Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Ibuprofen for Prevention of Altitude Illness

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Many persons who travel to high altitude are familiar with acute mountain sickness (AMS), which is estimated to occur in more than 25 percent of the tens of millions of people who travel to sufficient altitude to become vulnerable. The usual (and quite sensible) advice is to ascend slowly enough to allow the body to acclimatize to the high altitude, in order to avoid or minimize the likelihood of suffering AMS, and hopefully, to also prevent the onset of high altitude pulmonary edema or high altitude cerebral edema.

Despite acclimatization attempts, many people need pharmacological aids to help prevent AMS. The most commonly recommended drug is acetazolamide, which causes physiological changes that mimic (and promote) acclimatization. However, there are side effects from taking this drug, such as tingling in the hands and feet, excessive urination, altered taste of carbonated beverages, and (rarely) an allergic or toxic reaction. So, while acetazolamide is an excellent drug to take in prophylaxis against AMS (I personally use it), it would be nice to have other choices.

The Annals of Emergency Medicine just released an article online (found at http://www.annemergmed.com/article/S0196-0644(12)00090-X/abstract) from Grant Lipman, MD and his colleagues entitled “Ibuprofen Prevents Altitude Illness: A Randomized Controlled Trial for Prevention of Altitude Illness With Nonsteroidal Anti-inflammatories.” In this study, which involved 86 participants, either ibuprofen 600 mg or placebo was administered three times a day, beginning six hours prior to ascent from 1,240 meters (4,100 feet) to 3,810 m (12, 570 ft) in the White Mountains of California. The main outcome measures were acute mountain sickness incidence and severity as determined by the Lake Louise Questionnaire AMS score.

The results showed that 43 percent of the participants in the ibuprofen group developed AMS compared with 69 percent in the placebo group, and also that the severity of AMS was worse in the placebo group compared with the ibuprofen group.

If these results hold up over time, and ibuprofen is really as effective for the masses in protection from AMS as it was for the 44 persons who received it in this study, then this is good news for the high altitude crowd, because ibuprofen is readily available without prescription, has an acceptable side effect profile, and may turn out to be adjunctive to other approaches, such as gradual ascent to achieve acclimatization. To be able to know the best approach, it will be necessary to look at a large group of individuals, have them ascend at an identical rate, control for ancillary considerations (such as state of hydration), and compare individual drugs and drugs in combination. Until then, it appears that ibuprofen, which acts by a different physiological mechanism than does acetazolamide, may become a very useful drug in prevention of AMS.

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Tags: Climbing High , Backpacking

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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