Acute mountain sickness

Tablets, sustained-release capsules, and injection - For the prevention or amelioration of symptoms associated with acute mountain sickness in climbers attempting rapid ascent and in those who are susceptible to acute mountain sickness despite gradual ascent. 

Acute mountain sickness - 500 to 1000 mg/day, in divided doses of tablets or sustained release capsules. For rapid ascent (ie, in rescue or military operations), use the higher dose (1000 mg). If possible, initiate dosing 24 to 48 hours before ascent and continue for 48 hours while at high altitude, or longer as needed to control symptoms. 

Sustained release - May be used twice daily, but is only indicated for use in glaucoma and acute mountain sickness. 

The three main types of altitude illness, characterised initially by nausea, headache, sleep disturbance and stomach upset, are acute mountain sickness (AMS) high altitude pulmonary oedema (HAPE) and high altitude cerebral oedema (HACK). They occur after rapid ascent to altitudes greater than 2,500 m (about 8,000 feet) in unacclimatised people. In unacclimatised mountaineers, the prevalence of AMS at 4,559 metres (15,000 feet) is approximately 50% and HAPE 4%. Risk depends on individual susceptibility, rate of ascent and pre-exposure to high altitude. AMS is not a pre-requisite for HAPE. 

Other suggested uses include sexual dysfunction secondary to selective serotonin reuptake inhibitors (SSRIs), macular degeneration, premenstrual syndrome, and the prevention of acute mountain sickness at high altitude. Some of these uses are supported only by a single study. 

Acute mountain sickness PO 500-1000 mg/day in divided doses, if possible, begin 24-48 hr before ascent continue at least 48 hr at high altitude. Initially, 250 mg 2 times/day use lowest effective dose. 

V. Effective in ameliorating the symptoms of acute mountain sickness. 

Bihl G, Meyers A 2001 Recurrent renal stone disease — advances in pathogenesis and clinical management. Lancet 358 651-656 Brater D C 1998 Diuretic therapy. New England Journal of Medicine 339 387-395 Dumont L, Mardirosoff C, Tramer MR 2000 Efficacy and harm of pharmacological prevention of acute mountain sickness quantitative review. British Medical Journal 321 267-272 Hackett P H, Roach R C 2001 High-altitude sickness. 

The carbonic anhydrase inhibitors, of which acetazol-amide (rINN), a non-competitive inhibitor, is the prototype, are not suitable for normal diuretic use, because tolerance soon develops. However, they are well suited to brief intermittent use, particularly in the relief of glaucoma and in the prevention of acute mountain sickness. Acetazolamide and methazolamide (rINN) should be used with caution in the long-term control of glaucoma because of its serious systemic adverse effects. However, brinzolamide (rINN) and dorzolamide (rINN) are available for long-term topical administration. 

Chow T,Browne V, Heileson HL, Wallace D, Anholm J,Green SM. Ginkgo biloba and acetazolamide prophylaxis for acute mountain sickness. Arch Intern Med 2005 165 296-301. 

Gertsch JH, Basnyat B Johnson EW, Onopa J, Hoick PS, on behalf of the Prevention of High Altitude Illness Trial Research Group. Randomised, double blind, placebo controlled comparison of ginkgo biloba and acetazolamide for prevention of acute mountain sickness among Himalayan trekkers the prevention of high altitude illness trial (PHAIT). Br Med J 2004 328 797-801. 

Glaucoma (decreases formation of aqueous humor i IOP), acute mountain sickness (— - pulmonary and cerebral edema), metabolic alkalosis (e.g., thiazide-induced), elimination of acidic drugs (e.g., ASA, uric acid). 

American Medical Association as much as possible amorphous material ambulate ambulatory arm muscle circumference age-related macular degeneration acute megokaryoblastic leukemia acoustic myography acute myocardial infarction acute myelogenous leukemia agnogenic myeloid metaplasia acute myelomonoblastic leukemia amniocentesis acute monoblastic leukemia amputation ampule Austin-Moore prosthesis alternating motor rates acute mountain sickness amylase assisted mechanical ventilation... 

Consequently, diuretics have a variety of uses. Thiazide diuretics may be used either alone or in combination with other pharmacotherapy for the treatment of hypertension. Loop diuretics can provide immediate diuresis and are used for heart failure and in lieu of thiazides in patients with compromised renal function. In addition to more traditional uses, certain potassium-sparing diuretics provide added benefit to other pharmacotherapy in patients with primary hyperaldosteronism, heart failure, or post-acute myocardial infarction. Carbonic anhydrase inhibitors have limited use for diuresis however, they may be used to reduce intraocular pressure and treat acute mountain sickness. 

With prolonged use of the carbonic anhydrase Inhibitor diuretics, the urine becomes more alkaline, and the blood becomes more acidic. When acidosis occurs, the carbonic anhydrase Inhibitors lose their effectiveness as diuretics. They remain Ineffective until normal acid-base balance In the body has been regained. For this reason, this class of compounds Is limited In Its diuretic use. Today, they are most commonly used In the treatment of glaucoma. In which they reduce the rate of aqueous humor formation and, subsequently, reduce the Intraocular pressure. These compounds also have found some limited use In the treatment of absence seizures, to alkallnize the urine, to treat familial periodic paralysis, to reduce metabolic alkalosis, and prophylactically, to reduce acute mountain sickness. 

Carbonic anhydrase inhibitors are used to decrease intraocular pressure in patients with open-angle (chronic) glaucoma and are not used in narrow-angle or acute glaucoma. Other uses include inducing diuresis, management of epilepsy, and treatment of high-altitude or acute mountain sickness. 

Although acetazolamide can be used to treat acute mountain sickness at very high altitudes, a case report su ests that it may potentiate the respiratory depressant effects of benzodiazepines such as triazolam. Acetazolamide did not improve symptoms of sleep apnoea worsened by flurazepam. 

Mazzuero G, Mazzuero A, Pascariello A. Severe acute mountain sickness and suspected high altitude cerebral edema related to nitroglycerin use. High Alt Med Biol 2008 9 241-3. 

A 27-year-old man developed loss of visual acuity after treating himself with acetazolamide for acute mountain sickness. His distance vision deteriorated after a single dose of acetazolamide 250 mg. Fundoscopy was normal, but there was bilateral reduced acuity for distance vision, while near vision was unaffected. His visual acuity returned to normal within 48 hours. 

Kayser B, Dumont L, Lysakowski C, Combescure C, Haller G, Tram4r MR. Reappraisal of acetazolamide for the prevention of acute mountain sickness a systematic review and meta-analysis. High Alt Med Biol 2012 13(2) 82-92. 

Seupaul RA, Welch JL, Malka ST, Emmett TW. Pharmacologic prophylaxis for acute mountain sickness a systematic shortcut review. Ann Emerg Med 2012 59(4) 307-17. el. 

Acute Mountain Sickness Acute moimtain sickness (AMS) is the most common disorder at... 

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