Chest
RECENT ADVANCES IN CHEST MEDICINEMedication and Dosage Considerations in the Prophylaxis and Treatment of High-Altitude Illness
Section snippets
Medications Used in the Treatment of Altitude Illness
In the space that follows, we consider each of the medications used in the treatment of high-altitude illness. For each drug, we discuss the basic indications for its use and then review use of the medication in patients with renal insufficiency, hepatic insufficiency, and other important medical conditions, as well as the potential for drug-drug interactions. Other information is summarized in tabular form apart from these discussions. The doses used for management of altitude illness in
Conclusions
This review demonstrates that many factors can affect the medication choices for patients with underlying medical conditions who seek pharmacologic options for the prophylaxis or treatment of altitude illness. The information discussed above for each medication has been summarized in Table 4.
In taking these and the other recommendations into account, the reader must remember that all patients with preexisting medical conditions or complicated medication profiles require a thorough pretravel
References (104)
- et al.
Nifedipine for high altitude pulmonary oedema
Lancet
(1989) - et al.
High-altitude illness
Lancet
(2003) - et al.
The incidence, importance, and prophylaxis of acute mountain sickness
Lancet
(1976) Acetazolamide and renal stone formation
Lancet
(1970)- et al.
Acute respiratory failure precipitated by a carbonic anhydrase inhibitor
Chest
(1976) - et al.
Presumed “sulfa allergy” in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality?
Am J Ophthalmol
(2004) - et al.
Reduction of embryonic intracellular pH: a potential mechanism of acetazolamide-induced limb malformations
Toxicol Appl Pharmacol
(1990) - et al.
Risk of hospitalization resulting from upper gastrointestinal bleeding among patients taking corticosteroids: a register-based cohort study
Am J Med
(2001) - et al.
Alcohol and aspirin in combination with dexamethasone causes gastrointestinal bleeding at high altitude
Wilderness Environ Med
(2006) - et al.
Disposition of total and unbound prednisolone in renal transplant patients receiving anticonvulsants
Kidney Int
(1984)
Phenytoin/dexamethasone interaction: a clinical problem
Lancet
Spinning the risks and benefits of calcium antagonists
Lancet
The pharmacokinetics and hemodynamics of sildenafil citrate in male hemodialysis patients
Kidney Int
Fatal variceal rupture after sildenafil use: report of a case
Curr Surg
Cardiovascular safety update of Tadalafil: retrospective analysis of data from placebo-controlled and open-label clinical trials of Tadalafil with as needed, three times-per-week or once-a-day dosing
Am J Cardiol
Cardiovascular safety of salmeterol in COPD
Chest
Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange
Ann Intern Med
Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the Prophylactic Acetazolamide Dosage Comparison for Efficacy (PACE) trial
High Alt Med Biol
Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial
Ann Intern Med
Salmeterol for the prevention of high-altitude pulmonary edema
N Engl J Med
High-altitude illness
N Engl J Med
High altitude and common medical conditions
Travel to high altitude with pre-existing lung disease
Eur Respir J
The effect of altitude on the heart and lungs
Circulation
Medical recommendations for women going to altitude
High Alt Med Biol
Going high with preexisting neurological conditions
High Alt Med Biol
Adventure travel and type 1 diabetes: the complicating effects of high altitude
Diabetes Care
Going high with type 1 diabetes
High Alt Med Biol
Going to high altitude with preexisting ocular conditions
High Alt Med Biol
High altitude pulmonary oedema
Swiss Med Wkly
Physiological aspects of high-altitude pulmonary edema
J Appl Physiol
Acetazolamide prevents hypoxic pulmonary vasoconstriction in conscious dogs
J Appl Physiol
Pulmonary vasodilation by acetazolamide during hypoxia is unrelated to carbonic anhydrase inhibition
Am J Physiol Lung Cell Mol Physiol
Effects of acetazolamide on ventilatory, cerebrovascular, and pulmonary vascular responses to hypoxia
Am J Respir Crit Care Med
Elucidating the relationship between acetazolamide plasma protein binding and renal clearance using an albumin infusion
J Clin Pharmacol
Calcium phosphate stones during long-term acetazolamide treatment for epilepsy
Postgrad Med J
Carbonic anhydrase: pharmacology of inhibitors and treatment of glaucoma
The effects of diamox ammonia metabolism in liver disease
Clin Sci (Lond)
Hepatic urea synthesis and pH regulation: role of CO2, HCO3-, pH and the activity of carbonic anhydrase
Eur J Biochem
Carbonic anhydrase inhibitors and ventilation: a complex interplay of stimulation and suppression
Eur Respir J
Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics
N Engl J Med
Fatal anaphylactic reaction after oral acetazolamide (Diamox) for glaucoma [in Dutch]
Ned Tijdschr Geneeskd
Anaphylactic shock after a single oral intake of acetazolamide [letter]
Br J Ophthalmol
Plasma protein binding of drugs in pregnancy and in neonates
Clin Pharmacokinet
Toxic interaction between acetazolamide and salicylate: case reports and a pharmacokinetic explanation
Clin Pharmacol Ther
Experimental salicylate poisoning: observations on the effects of altering blood pH on tissue and plasma salicylate concentrations
Pediatrics
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2019, Wilderness and Environmental MedicineDiagnosis and prophylaxis for high-altitude acclimatization: Adherence to molecular rationale to evade high-altitude illnesses
2018, Life SciencesCitation Excerpt :Such interventions, although useful for most of the high-altitude visitors, are contra-indicated for individuals suffering from cardiac, renal and hepatic issues. Also, all such interventions require proper medical supervision for prescription and dosing with both over and under dosing causing harm [5]. Over the years, many solutions have been proposed which circumvent the issues related to both faster acclimatization and better side-effect free prophylaxis.
The authors have no financial interests in or relationships with companies that produce any of the medications discussed in this article. There are no other conflicts of interest to report.