This dosage may be less than enough for larger patients, thus a third dose may be taken mid day or during the night if headache or other symptoms appear. Most people acclimate within three to four days, though AMS may reappear on later trips to that altitude.
Treatment of AMS after the unset of symptoms may require acetazolamide 250 mg twice a day. Higher dosages can cause lightheadedness and an uncomfortable pins and needle tingling around the mouth, fingers tips and toes. Analgesics, such as acetaminophen, ibuprofen, or aspirin are helpful for headache. Keeping properly hydrated is important.
Acetazolamide appears to be safe in children of all ages at 3 mg/kg/day in two divided doses.
Acetazolamide is a very mild diuretic and increases urine output. If you are on a diuretic, such as furosemide (Lasix®) or HCTZ (hydrochlorothiazide) do not decrease or stop them, as the diuretic effect of acetazolamide is small.
IT IS A SULFA DRUG , the use of acetazolamide has been discouraged in people with known allergy to sulfa antibiotics. Recent literature indicates that there may be no increased allergic risk with non-antibiotic sulfa drugs, such as acetazolamide. ("Absence of Cross-reactivity Between Sulfonamide Antibiotics and Sulfonamide Nonantibiotics." NEJM 2003; 349(17):1628-1635.) It is a category C drug and not recommended in pregnancy or breast feeding due to lack of safety studies. It is not recommended in those with kidney failure.
Local guides and pharmacies generally encourage only coca leaves and soroche pills (Sorojchi pills). You may have difficulty finding acetazolamide in Cuzco or other cities of the Andes.
Steroids have been shown to be very effective in prevention and treatment of AMS. Adults are usually given dexamethasone 4 mg (Decadron®) every six hours. Children will respond to lower doses. Short term use is considered safe, but this medicine can cause significant blood sugar elevation in diabetics. As a preventative, this medication is prescribed for those that can not take acetazolamide.
Climbing expeditions higher than routine tourist destinations should carry dexamethasone to treat severe AMS, high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE).
AMS is not the same as high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE). These are two serious and life threatening conditions that require urgent medical attention.
HAPE is fluid build up in the lungs marked by increasing shortness of breath and associated with persistent cough, severe headache, confusion and finally collapse. It should be treated with immediate descent, oxygen and diuretics.
HACE is swelling of the brain whose hallmark is difficulty thinking, causing disorientation, confusion and collapse. It should be treated with immediate descent to lower altitude, oxygen, diuretics and steroids.
Questionable treatments for AMS:
Salmeterol (Advair®) comes as a dry powder to inhale by mouth using a specially designed inhaler for the treatment of asthma and COPD. It has shown some effect in HAPE in only one study. It has not been studied in AMS and should not be relied upon.
Nifedipine (Procardia®) is used chiefly for treatment of angina and hypertension but has shown slight effect in HAPE, as have Cialis® and Viagra® which are used to treat erectile dysfunction.
Captopril (Capoten®) is being offered to tourist for treatment of AMS. Both nifedipine and captopril are potent drugs for lowering blood pressure and may cause fainting. Neither drug has studies that show them effective in AMS nor should they be relied upon.
Ginkgo biloba
Tibetan ginseng also known as Hong Jin Tian, or the "red view of heaven" is a tea made from rhodiola, a common plant in cold mountainous regions.
Sorojchi High Altitude pills are a combination of acetylsalicylic acid, salophen and caffeine. Basically this would be similar to aspirin with caffeine. ASPIRIN CAN MAKE YOU BLEED- MAKES PLATELETS LESS STICKY ,... CAFFEINE MAKES YOUR HEART GO FASTER, MAKES YOU URINATE MORE AND DEHYDRATES YOU
Mate de Coca known as Infusion de Coca is a tea made from coca leaves and at best is a mild stimulant. It is illegal to bring coca leaves into the US. Use of coca leaves may result in a positive urine drug screen for cocaine.
