get used to high altitude, etc, etc. If you have a headache, just wait before taking some pills, etc, etc. Walking in the mountains on "medication".......?????? only with expeditions, when there is no way down. As normal trekker, just calculate more time instead of speeding up.
There is a list of scores for points of high altitude sickness, which can lead you in a safe way up the mountain IF you stick with it.

Harry

Spaceman347
10th October 2006, 05:24 AM
Catmandu,

Some people swear by diamox some people refuse to touch it. Please do a bit of research whichever way you go. I always say that health and taxation are both areas where you must make your own educated decision.

There are a whole heaps of threads mentioning diamox on this site alone http://www.trekinfo.com/forums/search.php?searchid=34242

I can't remember whether the Lonely Planet guide book has a write up on diamox but I do know that the Jamie McGuiness Trailblazer guidebook has a whole chapter on medicines.

You should educate yourself about the symptoms of AMS either way.

Ktrek
10th October 2006, 09:37 PM
An excellent article about AMS ant its treatments (diamox, diamethasone):

http://www.ismmed.org/np_altitude_tutorial.htm

[]s
Ktrek

Michael Sunkist
14th October 2006, 02:44 AM
First of all if you are ill and need to take diamox you have totally disregarded rule #1 of high altitude climbing. Above 10,000 ft. don't take on more than 1000 ft. of altitude in a 24 hour period from where you started. Diamox is not a cure so if you are ailing go back down to the altitude you last felt good at. This is the only cure, to disregard this is inviting cerebal edema which will cause you some serious problems if you are high enough. If you start at 14000 ft. for example you can go as high as you want during the day, (I.E. 18000 ft) just make sure you snooze and recuperate at 15000 ft. Take care and be a wise trekker, there isn't a whole lot of rescue teams out there in the hills Happy trails

Todd Delaney
14th October 2006, 05:20 PM
I was just talking to a climber here in Namche who has just come back from climbing Ama Dablam, he happened to also be a cardiologist in his spare time... his view on Diamox was that it does more harm than good and that you are far better to drink lots of fluids, ascend slowly and listen to your body...

Also, on the all the trails in the Solu Khumbu, there are 1 page leaflets posted by the High Altitude Clinics asking for volunteers to do a blind study on the actual effectiveness of Diamox...the deal is they give you tablets to take on your way up to Lobuche, the only thing is you don't know if they are sugar tablets or diamox, you then need to record how your feeling and what effects and then get back to them on the way back...it seems the jury is still out on diamox effectiveness even from the high altitude doctors in Nepal.

I have just yesterday come over Cho La 5350m from Gokyo and the whole trip have not taken Diamox and have not had anything as serious as even a headache.

Harry
16th October 2006, 05:14 AM
The more you've been on altitude, the more you learn how your body responds on it. So for those who first time get on higher levels than they ever been before, diamox might look like a good solution, but as told before it's just fooling yourself. Being on high altitude means you have to practise and see the results before going on any medication. Just take your time and might even take year to recover what it is about.
Going to fast; like bumping your head to the line where you get the headache and more!

yakshaver
16th October 2006, 07:04 AM
Certainly going up slowly and listening to your bio-feedback is the best thing. However I disagree with some of the negative comments made about diamox. It is helping to prevent altitude sickness to some extent, and research has found it to be useful. Of course it is not a "cure", nor does it provide total protection.

But, used in conjunction with common-sense ascent rate, it is useful. I will try to get my hands on the research, when I have a bit of time, link it here...

julia
16th October 2006, 02:05 PM
Yes, Spaceman i agree with with your post regarding diamox, research ams and the taking of diamox thoroughly before you go to high altitude, hopefully then you can make positive choices whether you really need to take it or not.

I wont give specific advice on that sort of thing, but i can tell you my experience with diamox and my altitude tolerance so far.

I have been at high altitude six times, in Nepal i walked very slowly, im a slow walker anyway, so it didnt worry me, arriving in Namche my head pounded, but after a couple of days it wore off, mostly through resting there a couple of days, doing light walks up higher and sleeping in Namche, the walk high sleep low to help acclimatise. I had the start of a stomach upset in Namche but obviously you have to carry on!

Carried on with the trek, went up Pokalde, no problems apart from the dodgy stomach , now this is where it started to go wrong, you are up in the early hours to do Pokalde, 3am start, the walking didnt end that day until 4.30pm and not only was i exhausted, i was also dehydrated from the stomach upset and lack of enough fluids. I wasnt suffering from any ams syptoms at this point, just tired.

One rest day, then a start to push on to Island Peak, but at this point i really hadnt been taking on enough fluids, from the exertion of the Pokalde day and bad stomach, but i didnt realise that, i wish i had known then what i know now. I think if i had taken on a lot more fluids and maybe taken something to stop the stomach problem i would have coped a lot better on Island Peak, did i feel rough, at Island base camp i felt sick, my head pounded, i wanted to die, honestly thats no joke, i felt that rough.

Instead of mentioning it to anyone i just carried on the next day going up to Island Peak high camp, my head was absolutley pounding, i swelled up like a mitchellin man, at this point i couldnt hide it, it was suggested i take a quater tablet of diamox, which i did, that made me feel just as bad as the other symptoms going on, it gave me severe pins and needles all over, and i mean severe, in hindsight, what i should have done was go back down to base camp, rested and take on as much fluids as possible. It took me five days to recover, i didnt eat for most of that time, but i did drink a lot, i think taking on the fluid, and having the stomach problem under control, albeit with drugs i started to recover.

When i go back to high altitude, i am going to make sure i drink non stop, even when not thirsty, you have to drink, drink and more drink, not the alchoholic variety either!

I would rather avoid having to take diamox, and i think if I get the fluids right and walk slow, take my time, enjoy the scenery, take photos etc hopefully i shouldnt have any problems. I read on a climbing website for climbers going up Everest that the people taking on five litres of fluid a day suffered less, if not at all from ams symptoms.

Its an interesting subject this one, whether you should take drugs to keep off altitude sickness or whether you should go drug free and listen to what your body is telling you.

jonathanellis
26th April 2009, 09:16 PM
Personally I wouldn't listen to anyone who says don't take diamox. I have recently been to both medical posts in manang and pheriche and the other one in Macherma and all the doctors were saying there is no harm in taking it.It does NOT mask symptoms at all.the side affects are so minimal you hardly notice them.I wouldn't take it for the sake of it but If you have any sort of altitude symptoms start taking it and it will be gone by morning.

Sharon
26th April 2009, 10:06 PM
I have never taken Diamox. I drink lots to keep hydrated and garlic soup. I am of the mind that you take it easy and be properly acclimatized. Do day hikes up higher and back down to sleep. I never actually have a rest day on a rest day.

Per
26th April 2009, 11:34 PM
We alway carry diamox but only use it in emergencies, i.e., in case we feel we are getting obvious initial symptoms of AMS.

There is no such thing as chemical acclimatisation. To function well on high altitude you must spend time on altitude and acclimatise. There is no escape from that.

Diamox is a medicine mainly used to treat glaucoma and as a diuretic. More on http://en.wikipedia.org/wiki/Acetazolamide. I think it should be avoided as much as possible.

The only way to avoid AMS is really to allow plenty of time for acclimatisation, which is not easy if one is short of time, but there really is no choice.

jonathanellis
27th April 2009, 12:38 PM
Yes ofcourse you would follow the normal recommended acclimatisation schedule, drink fluids , climb high sleep low etc etc but if you then are still getting symptoms then why would you sit around waiting to acclimatise when you can just take a drug with no negative impact that will enable you to keep following the normal schedule.I'm not saying take diamox and rush up the mountain 1000 m a day but if you are following the regular schedule and maybe getting mild headaches then why not take it.It can ease the worry some people have and make the trekking a lot more enjoyable.

Escher
27th April 2009, 01:58 PM
I've never taken it either. Same as Sharon - stay hydrated and monitor yourself. Many people (sure not all - but a sample of one person does not mean nobody does) get quite severe side effects. Excessive urination, tingling in the extremities and difficulty sleeping. Personally I always have some for emergencies but have never taken it. Its horses for courses. Its much better to find out whether you need it rather than take it when you don't. Why take drugs unnessarily when you don't need to? No drugs are 100% harmless. It will help some people, be pointless for others and will give some people horrible side affects. The situation is not as clear cut as you state it. It is from your experience but that is why medical research uses double blind studies and not personal testimony as the latter is always flawed. The doctors at the medical posts have an interest in preventing unnecessary deaths from AMS and will therefore advise anyone to take diamox as this may help prevent it. As general advice to lots of people this may work but specific advice to an individual (when you know their medical history) may well be different. If everyone took the advice about acclimatising then there would be very little problem. But people don't go down, and do go up too quick. It is a only a small fraction of people who are genetically predisposed to not be able to go over certain heights, the rest should be able to acclimatise well enough given time without diamox. The attitude that you need to get a certain amount out of your Nepal trip (get this high, visit this and that place) is exactly what gets people in to trouble with altitude.

My advice is not to take diamox but that is based purely on my own experience and therefore is pretty crap advice. Just as it is with you telling us we should. I acclimatise very well and don't need it. I can get over 5000m in 2 or 3 days with no problems. So my advice wouldn't apply to you and yours wouldn't to me. Doctors need to apply a one size fits all approach in their HA clinics. That doesn't mean it is right for everyone to take it, its just the least worst advice when applied to people generally. Its not black and white. The answer is - it depends.

Per
27th April 2009, 03:17 PM
The attitude that you need to get a certain amount out of your Nepal trip (get this high, visit this and that place) is exactly what gets people in to trouble with altitude.

You are right on, it is a difficult lesson to learn, has happened to us several times :(, we have had really ambitious plans, not least for having some post-trekking time (in Leh or Srinagar or Kathmandu), so we have gone up too fast. Then, we have simply aborted the ascent, stayed for a day camping, relaxing, before we have continued.

I think this is a very common problem, vacations are too short for most of us.

julia
27th April 2009, 04:22 PM
I had some side effects from diamox, terrible pins and needles like you can't imagine, and it makes you want to go for a wee much than you would normally.

I personally would not use them again for mild symptoms of AMS. I would take headache pills and if they were not working I would go lower down, rest and drink lots. Thats just my opinion. Each to their own as they say!

Oli
28th April 2009, 01:41 AM
Diamox most definitely does have some side-effects and contraindicators, and I would have expected the HRA medics advice will have mentioned these.

I've experienced the pins & needles sensation (paresthesia (http://en.wikipedia.org/wiki/Paresthesia)) that Julia mentions. Although this is not, per se, dangerous it is somewhat uncomfortable and disconcerting. Also there is the increased urination (the drug is a diuretic), but that may part of its mechanism and therefore a Good Thing.

Diamox should not be taken (without medical advice) if you are a diabetic, have liver/kidney conditions, a sulfa allergy or are pregnant.

Also bear in mind that it takes a while (day or two) to come into effect, so it is not much use in an emergency situation.

The prevailing wisdom is that diamox is not an acclimatisation wonder drug but that it can be an aid to that end if normal (best practice) ascent schedules are proving to be insufficient in your particular case. It is sensible to carry some on a trek but to use it only as a backup to safety margins and not as an integral part of an acclimatisation plan.

yakshaver
28th April 2009, 02:27 AM
I do take Diamox starting from about 2700m altitude, give or take. It works as a prphylactic too. I stop as soon as I start walking down again. Half a tablet (I forgot the mg...) per day, with dinner.
No big deal. Love drugs, though I rarely use. Diamox is not a favourite, I just put up with it.
Pins and needles give me a funny feeling, not enough to cause addiction, I believe.

sylvester
28th April 2009, 05:16 AM
I visited a travel medicine clinic in Ottawa Canada before my recent trip and they prescribed diamox. It was to be started the day before and was half a 250mg tablet twice a day while ascending and stop when decending unless symptomatic. This clinic and other authories I consulted stated that diamox will not mask symptoms of altitude sickness.

Also the CIWEC clinic in KTM is a respected travel medicine clinic in Nepal and there are interesting articles on their site. Here is what they have to say about diamox.

Use of Diamox- Diamox blocks an enzyme in the kidney and makes the blood acidic which is interpreted by the brain as a signal to breathe more. Diamox therefore, enhances the physiological response to altitude by increasing the rate and depth of breathing and it also acts as a mild diuretic. Side effects of the drug are: tingling of fingers and toes and tingling around mouth. Sulfa allergic individuals are recommended not to take this drug. Prophylactic dose of Diamox is half or one 250mg tablet twice a day. Use of Diamox will not mask the symptoms of altitude illness if it is to occur. Start taking Diamox the day before ascent to 10,000 ft (3000m), continue it through your ascent to higher altitudes and stop when you start descending. If you are taking medication for high blood pressure e.g. a diuretic, there is no need to stop your medication while you take diamox. Diamox can be used in children (please read trekking with children) at dosage of 5mg/kg/day in 2 divided doses.

Here is the link to their artical on altitude sickness from which about is quoted.

http://www.ciwec-clinic.com/articles/altitude_illness_advice_for_trekker.php

even more detail here

http://www.ciwec-clinic.com/articles/high_altitude.php

yakshaver
28th April 2009, 10:25 AM
Thanks sylvester, that's very useful. I guess with the need to self medicate on trek, it is good for people to start understanding some of these issues. Not just related to diamox, but also antibiotics, the effect of painkillers (including masking effect it can have on AMS), etc.

andrees
28th April 2009, 02:10 PM
As Sylvester wrote, Diamox is influencing the acidity of the blood which leeds to a faster and deeper breathing. Therefor it is nice to have, when one has light simptoms of AMS and help you to sleep better at night. I would see it more or less as a wellness drug.
But Diamox is not curring at all if you have real problems like

HACE: Hight altitude Cerebral Oedema. Symptoms ar heavy headaches, nausea,vomiting, strong problems with balance, problems with seeing well, strange behavior. In fact people look and act quite often like beeing very drunken. The reason is a hight preasure in the scull wich inhibits enough blood coming to the brain.
A very powerfull Drug is Dexametason, a steroid. You can buy a strip of ten 4 mg tabletts for a few roupis in Kathmandu . Take first 2 tabletts (8mg) then every 6 hours another on (4mg) The effects are often dramatic, I have seen people who could not walk on their own any more within 20 min. But it is not a cure, it just give you the oppotunity to walk down.

HAPE High Altitude Pulmonary Oedema
It starts that you are feeling very week which unfortunately is just very normal if you are in hight altitude so this sympton is not very clear. Later a a dry cought begins to finaly end in bloody sputum and you lungs full of liquid. Diamox has practically no currative effects on HAPE.
The adequate Drug is Nifedifin. For me it is always very sad, when I read reports of people who died from HAPE, and the other trekkers only had Diamox with them http://p6.hostingprod.com/@treks.org/2004porter.htm . Sweets would at least have a better taste. Nifedifin can be bought for 2 USD in Kathmandu.

For me it is rather strange that in the english forums everyone concentrates more or less on Diamox. :confused: Research results are rather clear that for severe cases Dexamethason and Nifedifin are the drugs to take.
See also the chapter about altitude thickness in Lonely planet trekking guides or "The hight Altitude Medice handbook by Anrew J.Pollard dan David R. Murdoch" wich is avaiable at pilfgims bookshop in Kathmandu.

Both drugs can be bought together for less than 3 USD without prescription in Kathmandu but could save your or someone else life. Rather a good deal isn't it?

Oli
29th April 2009, 03:34 AM
Good links to CIWEC, thanks sylvester, and some interesting thoughs from andrees.
I'm reviewing my understanding of the AMS/HACE/HAPE and treatments.
Some interesting medical notes here (http://www.high-altitude-medicine.com/AMS-medical.html).

yakshaver
29th April 2009, 11:31 AM
Andrees,



The emphasis on Diamox is warranted.

By rights people should not put themselves in the situation of needing the likes of Nifedipine and Dexamethasone.
People ought to ascend in a way to avoid AMS as much as possible. Unless they want to do trekking as an extreme sport!
Nifedipine and Dexamethasone are drugs to be used in emergency when you need your life saved from AMS.
Not as a routine, as a prophylactic. You should not put yourself in a situation to need it, unless you want to climb Evererest, K2 or something.

Diamox on the other hand, to some extent prevents the onsed of AMS, helps the body to adapt, and alleviates lighter symptoms. This is all you should need while trekking, in my opinion.
I always carry a couple of stirps of Dexa with me, just in case, but more for perhaps helping people who might be in big strife.

If one does need the likes of Dexa as a routine while trekking, they'd be better of staying in Thamel and buying some good hash.

Oli
30th April 2009, 05:11 AM
Anyone thinking of using or prescribing these drugs needs to have a good understanding of recognising the symptoms and how administer the treatment effectively. Trekkers experiencing AMS is relatively common, hence the widespread use of Diamox. HACE & HAPE are less common and consequently fewer medkits include Dexamethasone & Nifedipine. But if anyone is going to make the extra effort to carry these drugs should also do some research on proper usage.

How many readers know that correct diagnosis of HACE involves testing gait ataxia because the finger/nose coordination is not affected by HACE? I just learned that, but if I am going to add Dexamethasone to my medkit then perhaps it's an important detail.

Everyone who goes trekking up at altitude really ought to understand the need for acclimatisation, if they are sensible then AMS can be managed with or without Diamox. But unfortunately there will be the some who exceed their limits, and the occasional few may be unlucky enough to develop more lethal conditions. For them we can but hope that there is someone on hand who is prepared with the necessary skills and tools to save a life.

And whilst the main thread is discussing drugs I'd like to reiterate the advice that it's best to acclimatise with a sensible ascent and proper hydration, preferably without resorting to drugs.

It's serious, lives are on the line. Be prepared.

Michael Sunkist
1st May 2009, 01:11 AM
:D Nameste fellow trekkers, well time and time again I'd run into trekkers at high altitudes who took too much altitude in too short of a time and got a massive headache, flu symtoms, and just generally felt bad. Pop a diamox tab and it helps them a bit but by time you are at this state you should go back down to where you last felt good and hang for 24 hours. Diamox is not a cure. I'd meet these folks higher up having taken diamox thinking they were cured and went higher just to compound the symptoms. Don't be silly take a bite of reality and climb sensibly. Good rule of thumb beyond 10,000 ft., no more than 1000 ft of elevation gain in a 24 hour period. This means at 10,000 ft. trek to 14,000 ft thruout the day but try to sleep somewhere around 11,000 ft when you hit the ups and downs of the trail. Happy trails all.

marcy
4th May 2009, 06:01 AM
Diamox doesn't mask AMS symptoms. It does aid acclimatization. Even while following an appropriate acclimatization schedule, people vary in their natural ability to acclimatize - diamox is helpful in that regard. Also, I find it keeps away the dreaded Cheyne-Stokes breathing.

In 1990, I trekked the Annapurna Circuit on a very conservative acclimatization schedule. Nevertheless, managed to get HACE about 20 minutes from the top of the Thorung La. A doctor dosed me with diamox and another trekker hauled/carried me down at high speed. Were it not for the combination, I probably wouldnt be here now.

In 01 I went to Ladakh. Turns out my body is not so fond of flying into that altitude. The occassional dose of diamox got rid of the occassionial horrible headache and aided acclimatization a bit.. and after a week I was okay.. but didnt trek do to the risk. After that my doctor insisted I ALWAYS be on diamox at altitude.

Since then I've made several treks in the himalays and with the diamox I manage to acclimatize, even though slower than a normal schedule.. e.g. I have to spend much longer than most at Namche before going higher. This year, I still couldnt quite acclimatize and after several days at Namche I spent one night in Khumjung and awoke to find my 02 saturation down in the mid to low 70s rather than where it shouldve been. The Dr. in Khunde doubled my diamox dosage (to what is probably what most people take, I think) and sent me down for more nights in Namche). By 3 days later my 02 saturation was normal for there, and by the end my trek, passing through Namche it was 98%.

I very occassionally experience the annoying diamox tingling -- but its only a minor annoyance and seems to come on if I go too long between doses and simultaneously let my fingers or toes get cold. Other than that, the only symptom is lotsa pee-ing....which just means its working and is a good reminder to continue hydrating.. and also sometimes a wonderful oppportunity to see the beautiful stars and mountains in the middle of the night, when you would otherwise be tucked in your sleeping bag and miss that magnficent beauty.

yakshaver
5th May 2009, 01:55 AM
Interesting experiences marcy, thanks for sharing. Talking about masking AMS symptoms, I agree diamox does not do that.
However popular pain relief medication does that. Like Panedine (paracetamol and codeine phosphate) or Nurofen. I usually get a slight headache either at around 3000-3500m or more often 4000 and above. I wait for 2-3 hours putting up with it. If it does not get worse, I take pain relief and go to sleep. I think I read about doing this somewhere, in the old Lonely Planet Trekking in the Nepal Himalaya, or in Bezruchka or something like that...

critter2722
7th June 2009, 09:49 AM
Sorry; a little late on the response. I don't recommend anyone prophylaxing themselves with these medications unless they know they have a problem with altitude. Definitely the suggestions of hydration and a slower pace are the best options for all trekkers vs acetazolamide as a prophylaxis when you are unsure of how you will react. It is, like others have said, a great option to have them with you just in case. As mentioned before, the "common" side affects are common as proven by double blinded studies but there are numerous "serious" side affects that haven't been mentioned. I can assure you that you do not want to find out you have an allergy to a medication when you are in Namche.

As far as developing HACE or HAPE, don't worry about how to treat yourself. You probably won't have a say because you most likely will not be too responsive...especially if you have HACE. In the states we would treat the cerebral edema with mannitol and the pulmonary edema with a medium dose of furosemide and high rate/volume ventilation. Mind you that we really don't have "high altitude" in the states but edema is edema whatever the cause.

Whatever you decide, try to remember that safety should be near to the top, if not at the top, of your priorities. But I will close with what I tell all my patients: "It's your decision!" "I just present the options."

best,

critter