Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Questions about Diamox

We've been reading some of the messeges on the board regarding Diamox. If you've taken it, did you start a day or two before your hike or the day of? I have had problems with altitude sickness in the past on Mt. Shasta, but don't want to take it if there are crazy side effects. Please give me any info that you have on Diamox.

Thanks a bunch!!

You could start here, especially the information by Ken and the link by Versitle fred.

http://www.whitneyportalstore.com/forum/...=true#Post29666

The effects seem to vary but many people including ER teams do well with it. I'm leaving Tuesday for Cottonwood and we will take some Monday afternoon, Tuesday afternoon and Wednesday prior to Langley on Thusday. Many people do well at altitude without it. I have always been in great shape but that hasn't prevented me from getting real sick on Whitney going up quickly. As others have said, nothing is better that time to acclimate. But, Diamox has worked in Peru and on quick ascents in the Sierras. Good luck.

Regarding the usage of Diamox, can one of you more experienced in usage let me know what the normal dosage is? I'm taking Diamox to Kilimanjaro with me in 3 weeks and have been perscribed 250mg tablets to be taken twice/day as needed.
I would appreciate any input on this.
Thanks much

Here is a page I put together on Altitude Sickness. It addresses Diamox and gives links to several studies.

The studies stress that Diamox should be taken one to three days before you climb to altitude, because it takes time to get into your system.

As for dosage, some prescribe 125 mg twice a day, others 250 mg twice a day. Before you go on your trip, I would try the 250 dose for two days at home to see if you have adverse affects. My doctor has advised the lower dose, which seems to help me.

When you climb Kilimanjaro, don't you start low, and ascend slowly? If that is the case, you should be able to acclimate as you climb.

I've also had altitude problems in the past (severe headache/nausea), so have always used Diamox for my Whitney climbs (14 of 'em). I've used the 250 mg. twice a day. It's available in 500 mg. sustained-release form as well, which is nice, because you can take it just once a day. However, it is much more expensive that way. I start taking it 2 days prior to the climb. The only side-effects I've had involve a little diuretic effect, & some minor tingling of hands & mouth, mostly the first couple days. No crazy side effects other than that. Just keep in mind, however, that people all react differently to medications.

It seems each year that the dosage goes down. There is no question that side effects are directly related to dosage.

Currently, I recommend 1/2 of a 125 mg tab, taken once a day, at bedtime. Virtually all published dosages are derived from dosages used for treatment of glaucoma. There is no benefit from the sustained-release forms---for altitude illness, just for Glaucoma.

Of note, everyone talks about AMS, HAPE and HACE, but probably the most common form of altitude illnes is related to abnormal breathing patterns during sleep, which is highly disruptive to the sleep process. Diamox is highly effective and considered the treatment of choice for this....so those who have trouble sleeping when going up may want to consider this, also.

People note that there is increased urination, and that is so, although not so bad with the low dosage. However, one should understand that the process of acclimatization involves dumping certain things in the urine, and accelerating acclimatization will increase urination.....and that is exactly what one wants. If you start a couple of days before the climb, it will be largely over by the time of the climb.

Hope that helps.

I used diamox two years ago on a successful trip to the summit. I started taking it two days before and we acclimatized by spending a night at Onion Valley and the next night at Whitney Portal before hitting the trail. Then we camped at Trail Camp before summiting the next day. While I never experienced any symptoms of altitude sickness I don't know if that was because we stayed at altitude three nights before summiting or if it was because I used the diamox. Generally I disliked the diamox and wouldn't use it again. It made me a little bit jittery, and I didn't like the tingly sensation in my fingers and toes. My big toes were numb for a month after returning from the trip. I don't believe it was from the boots, which were roomy in the toe box and well broken in. So next time (hopefully next year) I will acclimatize in a similar fashion, use some ibuprofen for any slight headache, and go without the diamox. Not to minimize the potential for altitude sickness, but we're not talking about extreme altitude here.

Actually, it is significant altitude, of course not extreme like an 8,000 meter peak, but people do get AMS and its complications including HAPE and HACE and even death at altitudes less than the summit of Whitney. Rare, some would say? Well, no, not rare. One in a million is rare, but these problems happen in varying degrees with enough frequency that those of us in the medical and climbing communities have seen it, treated it, evacuated people with it, and advise caution. Yes, on Whitney they usually get down to safety. But, once you see someone gasping for air with heart pounding while sitting in the tent, or unconscious, or hauling them on your back in the middle of the night down to safety, then it will make a bigger impression. There is an educational reason for me and others here sounding rather patronizing about this, so the link below is offered as one of several good sources for more information.

One particular altitude tutorial is at:
http://www.ismmed.org/np_altitude_tutorial.htm#goldenrules

Hope this helps. Harvey

I agree with Harvey and would add another important comment - Diamox is a prescription drug with many known adverse effects, including:

-Cardiovascular: Flushing
-Central nervous system: Ataxia, confusion, convulsions, depression, dizziness, drowsiness, excitement, fatigue, headache, malaise
-Dermatologic: Allergic skin reactions, photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
-Endocrine & metabolic: Electrolyte imbalance, growth retardation (children), hyperglycemia, hypoglycemia, hypokalemia, hyponatremia, metabolic acidosis
-Gastrointestinal: Appetite decreased, diarrhea, melena, nausea, taste alternation, vomiting
-Genitourinary: Crystalluria, glycosuria, hematuria, polyuria, renal failure
-Hematologic: Agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia, thrombocytopenic purpura
-Hepatic: Cholestatic jaundice, fulminant hepatic necrosis, hepatic insufficiency, liver function tests abnormal
-Neuromuscular & skeletal: Flaccid paralysis, paresthesia
-Ocular: Myopia
-Otic: Hearing disturbance, tinnitus
-Miscellaneous: Anaphylaxis


You should not take this (or any) prescription drug without consulting a physician, particularly a physician experienced in high altitude medicine in this particular case. Even then, it would be smart to try it before you climb to avoid discovering that you have a reaction on the mountain. It is unwise (to be polite) to take Diamox just based on postings on this board.

This discussion comes up every year on this board and very good advice is given by the regulars such as Bob R., Harvey, Ken, and Sierra Sam.

However, I do not purport to know a thing about the pros and cons of Diamox but I relate this line of thinking to athletes that take drugs to enhance performance and then suffer consequences later in life. I know we have become a drug society and to some degree taking drugs to acheive an otherwise unacheivable result is considered okay, but I for one would opt out of going to the top if I had to do so artificially.

I know a lot here who will disagree with this point of view but I wonder how many people could have successfully summitted had they taken the time to properly acclimatize rather than opting for the security of Diamox. There have been many stories of people that have made unsuccessful attempts doing what was recommended to acclimatize and later were successful using Diamox.

I've been taking Diamox for the last 7 years and it has only been in the last year that I got the dosing right for me. You are not going to get good advice from a doctor in most cases because the doctor doesn't know a damn thing about its use to alleviate the symptoms of AMS.

Even when using this drug, I have had episodes of AMS, tossing my cookies at Whitney Portal...that's right 8,635' and more than a few episodes of loss of appetite at elevations in excess 12,000' but no alien trying to crawl out of my eye headaches.

The drug is effective and the side effects can be minimized but not eliminated. I've all but eliminated the tingling in the extremities but drinking a beer or soda is a no-no until 24 hours after the last dose.

The best source I have found about Diamox and AMS is Dr. Peter Hackett.

Lasting, my dosing regiment is not in line with the current recommendations. You are going to have adjust it meet your body's needs.

Thanks to all of you that replied to my question regarding dosage. It would appear from the responses that there is no right or wrong amount, that everyone is an experment of one. I will heed the advice and be cautious in it's use.

Joe

Memory Lapse,
I've been going back and forth with just the very thoughts that you wrote. Thank you. I'm not too hip on taking any type of drugs, and would love to see what my body can do on it's own. I'm also concerned about the side effects that some have had from Diamox - that can't be a good thing!

Happy Hiking!

Memory Lapse, I think you bring up an interesting point. I am quite opposed to performance enhancing drugs.

However, I disagree with you in this particular situation, and let me explain why:

Altitude illness is not a lack of ability to perform, it is an illness, the same as diabetes, asthma, or hypertension. When climbing the mountain, often those things are also affected by the climb.

Would you consider it "unfair" for a diabetic to adjust their insulin? An asthmatic to adjust their inhalers? A person with high blood pressure to adjust their medication?
Would a person who is artificially limited by their heart regulating medication, who adjusts that medication, "cheating"?

What is in common with those 4 examples and diamox treatment of altitude illness, is that using or adjusting the involved medications actually produces no performance enhancement.....beyond what a person would be able to do if they did not have the condition. It does not "boost" them beyond their "normal" non-illness baseline, it only returns them to normal. Like a person with bad knees, who uses poles.

Like the other 4 illnesses, altitude illness is primarily determined by genetic predisposition, it is not caused by lifestyle (although may be exacerbated).

Interestingly, Diamox IS banned by the Olympics, but not because it enhances performance. It can be used to artificially reduce weight (important in wrestling, for example), and can dilute other illegal drugs in the uring.

There is often a tendency for people with illness to consider themselves "weak", and that having the illness is a sign of fault, silly as that seems. The most common reaction when a person is diagnosed with Type I diabetes, is to ask how to "beat it".....but they will require lifelong insulin, or will die within weeks. That is the acceptance that is the first part of treatment. But many feel guilty their entire lives, feeling that they did something to deserve it.

There is certainly much anti-medication feeling among people, and a desire to return to a simpler time, such as 1900, only 100 years ago........when the life expectancy of Americans was about 30 years.

I see your point but would offer that going to altitude to summit Mount Whitney is a voluntary act and the four illnesses are not necessarly the result of voluntary actions (one could argue lifstyle choices that result in cardio and diabetic illnesses).

I don't believe for one moment we should regress to a "simpler life" and think there is a place for proper drug use but we are too quick in our society to find the easy way to get and do whatever we want many times at the expense of our bodies.

As I said I don't know the pros or cons of Diamox but I am guessing it was developed as a cure for something not as a preventive like vaccinations.

That's like taking motion sickness drugs without knowing if I'm going to get sick. And as you point out, altitude illness is primarily determined by genetic predisposition, therefore, I'll pop a Diamox to do something I couldn't already do just like hitting 751 homeruns. People adjusting their medication dosage in my mind is much different than going to the corner physician to get some high altitude high.

I appreciate your comments, I know you have the professional background in this area that I don't.

And I understand your comments about guilt, I had an MI when I was 35 and felt for several years I was damaged goods and completely without value. But I got over that and did so without taking drugs.

This is extremely obvious just from TV commercials, magazine ads, etc. Anything inconvenient can be remedied easily with a drug. Drugs to make you happy, drugs to make you sleep, drugs to stop up your bodily functions, drugs to increase the same, drugs to make you a 'bedroom athlete', drugs to mask the pain that tells you the painful part needs rest ("I haven't got time for the pain..."), drugs to let you go to work when you're sick, to make you relax, to stop the indigestion that's due to the stress that you should be eliminating, to lower your cholesterol count, to lower your blood pressure, and on, and on. In most cases, those drugs are consistently the WRONG way to do it, and in the long run either have other complications or don't really solve anything.

I don't consider treatment for diabetes or diseases at all like using a drug to achieve your goals, and whether it's hitting home runs, or climbing Whitney, those are elective goals.

There was a discussion a while back about losing weight, and it seemed overwhelmingly (and refreshingly) clear that most folks here understand that the way to do it is by diet and exercise. Why? Because, even though it might seem like it's harder, it works, it works long-term, and there are no side effects, short or long term, at least not bad ones. Yet so many are willing to pop Diamox to ascend Whitney. It's understandable, given the attitude we have toward drugs in general in this society, but whether it's the best way is another thing.

I'm afraid I'd also be one to choose not to summit if taking Diamox was the only way I could do it.

"That's like taking motion sickness drugs without knowing if I'm going to get sick."

NOW we're getting somewhere! Talking about the sailing!

Funny example you've chosen. That is EXACTLY the way we use motion sickness drugs. The problem is, that if you get seasick, and you are out there, NOTHING helps. First you're afraid you'll die, then you're afraid you won't. So, you either turn the boat around spoiling the trip for everyone, or you have the person suffer. I sail a lot, often with novices. The standard advice is: unless you are SURE you do not get seasick, please take a seasickness pill an hour before arriving at the dock.

"but would offer that going to altitude to summit Mount Whitney is a voluntary act and the four illnesses are not necessarly the result of voluntary actions"

You miss my point: the voluntary part is the going to Mt. Whitney. The genetically caused illnesses (all FIVE of them), all require medication adjustments to summit successfully, assuming the person with severe AMS tendencies has trouble acclimatizing the usual way, which some clearly do.

Let's try another much closer example: there are people who only get asthma at higher altitudes, say over 10k. There is not a body of research on this, but I could conceive that if they did a staged ascent, they might not need to treat. If that were an option (although untested), would a person using breathing treatments during their ascent be cheating?

The great adage is "all things being equal......" but the thing is, they almost never are. A person whose life involves circumstances that do not allow them reasonably to be gone to the mountains for an extended period, and who has a genetic predisposition to AMS....I don't think less of them that they have the same ambitions as the rest of us, and they work to improvise and overcome the obstacles. I think more of them for the effort.

If you thought the asthmatic was ok to use their medication as they ascended, even though they didn't know that they would actually get an attack, you should understand that those medications are VASTLY more dangerous than diamox used in appropriate dosages, except in one case....oral cortisones, which are exactly the same drugs, in exactly the same dosages. For asthma, it would be considered a routine drug. For AMS, it would be considered an extraordinarily strong drug.

My point is that it starts to get a little cloudy, as to what judgements should be passed upon others actions, when they don't apply to oneself.

I prefer not to discuss any individual's medical situation, because that can quickly turn into a pretty ugly discussion, which I'd like to not get into.

"I don't consider treatment for diabetes or diseases at all like using a drug to achieve your goals, and whether it's hitting home runs, or climbing Whitney, those are elective goals."

Gary, it sounds like you'd be astonished what motivates people to get medical care. Very very often, to accomplish elective goals.

The most common reason I hear middle aged people give to quit smoking? So that I can live to see my grandchildren.

Absolutely elective. Unreasonable? Can't see that.

Remember, diamox does not enhance performance. It only allows a person with a disease tendency to deal with it better. The person who does not have that genetic tendency, or who has all the time in the world to lounge around the mountains acclimatizing, has a very real advantage. If anything, it seems like they might be "cheating" somewhat.

Ken, you say it way better than I can, but I'll try to add some here...

I just don't get why some people are SO against taking something like Diamox. It is my personal experience that taking it has no more adverse effects than taking ibuprofen, and like ibuprofen, it seems to help relieve specific problems. I'll bet if you guys experienced the altitude symptoms I do, you would be singing a different tune.

Benadryl once required a prescription. So did Claritin. They all carry lists of warnings. I suspect the warnings for Diamox are particularly long primarily due to the fact that it is usually prescribed for people with glaucoma, and in that group, their general health may already be compromised.

Taking Diamox does not make or break a trip to the summit of Whitney. Its main effect for me is help maintain a normal appetite (and eating seems to help me keep up with my friends on the hike)

I also take Claritin sometimes for a weird allergic rash I get when hiking. Are you folks going to say that I shouldn't climb mountains because I get a rash?

On the other hand, I have had some severe adverse affects from taking Excedrin (a combination of aspirin, acetaminophen (Tylenol) and caffeine). On four separate occasions involving altitude, heavy exertion and fatigue, the dose left me nauseated to the point I needed to hyperventilate repeatedly to prevent barf attacks. The problem lasted from one hour to all night. Those four occasions were spread over a number of years, and I took Excedrin at other times with no problems, so it took some time to realize the cause of my symptoms.