Source
r/Ultralight•
JSX54

Acetazolomide advice

Question

Hey all! I am heading up to 13,200' from sea level in a couple weeks. We are driving to 6,500' then backpacking up to a peak within 2 days of flying out. I'm a big fan of long acclimation periods but it unfortunately it isn't possible on this trip.

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Do you think it is worth me getting a Rx for acetazolomide? I've never used it before. Our trip is only two nights before we settle back to ~6,000' for a week, before heading up to 14,000'.

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I'm not sure if the side effects are worth it given the elevation isn't that high, and if I'd be fine with some ibuprofen if a headache arises for the first couple days.

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Any thoughts? Thanks!

Posted Jun 29, 2021, 4:02 PM UTC

2157
InformedConservative•

I have used it in a similar circumstance and would use it again. Going from sea level to 13000’ in a few days is a large altitude swing. I live at sea level and always suffer from headaches above 8000’ without a long acclimatization.

31
DarkHater•

I used it as well for ~12k, as I live at sea level. I always drink a LOT of water so I pee frequently, but this was next level.

You will need to pee at night, so pack a wide mouth bottle for convenience if viable!

1
douche_packerdouchepacker.com•

It is absolutely worth it in my opinion. It was a game changer for me at elevation in Peru. I plan to use it again in Idaho in a few weeks.

My script was $5. Take a dose first to see how it can affect you rather than trying it first time on your trip. Studies show that 125mg and 62.5 are as effective as 250, but talk to your doc.

Everyone reacts differently to elevation, and you can even react differently than perhaps previous visits to high country. AMS is serious, and its not worth ruining your trip over it.

FWIW with all the talk in here of high routes and such, I'm surprised more people don't use it. We should start to normalize its use imo

15
jax2love•

Also be aware that all carbonated beverages will taste like shit while you’re on it, but it’s definitely helpful.

6
darkbyrd•

Didn't ruin beer for me

2
jax2love•

Interesting! It's a pretty common side effect. It made my sparkling water taste flat and salty.

1
JSX54OP•

Great idea to get a prescription and try out the side effects at home! I'll probably do that.

Have fun out in Idaho. Gorgeous out there.

4
WillWorkForCookie•

It made me have to pee a lot. It's not fun to wake up at 3am and have to crawl out of a warm sleeping bag when it's like 10-20 F outside. Also, I still got a bit of a headache flying into 10k feet.

1
b3lbittner•

Some of us have to do that even when we aren't taking any medications. :-(

3
stayshe87•

I took it before and had an awful experience. Had to pee constantly since it is a diuretic (not very convenient when backpacking), gave me bad nausea which was difficult determine if it was a side effect of the med or actual altitude sickness and I woke up in the backcountry one day with half my face numb worried I was having a stroke (later found out numbness/tingling especially in the face is a side effect). So safe to say I will never take it again but of course everyone responds to medications differently and I’m sure it’s helpful for some.

13
doccogito•

The tingling is a common side effect--mine was fingers/toes. It's a diuretic but works by tricking your CO2 receptors into showing you're not breathing enough, and so increases your unconscious respiratory rate. People say it also makes carbonated food taste weird (it's theoretically active in your mouth near taste receptors) but I didn't notice.

11
stusic[14 lbs]•

I want some carbonated food...

9
[deleted]•

[deleted]

1
knikless•

Can confirm. Made cola taste like gasoline (what I assume gasoline tastes like, at least). I was one of the few people in my tour group to not get altitude sickness though.

3
[deleted]•

[deleted]

1
journeyman1141•

There are controlled studies that show ibuprofen is effective combating altitude sickness, but slightly less effective than diamox. 600mg 3x per day. I've used it for AMS with good results.

13
Rocko9999•

A ibuprofen protocol starting 12h before hiking of 200mg x 4 per day took my wife from misery and vomiting at 10,000ft to only the slightest of headaches at 12,000ft.

13
Illbeintheorchard•

I wouldn't take a brand new medicine you've never tried before on a trip. If you have time to try it out for a few days at home first, might be okay, but you don't know if you're going to have severe side effects, an allergic reaction, or any other complications that you really don't want to discover two days into the backcountry... In my personal experience the side effects were so severe they ruined a trip, but obviously everyone is different.

12
editaurus•

It worked like a dream for me on a hike to 15,000 feet in Peru (compared to previous high altitude trips without it). I skipped the last couple of doses due to annoying tingling, but it had already worked its magic. The side effects were nothing compared to crushing headaches and nausea experienced without the medication.

10
EnterSadmanThe heaviest thing you carry is your fat ass•

You should be fine. Keep an eye out for severe AMS (vomiting, mainly) and everyone should know the basics of HAPE/HACE (though it's probably not incredibly common at relatively low altitude like 14k) -- mainly, weird confusion, inability to walk in a straight line, or hacking cough. I once saw signs of it up on Whitney. The guy didn't know how to get down, and he was standing next to the trail. Spooky.

I just did a very similar trip last week -- sea level to 13k, then stayed at over 11k for a week. Only the first night/next morning was rough with headache/insomnia/loss of appetite.

7
JSX54OP•

I am a proud almost-WEMT, the rest of my group will be fine as long as I don't get hit by it! Hah

2
Restimar•

If you don't know how your body will be impacted from prior experience, I'd recommend it. I've had to help people with debilitating symptoms (difficulty speaking, walking) as low as ~9,500 feet. The side effects do kinda suck though.

5
JSX54OP•

Which side effect was the worst for you?

2
Dutchnamn•

I would take it. It made me weel pretty happy and relaxed when I took it.

Last time I went to 4800m in Mexico straight from sea level I got pretty close to a serious situation.

4
thewickedbarnacle•

Not sure how well it really works, there is a drink mix called acclimate that is supposed to help. I use it whenever I plan on being over 10,000.

3
MelatoninPenguin•

Definitely get it. Try it before you go up though. It does cause you to pee more so keep hydrated

Also taking NSAIDs before and during can help with AMS. I think the studies have been done on ibuprofen but I prefer Naproxen

Lots of hydration + acetazolamide + NSAID is my go to for sea kevel to elevation without time to properly acclimate

I don't really get any side effects - maybe urinating slightly more but I dont notice

3
onwardyo•

A consideration for me (taken along with many other factors like personal history, time at various elevations etc) was that the potential side effects of diamox can be really similar to the symptoms of AMS: headache, nausea, etc. For my situation, where we were in a lower risk ascent with a very easy opportunity to descend, it made more sense to not take it — so that any symptoms we were feeling we could act on, and not dismiss as side-effects. Kept it simple: if we feel bad, we go down.

That may or may not be the right approach for your particular situation. My 2 cents.

3
mhchewy•

We did the Inca Trail on my honeymoon and it turns out my wife was allergic to the meds. Hives are not super romantic as it turns out.

3
OutdoorPotato•

Took it at times and it helped. But then some of my trips to the Alps were weekend ones, with lots of elevation gain after a long drive or bus ride from low altitude without much opportunity for proper acclimatisation. Yeah, a bit stupid, but it helped and none of my alpine ascents are really any ground-breaking, being the perpetual climbing gumby that I am... No worries about "cheating" there then :)

Haven't had much side effects either, but that can obviously depend on the individual.

Have a nice high altitude physician's write-up series on all that:

https://www.ukclimbing.com/articles/skills/series/altitude_and_acclimatisation/high_part_1_-_an_introduction-11898

3
seamslegit•

Ibuprofen would probably work fine too

2
willy_quixote•

Possibly, but this was a small study and they have compared ibuprofen to placebo, but not against the efficacy of diamox.

1
seamslegit•

They have compared with a small group and it works but not quite as well. https://pubmed.ncbi.nlm.nih.gov/30419226/

1
Saiyan-Luffy•

Hey! I contacted you for a discussion on healthcare. You know enough about it for a discussion right?

-1
roadmasterwagon•

If you typically experience issues with that elevation difference, then yes just take it and don't be miserable. On my Dr's advice, I do this when I go skiing at high elevation, which sadly is not very often.

Clarification: my reaction at moving to 8-10k from near sea level on Day 1 is a lot worse than a bit of a headache. More like a really awful hangover that won't go away.

2
FujitsuPolycom•

If you can get dexamethasone...

2
Redrot•

+1 to this. I have awful acclimatization beyond 9.5k. I take both acetazoalmine preemptively, and dexamethasone at a preemptive dose (4mg) and at a rescue dose (8mg, these doses are double what's listed online but that was the doc's recommendation) if I start getting splitting headaches. For me personally, dexamethasone is considerably more effective, and improves the asthmatic effects I get from altitude more. I'm told by my doc that for me, it's still worth taking both, though.

The downside at the moment is that it acts as a bit of an immunosuppressant, so it's advisable that you take caution and wear a mask when indoors even if you're vaccinated for a few days afterward.

1
JSX54OP•

... continue..

1
FujitsuPolycom•

Steroid that can be used as a prophylaxis or treatment:

  1. https://www.uptodate.com/contents/high-altitude-illness-including-mountain-sickness-beyond-the-basics

  2. https://wwwnc.cdc.gov/travel/yellowbook/2020/noninfectious-health-risks/high-altitude-travel-and-altitude-illness#:~:text=Dexamethasone,acclimatization%2C%20mild%20rebound%20can%20occur. "Dexamethasone is more effective than acetazolamide at rapidly relieving the symptoms of moderate to severe AMS. "

  3. https://pubmed.ncbi.nlm.nih.gov/2920585/

  4. https://pubmed.ncbi.nlm.nih.gov/3190622/

2
barryg123•

48 hours ought to be a sufficient period to acclimatize.

No one can tell you if you will want/need diamox, everyone reacts differently to altitude and it doesnt necessarily have to do with a person's fitness level.

If you have never been at altitude before then this will be your learning period :)

1†
samologia•

Eh... I'd be careful saying it's definitely sufficient. Not saying you're wrong, just saying that different people can respond to altitude changes differently. My husband still feels the effects a week after we go from sea level to 7,000 ft, whereas I usually don't notice any difference.

12
JSX54OP•

I've been up to 14,400', but usually with at least 3 or 4 days around 6,000 before anything strenuous! If not a whole month of bicycling out to it :p

Thanks for the input!

1
meraki8588•

It does help and it does dehydrate you via frequent urination. Any vaso-dilator will help with altitude.

1†
atheistpiece•

Interesting. This past weekend I went from sea level to about 11500' for the first time ever in the Sierras and was super concerned about attitude sickness.

I take a vaso-dilator normally for blood pressure control, so that probably explains why I didn't have too many issues. I did chug water like it was going out of style though.

2
meraki8588•

Viagra also helps too but people are far less inclined to believe it’s for mountain climbing when they find it in your glove box 🤷🏻‍♀️

6
[deleted]•

[deleted]

1
meraki8588•

Viagra is a vaso dilator…

2
AppropriateTooth•

Apparently the adaptations the body makes to deal with heat are many of the same that it uses for altitude, so some cross-acclimatization is possible. Heard it on Science of Ultra podcast.

1