Chest
Volume 133, Issue 3, March 2008, Pages 744-755
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RECENT ADVANCES IN CHEST MEDICINE
Medication and Dosage Considerations in the Prophylaxis and Treatment of High-Altitude Illness

https://doi.org/10.1378/chest.07-1417Get rights and content

With increasing numbers of people traveling to high altitude for work or pleasure, there is a reasonable chance that many of these travelers have preexisting medical conditions or are receiving various medications at the time of their sojourn. As with all travelers to high altitude, they are at risk for altitude illnesses such as acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema. While there are clear recommendations for pharmacologic measures to prevent or treat these illnesses, these recommendations are oriented toward healthy individuals and do not take into account the presence of preexisting medical conditions. In this review, we consider how the choice and dose of the medications used in the management of altitude illness—acetazolamide, dexamethasone, nifedipine, tadalafil, sildenafil, and salmeterol—are affected by a patient's underlying medical conditions. We discuss the indications and current dosing recommendations for individuals without underlying disease, and then consider how drug selection or dosing regimens will be affected by the presence of renal insufficiency, hepatic insufficiency, other important medical conditions, and the potential for serious drug interactions. We include comments about interactions with antimalarial medications and antibiotics used in the treatment of traveler's diarrhea, as well as the safety of use during pregnancy. By giving these issues adequate consideration, clinicians can increase the chances that properly evaluated patients with underlying medical conditions will enjoy a safe trip to high altitude.

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

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    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.

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