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John D. Wilson, M.D.
1200 Hilyard St., Ste. 560
Eugene, Oregon 97401 USA
fax 541.485.7702



Commentary on altitude sickness from an academic tropical medicine doctor

I agree that Diamox is optional and not mandatory, but I offer it to everyone going over about 9000 feet. Lots of folks have no idea whether they tolerate altitude well. Maybe they have done day hikes but have never slept high. If the traveler is ascending to over 10-12,000 feet, risk for problems and stronger recommendations to prevent altitude sickness increase as does the peak altitude. Diamox may help for either prevention or treatment. Rational options include:
  1. No Diamox prescription; the traveler may have tolerated higher altitudes before and doesn't
    want to take Diamox.
  2. Carry Diamox tablets; the traveler doesn't want to take Diamox ahead of time, but will
    carry it in case AMS (acute mountain sickness) develops.
  3. Take Diamox preventively for the entire time at altitude, or taper if the stay will be
  4. Take Diamox preventively at first. If, after a day or two, there are no AMS symptoms and the
    traveler feels great, one option would be to quit Diamox at that point.

Diamox helps prevent AMS, and is primarily a comfort measure. It is very safe, and basically does what healthy kidneys will do in the first few days at altitude, so it is pretty "natural" physiologically. That seems safer than masking symptoms with painkillers or steroids. With a preventive dose of 125 mg (one half of a 250 mg tablet) twice daily, the tingling "side effects" are pretty rare, and if they occur, it is merely annoying, not dangerous. The sad traveler is the one who loses a day or two feeling crummy and it didn't need to happen. With option 4, a trekker may know if AMS occurs and may know whether Diamox should be taken on a subsequent ascent. Not taking Diamox on a future trip would be an attractive option if there were no AMS symptoms on a previous similar ascent.

Neither city vs. remote travel, nor the degree of physical fitness influence whether AMS will occur. If the traveler is near civilization, there may be access to a doctor or friendly pharmacy (or more intense medical care if the traveler becomes symptomatic). It is important to remember that Diamox will help with AMS, but doesn't prevent severe altitude disease (maybe helps a bit with HAPE, probably not with HACE), so the reminders of limiting exercise initially and ascending slow are important even if taking Diamox. And I warn travelers about Diamox changing the taste of beer and soda.

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  John D. Wilson, M.D. 1999-2018; Last Update 2/26/2018