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Prophylaxis
Under certain circumstances, prophylaxis with medication may be
advisable
- for persons on forced rapid ascents (such as flying into Lhasa, Tibet,
or La Paz, Bolivia), for climbers who cannot avoid a big altitude gain
due to terrain considerations, or for rescue personnel on a rapid ascent
- for persons who have repeatedly had AMS in the past
Acetazolamide - a.k.a Diamox
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.
Ginkgo biloba extract
Recently some exciting work has been done studying the use of Ginkgo
biloba extract to prevent AMS. Much more work remains to be done, but in
three studies Ginkgo has been shown to be very effective in preventing
or lessening the symptoms of AMS. It has yet to be determined exactly
how Ginkgo works at altitude, but it may act as an antioxidant, reducing
stress on tissues that have been injured by low oxygen levels.
These studies used a standardized Ginkgo biloba extract (24% flavonoid
glycosides, 6% terpenoids). The dose used was 80 - 120 mg twice a day,
starting 5 days before a rapid ascent or at the beginning of a gradual
ascent. ConsumerLab.com is an independent lab that tests herbal products
to ensure that they contain what the label promises; they have a page
evaluating Ginkgo products available in the USA.
AMS Prophylaxis guide:
Acetazolamide (Diamox®)
125-250 mg (depending on body weight; persons over 100 kg (220 lbs)
should take the higher dose) 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). Children may take 2.5
mg/kg of body weight twice a day.
Ginkgo Biloba Extract
80 - 120 mg twice a day, starting 5 days before a rapid ascent or at the
beginning of a gradual ascent. tory depression (the slowing down of
breathing) can be caused by various medications, and may be a problem at
altitude. The following medications can do this, and should never be
used by someone who has symptoms of altitude illness (these may be safe
in persons who are not ill, although this remains controversial)
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