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Acetazolamide vs ginko biloba for AMS?

post #1 of 17
Thread Starter 

Hey, I am heading to vail, from New Jersey next week and am very concerned with altitude sickness. I have got it BAD in the past, vomitting, headaches, collapsed on the mountain and had ski patrol take me down. This was when I was a teenager (I a now 27). 


I have always had some ford of altitude sickness when I head out there to varying degrees. I have taken Acetazolamide in the past and remember it helping. Other times I just relied on oxygen, but it has been about 10 years since I have been out there and am wondering if I should get myself a prescription of Acetazolamide or if I should give ginko biloba a try. I do not remember any bad side effect from the diamox, but I would like to go natural if I can.


Does anyone have any personal experiences with either? 


Thank you

post #2 of 17



I routinely do the Acetazolamide regimen prior to all trips out west.

Like you , I live at sea level.


I tried Gingko B. without noticeable change.

Acetazolamide has a much more proven track record.

Remember that it works as prevention, not treatment for AMS.

It's a decades old diuretic which works in the kidneys.

Changes your acid/base balance in prep for the higher altitude.

Start taking it 2 days prior to your departure date.

The usual dosage is 250mg twice a day.

I usually begin to taper off of it the third to fourth day at altitude, but actually continue taking a half pill daily to combat

edema around my eyes. (yes, for cosmetic reasons).


Down sides:


You pee a lot.

Makes carbonated beverages (aka the apres-ski beer)

taste horrible.

Remember to hydrate aggressively to replace fluids.

My personal feeling is that diluted sports drinks/vitamin water type stuff is better than straight water.

The sugars/electrolytes help "hold" the fluid in your system better.



post #3 of 17

Be sure to read the Epicski article by DP on Altitude Adaptation and Acute Mountain Sickness.  It is one of the best ones out there.

post #4 of 17
Thread Starter 

Thanks I know it by heart, I have read it a few times? The other thing I wanted to point out is that, the time I was really sick was in summit county at breckenridge, we slept at about 10,000 feet. I will be at the base of vail this time which is around 8-9000 ft, do you think that will make a difference?

post #5 of 17

Not to put a damper on your trip, but I would recommend that you talk with your doc.  If they aren't familiar with HAI then have them refer you to a pulmonologist or other specialist that is.  There are several factors that will predispose you to it.  One of the strongest predictors is a prior history of HAI.  HAI is one thing, but HACE (cerebral edema) can kill you and is just further along the spectrum of AMS.   If you were that sick before, I wouldn't take a chance without talking to someone about it.   Diamox is a good prevention and so is Dexamethasone if you can't tolerate Diamox.  Neither of which will prevent HAPE (pulmonary edema) though.  Just my 2 cts.

post #6 of 17

The lower altitude of Vail will definitely help.  Whether you still will be susceptible is another matter.  Follow DP's advice (he is an anesthesiologist at the CU Med School) and a mountaineer so he has expertise in the area.  Stay off of the alcohol and drink lots of water.  And remember to enjoy your trip.



post #7 of 17

Based on your posts it sounds like you're trying to bargain with the forums. You have stated several times that you have had symptoms of varying degrees. I'd listen to what others that obviously know what their talking about have said but you really need to see your own MD & speak with your buddies about keeping you out of trouble if you start going downhill (pun intended). 


Fyi many if the drugs we prescribe are originnaly derived from natural substances. A packaged pill is not going to have less potential side effects than a plant extract that, for governmental and financial (forget scientific) reasons is sold as a food supplement. I'm surprised in our litigious society that water doesn't have a package insert. Oh wait...


Anyway, acclimate slowly over days, drink h2o/electrolyte drinks a lot , no alcohol, come to lower altitude ASAP if you remotely think you have symptoms. 


Report back to us when you get back from your trip!

post #8 of 17

I've had good luck with Diamox myself--and I've had very bad altitude sickness in the past, and possibly HAPE when I went from sea level to 14000+ in a few hours (I was a subject in a high altitude research project when I was in med school). I have  no experience with Ginko. I would caution anyone who takes high blood pressure medication to back off or stop it if taking diamox--diamox will lower your bp--I found out the hard way.  Your physician should advise you of course and if you have a bp machine take it with you. Altitude sickness does improve some with age in some folks so you may do better this time around.  It helps to sleep lower as you will be doing. Effort also makes a difference--take it easy until you see how you are doing and stop skiing as soon as you start to get symptoms. Since you've been able to get by with Diamox in the past since your bad episode you should be able to do well.  Obviously you'll have to see your doc to get a prescription but it doesn't seem like you'd need to see a specialist.    

post #9 of 17

Acetazolamide works quite well in preventing, not treating, altitiude sickness.  I have responded to a low dose, 125mg twice a day, starting the morning of travel.  Higher doses make my fingers tingle.  Vail will be easier on you than Breckenridge; 8k is way better than 10k.

HACE or HAPE are quite unlikely at 8000 ft.  Even at the top (11,000) it's quite unlikely since you're taking a lift to to the top and will be there briefly.  Hiking there with a heavy pack is far more lilely to cause issues, as the level of exertion and dehydration are big factors.  

post #10 of 17

Another fan of Diamox/Ace.  Also, just because you had problems as a teen doesn't mean you'll have problems this time, especially if you follow the standard precautions.  It seems to strike with a funny randomness even for the same person or between several travel companions without respect to overall fitness.

post #11 of 17
Thread Starter 

Thats for all the tips, I am going to see my doctor this afternoon, I was just looking for some advice from people with actual experiences at altitude. Any down side to taking both the ginko and the diamox?

post #12 of 17
Thread Starter 

Thats for all the tips, I am going to see my doctor this afternoon, I was just looking for some advice from people with actual experiences at altitude. Any down side to taking both the ginko and the diamox?

post #13 of 17

Probably not!

Different "pathways" for sure.


Try a google search to make sure.

I don't mind experimenting on myself, but don't advise it for others!wink.gif


One poster mentioned tingling fingers/lips. This is a side affect.

And one that let's you know you have the medication on board.





post #14 of 17
I used to come west each spring from 600 feet above sea level, visiting different areas each time, from the 1970s on. In 2003 I had a lot of headaches, nausea, but not worse symptoms at the Salt Lake area. I started using Diamox after that, beginning three days before travel and had a much easier time. Now that I live in Breck, I have little trouble coming back from trips to low altitudes that last a month or so. That's as long as I've been away since moving here.

Anyone who experiences your type of symptoms when at altitude should print out DP's artical, highlight your symptoms and show it to your physician. Diamox requires a prescription. If your doctor balks, find a more modern physician.
post #15 of 17
Thread Starter 

Alright I got my diamox, the doctor admittedly did not know much about AMS, He said start taking the 125 mg twice a day 3 days out, and continue while there.


What does everyone think, how does that sound? From what I have read some people have waited til the day of travel

post #16 of 17

Some people do well with 125 twice a day, I need 250. I would start 1-2 days before the trip.  Here's how it works: some people's respiratory drive (the drive that makes them breath more) is most sensitive to low oxygen--these people do well at altitude. Other people are more sensitive to pH and carbon dioxide--when they breath more their carbon dioxide in the blood falls and the pH (alkalinity) rises--this makes them cut back on their breathing, despite the low oxygen in their blood, These people do not do well at altitude.  The differences between the groups are most marked during sleep.  Diamox lowers the pH of the blood and allows the second group to tolerate hyperventilation in response to low oxygen.  It takes time for the pH to fall which is why you should start before the trip. 

I usually take it for 2 days after I arrive at altitude--by that time I'm acclimatized enough at the altitudes I go to (sleeping about 11000, climbing to 15000)

I would emphasize staying hydrated.  You can't use urine output to tell if you're drinking enough--diamox is a diuretic--makes you pee more, even if you're dehydrated.

post #17 of 17

Sorry to be so late to this discussion. I think that it's been covered fairly well. As was mentioned, someone who is prone to develop AMS will be better off at Vail than Breck. I think that the biggest difference is not actually the peak elevation that you ski from (which is close to 300m higher), but rather the elevation you sleep at, which is 300m higher at Breck. There is no question that 1000 feet- or less- makes a difference, and descent by as little as that can make a difference for someone who is sick.


With a history like the OP's, I would go right to diamox, especially since he has responded to it in the past, unless the side effects have been problematic or he has a sulfa allergy. Graded ascent (a day or so in Denver before going high) is also a very good idea. High carbohydrate diet 1 week before ascent has been shown to be helpful, as has avoiding alcohol (it appears to slow adaptation.


Diamox dosing: 125mg twice a day is what I recommend starting with, 48-72 hours before ascent. There are people who need twice that dose, but more than 75% will do well with the lower dose, and the side effects from the lower dose are usually much less obnoxious, although I would still recommend avoiding beer (it will taste terrible while on the drug). (see van Patot, M.C., et al., Prophylactic low-dose acetazolamide reduces the incidence and severity of acute mountain sickness. High Alt Med Biol, 2008. 9(4): p. 289-93.)


It is not completely correct that acetazolamide (Diamox) is useful only for prophylaxis of AMS- it can be used for treatment as well, although the standard for treatment is descent, not medication. Dexamethasone is usually recommended for HACE but acetazolamide, if not already in use, can be helpful as an adjunct as well, and starting diamox just for symptoms of AMS after ascent has been shown to be effective. Gingko, on the other hand, has only been shown to be effective for prophylaxis. There has been considerable variation in the effectiveness of gingko in the numerous studies that have been published, which may relate to study methodology, drug potency and purity (remember that these "alternative" therapies are not FDA regulated and thus subject to tremendous variability in  preparation). Since we do not know what the active agent is, one cannot rule out pharmacogenomic factors either. For a good review of this see a paper by my colleague Martha Tissot van Patot (van Patot, M.C., et al., Ginkgo biloba for Prevention of Acute Mountain Sickness: Does It Work? High Alt Med Biol, 2009. 10(1): p. 33-43.).


There's a really good up to date review of AMS by Brownie Schoene, one of the major figures in high altitude research (you will probably need a technical background to understand some of it): Schoene, R.B., Illnesses at high altitude. Chest, 2008. 134(2): p. 402-16.

We are doing some new cutting edge work on gene expression here that may lead to new treatments in the not too distant future. The first series of studies were done last summer in Breckenridge, and we are going to Bolivia to do some further studies at 5000m this coming summer. The DOD is very interested in this because of problems they have had with rapid deployment of soldiers in Afghanistan and AMS. Stay tuned for further developments!
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