Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Diamox - Needed or not ?

Hi team of adventure warriors,
I am seeking opinions on the benefits or not of taking Diomoxin, which may be spelt wrongly, prior to doing a one day summit attempt.
Me, well i've always taken it, usually 125mg twice a day for three days prior and i've never had an altitude sickness issue. Is it helping, who knows?
Others I know have never taken anything......

So, oh gang of experienced outback pioneers, what are your experiences or suggestions.

* Getting ready for the altitude
* Altitude and Diamox
* Diamox for mountain sickness
* Altitude sickness medication

see links under Orientation Notes for Whitney first timers

The correct spelling is Diamox.

There are other threads where this has been debated at great length. Here is a quick answer:

Diamox is the most popular drug for dealing with high altitude. It helps you acclimatize, it has minimal side effects, and it's available as a cheap generic. Most people climbing in the Sierra don't need it, but some do.

As with any drug, the best dosage is the lowest one that will do the job. When I climbed Denali, the guides had us wait until we had difficulty sleeping before we took any. We took a quarter or a half of a 250mg tablet twice a day. Everybody did fine. It's not necessary to take it as a preventative, though many people do that. I think most people will tell you that taking it for three days in advance is overkill. Trying it before you go into the mountains to make sure you don't have bad side effects is a good idea.

If you can climb without using Diamox, don't use it. If you know you're going to have problems, bring it, and consider taking it before symptoms appear. If you don't know how you will do without it, I would bring some and just wait and see what happens.

The way I see it is if you have to take "something" to be on top of "something" maybe you shouldn't be on the mountain to begin with.

Pop a pill, there go your ills.

That's just my opinion.

as an ER Doc and climber ... it's probably the most effective anti-AMS med. Studies have shown that the young, elderly, and women frequently do better at altitude than others. If you've climbed above 10k in the past and have developed nausea/headache then you may benefit from diamox. If you've never climbed above 10k without the med, it may be worth a trial climb above that threshold without it. One of the potential significant side effects of the medication is dehydration, especially if on a longer trip. Another very annoying effect is the complete destruction of the taste of beer, and after a long hike that really sucks! A buddy and I are doing the HST/WPT from crescent meadows to whit summit and down to WP this week, I'll be taking diamox. See you on the trail.

OK, see, yeah, you lost me right there...

Moosie, you are never OUT of the mountains long enough to De-Acclimate. So your comments are not allowed.

This may come under the heading of "Too Much Information", but
others and I too have experienced that Diamox = you pee alot more. On Kilimanjaro in 1994 I (age 57) had to get up 5 times a night vs only once a night normally. On Kili my son(age 32) did not take it & reached the summit OK. I did not want to take it, but felt if I didn't take it and failed to summit, I would never forgive myself, thus I took a diamox each day above 14,000'. Really enjoyed seeing the stars at night, but that was the only pleasant part of the 5 times my sleep was interrupted.

I took it once to try and get a better nights sleep at 12k. I didn't sleep any better and I "tingled" (a common side effect)for days. Nope, I wouldn't recomend it.

About a month ago: A hike over approximately 85-100 miles ranging from approximately 10,000 - 16,000+', five in party. Three of the five (other than my wife and I) were taking Diamox.

First member of the party, a young lady of around 23, crashed at ~11,000'. Despite the diamox, she got AMS really bad. Guides put her in the gamow bag. Even that and additional meds made no difference. Sadly, she had to turn around and head down.

The other couple were real strong hikers. Showed no altitude problems even at 16K. (Of course, being on the diamox probably helped.) But, diamox makes you have to pee more, and the lady wasn't real keen on going to the bathroom on the trail that much, so she wasn't drinking much or "going" much. In short, gave herself a bladder infection. They ended up being rescued ('cause she got herself really sick), a couple days out from the end of the trek.

Only my wife and I (the ones not using diamox) finished the trek.

So, basically, it's based on your individual physiology how you do with either approach. I did have one "bad" day - the day we went from ~11K over one of the 16K passes. Other than that, I felt great for the entire trip, which was mostly above 12K and included the highest pass we went over (~16,300').

p.s. Oh, the couple were both having pretty bad trembling and tingling of the extremities the whole time. The guy would go to pick up a cup of tea and his hand would shake really badly. Yech.

And how much were they taking???

You can minimize side effects by using the lowest dose that alleviates symptoms. (That's true of all drugs.) One quarter of a 250mg tablet twice a day may be enough. That's all I used on Denali, and I didn't notice any side effects on the mountain. Carbonated beverages tasted a little strange when I got down, but I decided that reaching the summit was more important than how a beer tasted.

Hey, Steve. I don't know how much they were taking. I think I remember them mentioning a 250mg tablet, 2x per day, but could be wrong.

I do know they followed whatever their doctors directed them to do, as they were discussing when to start taking the meds, etc. (I think that was something like three days prior to the highest point, or something along those lines.) So, if the above is the "standard" regimen, pretty sure that's what they did. They definitely weren't cutting tabs in half at the dinner table or anything.

I believe both parties had the same dosages/intervals prescribed to them (the young lady and the other couple).

Bob's nailed it.

It used to be Diamox wasn't FDA approved for AMS but it was commonly prescribed off-label because of strong evidence that it was safe and effective. Eventually a proper drug trial was conducted and AMS was added to the label. Later it was learned that a lower dosage was usually just as effective but the approval process for this dosage has so far not been completed. So if you look it up in the PDR it says 500mg daily taken in two doses but it's pretty well understood that this is overkill for most people. The Nepal Himalayan Rescue organization recommends 125mg [half a tablet - edited by Steve C.] twice daily.

Diamox and whiskey mix okay.

Got AMS on my first trip to Sierras at Crabtree Meadow; Cheyne-Stokes breathing, claustrophobia in tent, etc. Next trip I took diamox and had no problems. I do agree that the minimal dosage that works is the way to go.
Third time I decided to stay better hydrated, but also carried Diamox. No problems, didn't need the Diamox.
This year, after deciding that keeping well-hydrated was the key, I decided to forego the diamox. On two camps above 10,000', I once again developed my usual AMS symptoms; I remember lying in the tent at 3a.m. and thinking to myself, "I should have brought some Diamox."
As far as the peeing issue, I was going 4 times a night anyway from all the water that I was slamming, not to mention a 58 year old bladder/prostate. ;-)
Bottom line - if you're nervous about AMS get a prescription for Diamox and take it along, just in case. Try to stay well-hydrated too.

Mark

packmule: Cheyne-Stokes and associated claustrophobia are not symptoms of AMS. But it is true that Diamox works pretty well to prevent Cheyne-Stokes breathing. I've read that it can work to start acidifying your blood within one hour. So you can wait and see if you're going to have that problem and take it at bedtime (along with your whiskey) rather than in advance.

http://en.wikipedia.org/wiki/Cheyne-Stokes_respiration

Cheyne-Stokes respiration (/ˈtʃeɪnˈstoʊks/), also known as periodic breathing is an abnormal pattern of breathing characterized by oscillation of ventilation between apnea and tachypnea with a crescendo-decrescendo pattern in the depth of respirations, to compensate for changing serum partial pressures of oxygen and carbon dioxide.

This abnormal pattern of breathing, in which breathing is rapid for a period and then absent for a period, can be seen in patients with heart failure,[4][5] strokes, traumatic brain injuries and brain tumors. In some instances, it can occur in otherwise healthy people during sleep at high altitudes.


http://www.theuiaa.org/medical_faq.html

Q: I tend to get up very often at night at high altitude with a “choking sensation” causing me to be very anxious. What can I do?

A: This phenomenon is probably due to excessive “periodic breathing” at altitude and often leads to an anxiety attack. This is a common problem. Reliable data has shown that low dose acetazolamide (125mg before dinner) may decrease these spells of periodic breathing in sufferers and bring the oxygen levels higher and do away with the choking sensation.

http://www.theuiaa.org/upload_area/files/1/UIAA_MedCom_Rec_No_2_AMS_HAPE_HACE_2008_V2-2.pdf

I've just obtained my prescription for Diamox and have never used it before. Unfortunately, my generic version of the drug is contained in a 500mg capsule so it may be hard to split.

Aside from being a little tired above 14,000 feet, I've never experienced altitude sickness. However, my Mt. Blanc guide recommended it because the peak is over 15,000 feet.

I first plan to test it at sea level. If all goes well, I then plan to see how it affects a climb on Mt. Dana.

Will the side effects be the same at different altitude levels? Also, does the amount of physical exertion change the side effects?

WhitWalker: First, I'd call the pharmacy and ask whether they will trade you for 125 or 250 mg tablets. And I don't think the side effects would differ much at different altitudes.

Also:  All you guys talking about "enjoying the stars" multiple times in the night:   I was given a tip by an old guy one winter evening in the Pear Lake hut -- He used a bottle for a very special purpose.  Said it really saved him from needing to climb down from the bunk in the middle of the night.

It sure is better than trying to limit your fluid intake several hours before bedtime. A 20 oz Gatorade bottle only weighs an ounce.

And I'll throw this out to you girls ('cause I don't know about the rest of y'all... but I am not so talented as to be able to use a gatorade bottle.. maybe with a little practice...) a couple gallon sized ziplock bags work just as well... make sure they're sealed completely... can be emptyed in the morning instead of leaving the tent and dealing with all that in the middle of the night.