Diamox (poll)

[Rob]

Do you use Diamox for high altitude hikes? (See poll)

[Perry]

so much for drugs. turns out most of us don't need it, at least in socal.

[Hikin_Jim]

I posted "other." I had Diamox perscribed as a "just in case" for a Mt. Whitney backpacking trip. I didn't actually use it on the mountain even though I did have altitude sickness above 13,500. I understand it causes dehydration, so I decided not to used it unless it was truly necessary.

I did however have trouble sleeping the first night at the trailhead and the second night at Trail Camp. I took a Wilderness First Aid Class last June. In it the instructors said, based on their and their acquaintances experinces, that Diamox really aids sleep at altitude.

[Norris]

I used it for the first time on Aconcagua (summitted on Feb 12) along with Nifedipine (prevents pulmonary edema). I used it sparingly, generally only for the first night at a new, significantly higher elevation, in order to reduce Cheyne-Stokes respiration syndrome at night, which really annoys me. I found that 125mg of Diamox essentially eliminated the Cheyne-Stokes problem.

[Hikin_Jim]

Cool. Good info. Thanks for being specific on dosage.

[FIGHT ON]

I heard about it last year when I was going to go to Mt Whitney. I chose not to use it. I figured that if I could not do it without it then [b]I[/b] couldn't do it. And sure enough after all my hiking last year to prepare for Mt Whitney I got to the switch backs just before the windows and could not go on and turned back. I went back the next week and started to take deep breaths on every step from trail camp where those 100 switchbacks start and had no problem.

[Rick M]

In 1985 prior to going to Denali and since I was working below sea level in Death Valley, I asked my physician for some Diamox and he gave us enough for fifteen days. A few years ago I asked my new physian for some and referenced the fact that I was on search and rescue and might go from essentually sea level to ten thousand feet in a matter of minutes if being taken up by helecopter. He declined to do so sighting its effects would take a day or two to begin working and that they wouldn't do anything for me for 24-48 hours and sighted the negative effects and asked if I would normally be still searching after 48 hours (rare). So I do my SAR work and personnal hikes drug free except for caffine and sugar highs...I need to check with Ellen about this.

[Norris]

I think your doctor is working with out-of-date information on Diamox. My understanding (and personal experience) is that the idea that it takes several days to begin working is wrong and an obsolete notion. It is actually quite fast acting. The older notions also included excessively high dosages (like 250 mg several times a day) which produced a lot of side effects. The current recommendation is to take 125 mg twice a day. This drastically reduces the side effects like tingling in the extremities and frequent need to pee. I found that taking only 125 mg per day was effective, for example, only in the morning just before a strenous hike to a significantly new and higher elevation, like carrying to camp 2 on Aconcagua (which is the equivalent of carrying a 45 lb pack to on summit day from the hut on Cotopaxi) or only in the evening before bed the first time sleeping at a significantly higher elevation.

[Rick M]

Note sure what "out-of-date" is. On Denali we didn't start taking it till we were above 14,000'. Prior to that we had no problems. In our push from 14,500' to 17,000'+ I felt fine but one of the others in our group started getting AMS or beginning HACE. In our haste to get down I frostbit five toes. He recovered when we got below 12,000'. Was my frostbite related to increased urination from the Diamox or from the -44 temperature or from our lack of breakfast/hydration routine or a combination, I don't know. I have never used Diamox since and I've been over 17,000 and 18,000' but taking time to acclimatize.

This is an except from a 2006 draft by the International Society for Mountain Medicine on An Altitude Tutorial
http://www.ismmed.org/np_altitude_tutorial.htm

We do not recommend acetazolamide as a prophylactic medication, except under the specific limited conditions outlined above. Most people who have a reasonable ascent schedule will not need it, and in addition to some common minor but unpleasant side effects it carries the risk of any of the severe side effects that may occur with sulfonamides.The dose of acetazolamide for prophylaxis is 125-250 mg twice a day starting 24 hours before ascent, and discontinuing after the second or third night at the maximum altitude (or with descent if that occurs earlier). Sustained release acetazolamide, 500 mg, is also available and may be taken once per day instead of the shorter acting form, though side effects will be more prominent with this dose.

This is an interesting article in that it also talks about AMS, HAPE, HACE and other altitude related things. From what I can recall, I've only gotten AMS once and that was on an evening drive up to Whitney Portal followed by a night hike up to the base of Mt. Russell without sleep, 1,000-14,000' in approx 10 hours. I had a splitting headache and my friend also vomited near the summit. From the readings I have done, some people to alright without Diamox while others on the same climb suffer with it. When you say you found it effective, how do you know that you wouldn't have been fine without taking it. And for most of our SAR missions, we are off the mountain within 24 hours anyway.

Rick M

[Rob]

Not sure what "out-of-date" is.

I think Norris was pointing out politely that the your second doctor holds an opinion different from most other literature and experiences on Diamox. You second doctor wanted a couple of days prophylaxis while other sources and experiences say that is not necessary.