When to use Diamox?
July 17, 2017 3:17 AM   Subscribe

I'm about to embark on a 16 day hike which starts at 3000m and goes up to 5300m. I have a stash of diamox from my doctor, but now my more experienced friend has discouraged me from taking it unless I start to experience AMS. My doctor recommends taking it preventatively, but says I can also wait until I have symptoms. Experiences and advice? (You are not my doctor.)

I have been at altitude in the past, but never more than 4200 meters and never for more than a few days. I'm an experienced hiker but I have hiked mostly in lower ranges (hung out between 3000m-3500m, mostly).

My doctor recommends the diamox used preventatively, and even encourages taking it two days early.

I have had no incidents of altitude sickness at all in the past. I do sleep at sea level, and have done most of my life.

My fitness levels are mixed. I've been very fit most of my life (was running half marathons and 25km trail races with 1200m elevation as of the end of March). However, I had an accident at the beginning of April which knocked me out for two months and the nerve medicine I had to take added 15 pounds to my frame. I'm back to working out 4-5 days a week, and I peeled off 5 pounds of the 15, but I'm still 10 pounds heavier than I was (and I'm short! and middle aged to begin with! so that 10 pounds has a big impact on my frame) and I can feel that my fitness is okay, but not as strong as it was. Hiking qua hiking should not be a problem, but I'm worried about the altitude. The hike I'm doing is going very slow-- no more than 350m altitude increase per day, so that's good. But I just don't know how I'm going to react.

I'm traveling with a friend who has done Everest base camp in the past and Kilimanjaro. She said her experience with the diamox was that it has unpleasant side effects and it was better to take it only when symptoms started to develop. She said Ibuprofen was enough for her to control the minor headache for most of her treks.

Google shows a range of views on this point as well. I'm looking for relevant experience or views from people who may have tried it both ways, or people who have done their own research and come to a conclusion. Thanks!
posted by frumiousb to Travel & Transportation (7 answers total) 1 user marked this as a favorite
I've taken a high dose (1000mg) of acetazolamide (diamox) every day for a little over ten years to help control symptoms of my Chiari malformation. Turns out it works great off-label for thinning your CSF, and helps me do things like see and stand upright without falling over. It's been a great drug for me.

When I originally went on diamox at 750mg it was pretty rough. I had flu-like symptoms for a couple weeks, but they eventually subsided. When I increased my dosage a few months later, I went through it again. Now I get flu-like symptoms if I skip more than one dose. But that's me taking high doses at regular intervals for a long time; I don't know how that compares to short term use.

The big thing to watch for on diamox is dehydration. I hope your doctor told you that, particularly since you'll be hiking. Diamox is a diuretic. You'll be peeing a lot and you need to make sure not only that you're drinking enough water, but that you're replacing your salts as well. (I take a potassium supplement daily, too.) Don't hold back on salting your food, eat bananas, drink milk, drink lots of water.

I assume you've been given a much lower dosage than what I'm on, and I think you'll probably be fine taking it preventatively. Diamox isn't a fuck-you-up drug with things like suicidal thoughts or pooping yourself to death as side effects. It's a (maybe) make you feel a little sick drug, which if that's the case for you, you can stop taking it.

But it will dehydrate you, that is real and potentially serious if you don't compensate for it. Just be prepared.
posted by phunniemee at 5:02 AM on July 17 [3 favorites]

No experience, but I would suggest you to ask this question on a climbing or mountaineering forum.

I have friends who took it pre-emptively.
posted by Dashy at 5:56 AM on July 17

I went on a hike like yours (Everest base camp/Kala Pattar as the highest points). I was advised to start taking it when we got to 12,000 ft or something, so I did, even though I've never suffered from altitude sickness and wasn't on that trip either. What resulted was a total disaster - uncontrollable diarrhea. As soon as I stopped taking the diamox, the big D stopped. And trust me, the big D on a trail in a foreign country - not fun!

I'd say if you aren't prone to altitude sickness, maybe take the diamox with you but only use if you get uncomfortable. Some headaches, loss of appetite, or slight barfiness were common amongst our group, but iboprufin kept me fine.

If you're going with a trekking group in Nepal (I'm making some assumptions here!) the trail really only gains a couple thousand feet in elevation each day, so it didn't turn out to be a problem for us.
posted by bluesky78987 at 7:44 AM on July 17

Will you spend any time at altitude to acclimate before you start hiking? That generally helps a lot.
posted by leslies at 10:13 AM on July 17

I've done the Annapurna Circuit and Everest Base Camp. Annapurna Circuit I did slowly with many acclimatisation days and had no problems at all with altitude sickness. I had diamox with me but didn't use it at all.

Everest Base Camp I skipped an acclimatisation day and went up a little too fast. Standing on Kala Pattar i got hit by a thumping headache. I went down to my hostel at Gorak Shep, took a Diamox, had dinner and drank lots of water. Went to bed shortly after, still with a headache but not thumping anymore, and woke up in the morning absolutely fine.

The guide books I used (Trailblazer) recommend not ascending more than 300m vertically in a day once you're above 3500m and doing an acclimatisation day for every 500 vertical metres (I think, this is from memory).

Every guide book I've read, and I've read a lot, recommends going slow. You can be in great condition but if you ascend too fast you can get into trouble. I'm not in great shape at all, have been about 15kg overweight on both treks.
posted by DelusionsofGrandeur at 12:25 PM on July 17

I did the Annapurna circuit in 2013. I took Diamox preventatively from just before 3000m. I didn't suffer any side effects. You do have to keep the water up though. However my suggestion is trust your doctor on this one. That is what you are paying them for.

Also as others above have said. Take it slow. You should always sleep lower then the highest you walked. We achieved this once we were over 3000m by doing an afternoon acclimatisation walk after reaching our tea house. We walked higher and then came back to the tea house to sleep. Also just take it slow because you will enjoy it more. It is surprising how much harder it is to get your breath back if you push yourself once you are at high altitudes.
posted by daffodil at 2:05 PM on July 17

In the end, I trusted the acclimation programme of the tour operator and I never touched the Diamox. My sats never went lower than 88 the whole trip and I felt fine. I went with the Mountain Company (and would highly recommend them!) and their philosophy was to take it slow, and it worked. We lost nobody due to AMS and other groups with more aggressive schedules really suffered. Thanks!
posted by frumiousb at 7:06 PM on August 20 [1 favorite]

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