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Article on Altitude Sickness

post #1 of 33
Thread Starter 
Found this on http://www.sportsci.org

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ALTITUDE: Acclimatization to Intermediate Altitudes
Luanne F. Hallagan
Edwin C. Pigman
Department of Emergency Medicine
George Washington University Medical Center
Washington, DC

Physiologic Effects of Altitude Acclimatization and Exercise
Prevention and Treatment of Acute Mountain Sickness

By 37 BC, the ancient Chinese recognized a peculiar illness when they hiked the passes of what they later named the Little Headache and Great Headache mountains. The first westerner to describe mountain sickness was the Jesuit priest, Jose de Acosta, who accompanied the Spanish Conquistadors in Peru. Since then researchers have described the consequences of travel to high altitudes and named the syndrome acute mountain sickness (AMS). Acute mountain sickness is characterized by a constellation of symptoms. Headache is the main symptom. Nausea, vomiting, dyspnea (shortness of breath), and insomnia are other common symptoms. The traveler at altitude can also experience impaired cognition and balance. Onset of symptoms typically occurs within hours to three days after arrival at altitude. These symptoms tend to resolve after several days but can persist for up to two weeks. They can be the harbinger of the fatal conditions, high-altitude cerebral edema and high-altitude pulmonary edema.

At intermediate altitudes, 1,500-3,000 meters, up to 25% of unacclimatized travelers may experience AMS. People with serious lung, heart and blood diseases are more likely to develop AMS. Healthy young adults who participate in vigorous activity upon arrival at altitude are also at great risk for AMS. Individuals with a prior history of AMS and who live at low elevations are especially susceptible. Those who travel rapidly to altitude, as is common with air travel, are also at greater risk for AMS.

Physiologic Effects of Altitude Acclimatization and Exercise


Studies have been conflicting regarding the impact of increasing altitude on cardiac output and contractility. Laboratory studies using hypobaric chambers to duplicate the effects of altitudes of 4,000 to 8,000 meters have shown a diminished cardiac output at maximal exercise. Other laboratory studies have shown an unchanged or improved cardiac performance at those same altitudes. These studies have shown that, despite a decrease in blood volume and reduced ventricular filling pressure commonly seen at altitude, cardiac output is maintained. Furthermore, an increase in cardiac output is seen at rest and at exercise when compared to the same activities at sea level. This increase is related to an increased sympathetic nervous activity, as demonstrated by increased blood norepinephrine concentration. On initial exposure to altitudes heart rate increases for a given intensity of exercise, but later the maximal heart rate declines. This decline may be due to altitude-induced increase in activity of the parasympathetic system. The decrease in maximal heart rate may be a beneficial adaptation to limit oxygen consumption.


An individual's initial response to the lowered oxygen tension at altitude is to increase ventilation, by increasing the rate and volume of breaths. This phenomenon, the hypoxic ventilatory response, varies between individuals. Clinical studies have shown that those individuals with a history of AMS have a diminished ventilatory response to simulated altitude exposure, as manifest by lower minute ventilation and higher arterial carbon dioxide, despite low transcutaneous oxygen saturation. In contrast, those who remain asymptomatic upon acute exposure to altitude have a high hypoxic ventilatory response. The mechanism for this process remains unclear.

As extremes of altitude are reached, the normal lung faces additional impediments in transferring oxygen to the blood. A non-uniform pulmonary arterial vasoconstriction has been demonstrated by using scintigraphy scanning with radiolabeled particles to evaluate the relationship of lung ventilation with pulmonary perfusion. This effect becomes apparent at 3,000 meters. Increasing exercise at this same altitude is also associated with an increasing limitation for the diffusion of oxygen across the alveolar-capillary membrane. At an elevation of 3,900 meters, the unacclimatized individual consumes more oxygen with the increased work of breathing than is gained by that additional ventilation.

There are clear pulmonary conditioning benefits from exercise at intermediate altitude. A greater metabolic efficiency is suggested by a 20% reduction in an individual's oxygen utilization with the same maximal exercise upon return to sea level after intermediate altitude conditioning. Hemoglobin saturation is achieved with lower partial pressures of oxygen and blood levels of 2,3-diphosphoglycerate are elevated after intermediate altitude conditioning. The ability of hemoglobin to carry oxygen to the tissues is further enhanced by the increase in the number of red blood cells.


Conditioning at intermediate altitudes results in increased buffering capacity of muscle, increased capillary supply to muscle, and a substantial improvement in aerobic capacity. At extreme altitudes (over 5,000 meters) there is a progressive decrease in muscle fiber size and oxidative enzyme activity. Anaerobic capacity is usually unaltered until altitude exceeds 5,500 meters.


Despite fatigue, travelers to altitude often have unrestful sleep because of diminished stage-3, stage-4, and rapid eye-movement sleep. In addition to a diminished quality of sleep, many individuals exhibit periodic breathing at intermediate altitudes, and all do at altitudes over 6,300 meters. Periodic breathing, waxing and waning respirations with periods of apnea, interferes with the already suboptimal arterial oxygenation in the hypobaric environment to produce cycles of even more profound arterial oxygen desaturation. Periodic breathing occurs during 24% of all sleep at 2,440 meters. Lastly, sleep at altitude is characterized by frequent wakening. All of these produce an unsatisfying sleep and contribute to daytime fatigue.

As with the other symptoms of AMS at intermediate altitude, sleep can be expected to return to normal with acclimatization. Sleep at very high altitude will remain persistently disturbed.


A diuresis takes place with loss of water and sodium during the body's attempt to acclimatize to altitude. This places the individual at risk for dehydration, especially when the individual is involved in maximal exercise.

This diuresis is a component of a successful adaptation to altitude. Acute mountain sickness, an unsuccessful adaptation, is characterized by a diminished diuresis, with fluids that are normally in the plasma volume moving into the cells and interstitium, resulting in facial and extremity edema.

Intermediate altitude conditioning commonly involves exposure to a dry and cool atmosphere. A large amount of body water can be lost that will not be apparent to the exercising traveler. Whether symptoms of AMS are present or not, drinking increased volume of fluids is recommended to prevent dehydration, especially with exercise.


Nausea and anorexia are common symptoms of AMS at intermediate altitude. Because extra fluid intake is important to replace the fluid loss from high-altitude diuresis, inability to drink and additional losses from vomiting may worsen and prolong the illness. A high-carbohydrate diet may be beneficial, and a low-salt diet may reduce tissue edema. A liquid carbohydrate diet may be easier to tolerate at first exposure to altitude. Because individuals with low iron stores are unable to increase their red cell mass in acclimatization, the diet should be supplemented with iron for those at risk, particularly menstruating females.


Headache, ranging from subtle to incapacitating, is often the first and most common symptom of AMS. The pain tends to be bilateral and throbbing in quality. It is worse in the morning hours and is exacerbated by strenuous exercise. Individuals with a history of migraine headaches are more likely to develop the headache of AMS. The headaches may be caused by a benign cerebral vasodilatation in response to hypoxia. Acetaminophen, aspirin or ibuprofen may be used along with rest and fluids to ease the headache. Resolution of the headache occurs with acclimatization to intermediate altitude.

At very high altitudes, headache may be the first warning sign of cerebral edema. This potentially fatal complication is rarely seen at intermediate altitudes and is associated with changes in the level of consciousness and disturbances in fine motor control and balance. It is treatable only with rapid descent.

At very high altitudes, individuals can experience hostile behavior changes, with thoughts of paranoia, depression, anxiety and obsessive-compulsiveness predominating. Those at intermediate altitudes do not experience any behavior changes consistent with increased aggressiveness. Feelings of diminished vigor, weariness, and increased sleepiness are commonly experienced at intermediate altitudes.

Alcohol, Sedatives, Tobacco

Alcohol can impair the altitude acclimatization process in a variety of ways. Alcohol acts as a diuretic and will exacerbate the dehydration seen at altitude. Alcohol can also impair judgment and depress respiration. Similarly, sedative and hypnotic agents impair the sleep-related respiratory cycle. While they may be used by the uninformed altitude traveler to improve the poor quality of sleep that is commonly experienced, the consequence of their ingestion is the further reduction in arterial oxygen saturation during sleep cycling. Furthermore, the type of sleep induced by alcohol and many of the hypnotic agents is not a satisfying, restful sleep.

Tobacco poses a number of long-term threats to the individual. A short-term effect of tobacco exposure on the traveler to altitude is the accumulation of carbon monoxide. This toxic gas is present in tobacco smoke and poisons the binding site of hemoglobin for oxygen. At the cellular level, carbon monoxide prevents the utilization of oxygen in cellular respiration.

Prevention and Treatment of Acute Mountain Sickness

Travelers from low elevations who must compete in athletic events at higher altitudes should be aware that the effects of AMS will seriously impair their performance. Their feeling of well-being and ability to remain fit will be compromised. They must allow adequate time for acclimatization. Their acclimatization will occur more rapidly and with fewer symptoms if several recommendations are followed. A slow ascent to altitude, as can be achieved by driving rather than flying to the destination, is associated with milder symptoms. The rate of ascent should be no more than 300 meters a day when above 3,000 meters. Sojourning for a couple of days at an altitude intermediate between the destination altitude and the home altitude is also associated with milder symptoms. After arrival at the destination altitude, heavy exertion should be avoided during the first two days. The traveler should drink plenty of liquids to maintain hydration and eat a high carbohydrate diet. Tobacco, alcohol, and sedative agents must be avoided.

If a slow acclimatization is impossible, several medications have shown promise in the prevention or amelioration of AMS. Acetazolamide is a carbonic-anhydrase inhibitor, which creates a metabolic acidosis due to a renal loss of bicarbonate and an inhibition of red blood cell enzymes with a retention of carbon dioxide. If acetazolamide is taken daily, starting three days before reaching altitude, more than just the overt symptoms of AMS are reduced. The periodic breathing of sleep is reduced, satisfaction of sleep is increased, exercise performance is improved, and higher altitudes can be tolerated.

Dexamethasone is a catabolic steroid that is effective in reducing vasogenic cerebral edema. It has been found to reduce the symptoms of AMS with exposure to very high altitudes. Nifedipine, a calcium-channel blocker, may prevent the pulmonary problems seen at very high altitudes. The usefulness of these two agents with intermediate altitude exposure is unclear.

At intermediate altitudes, AMS is very unlikely to progress to the severe illness seen at very high elevations. If serious illness does occur, descent remains the only definitive intervention. A dramatic improvement can occur with as little as a 300-meter descent. The natural history of intermediate altitude AMS is improvement within 3-5 days. If the symptoms are very uncomfortable, or if they interfere with normal activities, improvement can occur with the administration of supplemental oxygen, oral or intravenous rehydration, rest, and treatment with either acetazolamide or dexamethasone.


1. Consolazio, C.F., L.O. Matoush, H.L. Johnson, et al.: Effects of high carbohydrate diets on performance and clinical symptomatology after rapid ascent to high altitude. Fed Proc 28: 937, 1969.

2. Cymerman A, J.T. Reeves, S.R. Sutton, et al.: Operation Everest II: maximal oxygen uptake at extreme altitude. J Appl. Physiol. 66: 2446-2453, 1989.

3. Gale GE, J.R. Torre-Bueno, R.E. Moon, et al.: Ventilation-perfusion inequality in humans during exercise at sea level and simulated altitude. J. Appl. Physiol. 58: 978-988, 1985.

4. Green, H.J. Muscular adaptations at extreme altitude: metabolic implications during exercise. Int J Sports Med 13: S163-S165,1992.

5. Hoppler, H. and D. Desplanches: Muscle structural modifications in hypoxia. Int J Sports Med 13: S166-S168, 1992.

6. Mairbaurl H, W. Schobersberger, E. Humpeler, et al. Beneficial effects of exercising at moderate altitude on red cell oxygen transport and on exercise performance. Pflugers Archiv 406: 594-599, 1986.

7. Mizuno, M., C. Juel, T. Bro-Rasmussen, et al. Limb skeletal muscle adaptation in athletes after training at altitude. J Appl Physiol 68: 496-502, 1990.

8. Moore, L.G., G.L. Harrison, R.E. McCullough, et al. Low acute hypoxic ventilatory response and hypoxic depression in acute altitude sickness. J Appl Physiol 60: 1407-1412, 1986.

9. Suarez J, J.K. Alexander, C.S. Houston. Enhanced left ventricular systolic performance at high altitude during Operation Everest II. Am J Cardiol 60: 137-142, 1987.

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Edited and webmastered by Will Hopkins
Last updated 13 July 1998
post #2 of 33
Thanks! I guess no booozing before I go hiking in Colorado this summer, eh?
post #3 of 33
Yep! No booze for lowlanders at high altitude.
post #4 of 33
Whoa! This will take a while to go through. Thanks for the post though, looks interesting!
post #5 of 33
Thread Starter 
LOL, You are welcome! My very first post here was a Diamox question. Periodically, we get questions about altitude sickness, so its nice to have all the info in one spot.

A reallly good book, BTW is Going Higher, Altitude. Man and Mountain. I beleive its put out by the Mountaineers.
post #6 of 33
I know this topic was awhile ago, but I was interested. I think I had a touch of this once last year. Last year I only skied a few times. I'm a smoker, "in the process of trying to quit". I drove up an hour to go skiing. I had breakfast. After being on the mountain for about an hour I was feeling so sick. I was dizzy and nauseas. At the top I went into the lodge and had a snickers bar and a drink. I was so thirsty. I tried to ski some more. I wasn't having fun and after being there for only 2 hours I just dazzingly skied down the mountain to my car and drove home. I lost all ambition to ski. Once in my car and driving home I started feeling better. I know there is a lot to this, but I think smoking might have something to do with it, although I've been smoking for many years and it never happened before
post #7 of 33
Depends on what altitude you were at. I had a touch of altitude sickness once on my first trip out west, between 11-12,000 ft. Had a bad cold at the time, so I don't know how much affect that had. Have not had a problem with it since. Only a shortness of breath, and mostly above 10,000 ft. I don't smoke, so I can't relate to that end of it. Quit when I was in my early 20's. I'm 50 now, and still going strong. I'd hate to think of where I'd be today if I hadn't. I doubt if I'd still be tearin' it up, or doing the other things that I enjoy for that matter. Life's too short as it is, and nothing good ever comes of smoking. Don't cheat yourself out of any of it.
Sorry for the lecture.
Good luck
post #8 of 33
This is of particular interest for us "extreme flatlanders", I'm talking like living 20-50 feet above sea level. I had a little experience with this over the summer when I visited Portillo, Chile.
I had a 3 hour layover in Atlanta so I indulged in a few adult beverages, which continued on the flight (an extremely long 9 1/2 hrs) and resulted in what some might describe as a "not so fresh feeling" upon arrival. Now throw in a 2 hr. drive that ended at 10,000 ft. and we've got a very unhappy camper.
After resting the first day, and drinking copious amounts of H2O, I was feeling much better by day 2. Sleep though, was quite fitful. And I did experience serious shortness of breath and some nagging headaches til day 3.
So I'm wondering, is anyone out there who resides at or near sea level utilizing these medications mentioned when heading to altitude? I'm headed to Breck 12/6 with my wife and I'm wondering if I should see my Dr. about it. We don't have any time to acclimate, it's only a 4 day trip. Any input would be appreciated, thanks.
post #9 of 33
Thread Starter 
A few years ago, I went to Keystone for a weekend. Mark was there earlier at conference... Had to use an oxygen mask for 4 days, he was so bad. I decided since I had no time to acclimatize, I took Diamox. Felt great! BUT>>> Some people have bad reactions to it. If you are allergic to sulpha drugs, its not a good choice.

disski, comments?

[ November 18, 2002, 09:42 AM: Message edited by: Lisamarie ]
post #10 of 33
A friend of mine always takes Diamox when she flies to Aspen from San Francisco. Without it, she has headaches, can't sleep, and has no appetite. Most of the side effects of Diamox are only minor annoyances, like tingling fingers. Carbonated beverages taste bad, too.

I live at sea level, but altitude doesn't affect me (so far). I'm planning a one-day climb to 12,000 feet in the Sierra this spring. I'm a little concerned about doing that without acclimating.
post #11 of 33
An effective alternative to Diamox is about 200 mg/day of gingko biloba. Clinical studies are still ongoing but at least 2 have shown it works. No prescription needed and none of the unpleasant side effects of Diamox (tingling of lips and fingers, ruined taste of beer, excessive peeing, etc).
post #12 of 33
You're scaring me, all this talk of ruining the taste of beer. Tingly fingers, fine. Can't drink Pepsi One or Sam Adams, not so good. Is this side effect guaranteed? If not, how frequent is it? I surfed all the sites that came up under Acetazolamide and couldn't find a frequency of side effects as compared to placebo.
Any other experiences w. this anyone? :
post #13 of 33
This is anectdotal, rather than scientific, information about altitude issues.
At the elevations we are talking about, a person's response to altitude is highly individual. My son has a great deal of trouble dealing with altitude in the Rockies. No one else in the family is particularly bothered by it. If you drink too much at any altitude, you're going to be bothered. From personal experience it takes less at higher altitudes to feel lightheaded.
Information is certainly a useful tool, but the best information you can have for this issue is how your body has handled the transition and the stress in past experiences.
By the way, what I'm saying is applicable to skiers in the Rockies/Wasatch/Cascades. To use a Nixonian phrase, it's inoperative for climbers above about 14,000. For climbers at those elevations, it's a real good idea to listen to didactic pronouncements phrased in absolutes and follow your guide's regime for acclimation to altitude.
post #14 of 33
Thread Starter 
Wow, gingko, this is interesting. I seem to recall I decided to go into overkill, and took both diamox and gingko. Don't drink beer, so I can't comment, but no tingling sensation in my feet. Maybe ginko lessens the side effects. Also, maybe it was not the diamox that really helped, but the gingko. Who knows?
post #15 of 33
I take ginko and it works great for me.
post #16 of 33
Here you go - formatting gone haywire - but this is the Consumer Medicine Information for Diamox

It is a part of registering a drug here to provide one of these.

Acetazolamide Tablets


Consumer Medicine Information

What is in this leaflet
This leaflet answers some common questions about DIAMOX. It does not contain all of the available information.

It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking DIAMOX against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine.

You may need to read it again.

What DIAMOX is used for
DIAMOX is used to lower raised pressure in the eye and to treat the following forms of glaucoma:

Chronic simple (open-angle) glaucoma
Secondary glaucoma, where glaucoma has developed as a result of other eye disorders
Acute angle-closure glaucoma before undergoing surgery
Glaucoma is the name given to a group of eye diseases in which the optic nerve at the back of the eye is slowly destroyed. In most people this damage is caused by increased pressure in the eye. However, some people with glaucoma may have normal eye pressure

Glaucoma is usually caused by a build up of fluid which flows into the eye. This build up occurs because the fluid drains out of your eye more slowly than it is being pumped in. Since new fluid continues to enter the eye, joining the fluid that is already there, the pressure continues to rise. This raised pressure may damage the back of the eye, resulting in gradual loss of sight. Damage can progress so slowly that the person is not aware of this gradual loss of sight. Sometimes even normal eye pressure is associated with damage to the back of the eye.

There are usually no symptoms of glaucoma. The only way of knowing is to have your eye pressure, optic nerve, and visual field checked by an eye specialist or optometrist. If glaucoma is not treated it can lead to serious problems. You may have no symptoms but eventually glaucoma can lead to total blindness. In fact, untreated glaucoma is one of the most common causes of blindness.

DIAMOX is used, either alone or in combination with other eye drops or medicines, to lower raised pressure within your eyes.

DIAMOX is also used to help treat some other conditions such as:

Fluid retention due to congestive heart failure
Fluid retention caused by other medicines
Epilepsy in both adults and children
Your doctor, however, may have prescribed DIAMOX for another purpose. Ask your doctor if you have any questions about why DIAMOX has been prescribed for you.

DIAMOX works by blocking an enzyme, which is responsible for fluid formation. In people with glaucoma, blocking this enzyme causes the pressure in the eye caused by fluid build up to fall.

Blocking this enzyme also seems to slow down abnormal or excessive discharge from your nerves. This helps prevent fits in people with epilepsy.

DIAMOX also acts as a diuretic. This gets rid of excess fluid in the body by increasing urine production. This action helps people with congestive heart failure or fluid retention caused by other medicines.

DIAMOX is not addictive.

This medicine is available only with a doctor's prescription.

Before you take DIAMOX
When you must not take it
Do not take DIAMOX if:

you are allergic to:
DIAMOX or any of the ingredients listed at the end of this leaflet
medicines called sulphonamides, which are a group of antibiotics used to treat bacterial infections
Some of the symptoms of an allergic reaction to DIAMOX or sulphonamides may include fever, rash and crystals in the urine.

you have chronic noncongestive angle closure glaucoma.
you have any of the following conditions:
liver or kidney disease
If you have chronic liver disease and you take DIAMOX you are at risk of disease of the brain.

problems with your adrenal glands
unusual amounts of salt in the body
low levels of sodium and/or potassium in your blood
Do not use DIAMOX if the packaging is torn or shows signs of tampering.

Do not use DIAMOX after the expiry date (EXP) printed on the pack.

If you take it after the expiry date has passed, it may not work as well.

Before you take it
You must tell your doctor if:

you have any allergies to:
any other medicines
any other substances, such as foods, preservatives or dyes
you are pregnant or plan to become pregnant.
Your doctor will discuss the risks and benefits of taking DIAMOX during pregnancy.

you are breastfeeding or plan to breastfeed.
Your doctor will discuss the risks and benefits of taking DIAMOX when breastfeeding. DIAMOX has been found in low levels in breast milk.

you have or have had any other medical conditions including:
blockages in the lung
If you have not told your doctor about any of the above, tell them before you take any DIAMOX.

Taking other medicines
Tell your doctor if you are taking any other medicines, including medicines that you buy without a prescription from a pharmacy, supermarket or health food shop.

Some medicines may interfere with DIAMOX. These include:

phenytoin, a medicine used to treat epilepsy
medicines used to stop blood clotting
medicines used for low blood sugar levels
a group of medicines used to treat cancer called folic acid antagonists
medicines used for high blood pressure
medicines used to treat heart failure
These medicines may be affected by DIAMOX or may effect how well it works. You may need to take different amounts of your medicine or you may need to take different medicines.

Your doctor or pharmacist has more information on medicines to be careful with or avoid while taking DIAMOX.

How to take DIAMOX
How much to take
The dose of DIAMOX may be different for each person. Your doctor will decide the right dose for you.

The usual dose for chronic simple (open-angle) glaucoma is 250mg (1 tablet) to 1 gram (4 tablets) per 24 hours. If the dose per 24 hours is greater than 250mg, then the tablets are taken in divided doses.

For secondary glaucoma and for use before surgery in people with acute closed-angle glaucoma, the usual dose is 250mg every 4 hours.

For epilepsy, the recommended dose for children is based on their bodyweight. Children take 8 - 30mg per kilogram of bodyweight a day in divided doses. The total daily dose must not be greater than 750mg per day. This equals three tablets a day.

For adults with epilepsy the usual dose is 250mg (1 tablet) to 1 gram (4 tablets) daily in divided doses

If you are taking DIAMOX with another medicine for your epilepsy, the starting dose for DIAMOX is usually 250mg once daily in addition to your epilepsy medicine.

For congestive heart failure, the usual starting dose is 250mg to 375mg once daily in the morning.

For fluid retention caused by other drugs, the usual dose is 250mg to 375mg once daily for 1 to 2 days, alternating with a day of rest.

How to take it
Swallow DIAMOX with a glass of water.

DIAMOX may be taken with or without food.

When to take it
If you are taking DIAMOX in divided doses, take your tablets at evenly spaced time periods over a 24-hour period.

For congestive heart failure, take DIAMOX in the morning.

For congestive heart failure and drug-induced fluid retention, if your doctor prescribes two days therapy of DIAMOX, take DIAMOX on the first day, then no DIAMOX the next day and then the second dose on the third day.

DIAMOX gets rid of excess fluid best when given every other day over a three day period.

Follow your doctor's dosing instructions if they are different from the instructions given in this leaflet.

How long to take it
For congestive heart failure and fluid retention caused by other medicines, do not take DIAMOX for longer than your doctor says.

DIAMOX may not work as well if too many doses are given

For glaucoma DIAMOX helps control your condition, but does not cure it. Therefore you must take DIAMOX every day.

Continue taking the tablets for as long as your doctor tells you.

If you forget to take it
If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Otherwise, take it as soon as you remember, and then go back to taking it as you would normally.

Do not take a double dose to make up for the dose that you missed.

If you are unsure about whether to take your next dose, speak to your doctor or pharmacist.

If you have trouble remembering when to take your medicine, ask your pharmacist for some hints.

If you take too much (overdose)
Immediately telephone your doctor or Poisons Information Centre (Australia 131 126), (New Zealand (03) 474 7000) for advice, or go to casualty at your nearest hospital, if you think that you or anyone else may have taken too much DIAMOX. Do this even if there are no signs of discomfort or poisoning. Also report any other medicine or alcohol which has been taken. You may need urgent medical attention. Keep telephone numbers for these places handy.

While you are using DIAMOX
Things you must do
Take DIAMOX exactly as your doctor has prescribed.

Tell all doctors, dentists and pharmacists who are treating you that you are taking DIAMOX.

If you become pregnant while you are taking DIAMOX, tell your doctor immediately.

Tell your doctor if you feel DIAMOX is not helping your condition.

Visit your doctor regularly.

Your doctor needs to check your progress and see whether you need to keep taking DIAMOX.

Always discuss with your doctor any problems or difficulties during or after taking DIAMOX.

Tell your doctor if, for any reason, you have not taken your medicine exactly as prescribed.

Otherwise your doctor may think that it was not effective and change your treatment unnecessarily.

Keep enough DIAMOX to last weekends and holidays.

Things you must not do
Do not drive or operate machinery until you know how DIAMOX affects you.

DIAMOX may cause drowsiness or dizziness in some people and therefore may affect alertness.

Make sure you know how you react to DIAMOX before you drive a car, operate machinery, or do anything else that could be dangerous if you are drowsy, dizzy or not alert.
Do not take DIAMOX for a longer time than your doctor has prescribed.

For some conditions, DIAMOX should be taken for short periods only unless advised otherwise by your doctor.
Do not change your dose without first checking with your doctor.

Do not suddenly stop taking DIAMOX if you suffer from epilepsy.

Stopping this medicine suddenly may make your epilepsy worse.

Do not use this medicine to treat any other complaints unless your doctor says to.

Do not give DIAMOX to anyone else, even if their symptoms seem similar to yours.

Things to be careful of
Be careful if you are elderly, unwell or taking other medicines.

Some people may experience side effects such as drowsiness, confusion, and dizziness, which may increase the risk of a fall.

Side effects
Tell your doctor or pharmacist as soon as possible if you do not feel well while you are using DIAMOX.

DIAMOX helps most people with your condition, but it may have unwanted side effects in some people.

All medicines may have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if you notice any of the following and they worry you:

tingling or numbness of fingers, toes, hands or feet
loss of appetite
feeling extremely thirsty
passing more urine than normal
These side effects are usually mild.

Less common or rare side effects include:

increased sensitivity of the skin to the sun
fast breathing
low potassium levels in the blood
temporary shortsightedness
itchy rash or hives
blood in the urine
sugar in the urine
black tar-like stools
liver problems
paralysis where the muscles are limp and unable to move
Tell your doctor immediately or go to casualty at your nearest hospital if you notice any of the following:

frequent infections such as fever, severe chills, sore throat or mouth ulcers
bruising or bleeding more easily than normal
tiredness, headaches, being short of breath when exercising, dizziness, looking pale and yellowing of the skin and/or eyes.
These are serious side effects. You may need urgent medical attention. Serious side effects are rare.

Deaths have occurred rarely due to severe adverse reactions to sulphonamides

Other side effects not listed above may occur in some patients. Tell your doctor if you notice anything else that is making you feel unwell when you are taking, or soon after you have finished taking, DIAMOX.

Ask your doctor or pharmacist if you don't understand anything in this list.

Do not be alarmed by this list of possible side effects. You may not experience any of them.

After using DIAMOX
Keep your tablets in their bottle until it is time to take them.

If you take the tablets out of the bottle they may not keep well.

Keep DIAMOX in a cool dry place where the temperature stays below 30 degrees C. Do not store it, or any other medicines, in a bathroom or near a sink. Do not leave it in the car or on window sills.

Heat and dampness can destroy some medicines.

Keep it where children cannot reach it.

A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

If your doctor tells you to stop taking DIAMOX or the tablets have passed their expiry date, ask your pharmacist what to do with any tablets left over.

Product description
What it looks like
DIAMOX tablets are white, cross scored and marked with "Lederle" on the back.

DIAMOX comes in a plastic bottle containing 100 tablets.

The active ingredient in DIAMOX is acetazolamide. Each tablet contains 250mg acetazolamide.

DIAMOX tablets also contain the following inactive ingredients:

sodium starch glycollate
calcium hydrogen phosphate
maize starch
magnesium stearate
DIAMOX does not contain gluten, lactose, sucrose, tartrazine or any other azo dyes.

DIAMOX is supplied in Australia by:

Lederle Laboratories
Division of Wyeth Australia Pty Limited
ABN 16 000 296 211
17-19 Solent Circuit
Baulkham Hills NSW 2153
Telephone numbers:
(02) 8850 8200 or
(02) 9761 8200
For further information please contact Wyeth Australia on toll-free 1-800-500-498.
Australian Registration Number
DIAMOX 250mg Tablets
AUST R 15204
This leaflet was prepared on 8 December 1999
Updated 30 April 2001
® Registered Trade Mark
post #17 of 33
& the Merck Manual link

altitude sickness description
post #18 of 33

I'm an extreme flatlander also(live at a whopping 38 ft.), and I always take Diamox before going to altitude. I haven't had any of the side effects mentioned, except for the increased unrination. --It pretty much saved my winter ambitions a few years ago after a strong bout with AMS. ...I get the stuff down in Mexico for little or nothing, and take it for the two days prior to reaching elevation.

Hope you have as good a luck with it!! [img]smile.gif[/img]
post #19 of 33
Thread Starter 
Disski, thanks! That could not have been fun after having to deal with this stuff all day!
post #20 of 33
That's fine LM - just had to find the sites again

Actually quite fun - beats being treated like a glorified stores person - which tends to happen a bit.

Once upon an incarnation I had good nursing staff(well trained) who worked out that I could fix a lot of their problems if they worked on the theory I was the 'drug expert' rather than the supply clerk.
I get to stretch the brain from time to time each day - but way to many people just want us to 'give me something FAST'

In another incarnation I worked in drug registration....

My favourite topic - wounds - like playing with dressings - but the local doctors here see that as a threat.... Oh well... I am close to the snow... siiiiigh
post #21 of 33
Not just warfarin - anything that affects clotting mechanisms I believe.
So clopidogrel, dipyridamole, aspirin etc...
post #22 of 33
Originally posted by Telefit:
An effective alternative to Diamox is about 200 mg/day of gingko biloba. Clinical studies are still ongoing but at least 2 have shown it works. No prescription needed and none of the unpleasant side effects of Diamox (tingling of lips and fingers, ruined taste of beer, excessive peeing, etc).
Gingko biloba should not be taken straight off the shelf as it has risks itself. Talk to your doctor. It increases the blood supply to the brain at the very least and should not be taken by anyone on wayfarin. Try not to self medicate even with healthstore stuff.
post #23 of 33
Just found a couple of useful links:

Altitude Tutorial
Good layman's guide for practical application for the prevention, treatment and symptoms of altitude related problems.

Known Drug Interactions With Gingko

Originally posted by Nettie:
</font><blockquote>quote:</font><hr />Originally posted by Telefit:
An effective alternative to Diamox is about 200 mg/day of gingko biloba. Clinical studies are still ongoing but at least 2 have shown it works. No prescription needed and none of the unpleasant side effects of Diamox (tingling of lips and fingers, ruined taste of beer, excessive peeing, etc).
Gingko biloba should not be taken straight off the shelf as it has risks itself. Talk to your doctor. It increases the blood supply to the brain at the very least and should not be taken by anyone on wayfarin. Try not to self medicate even with healthstore stuff.</font>[/quote]

[ November 29, 2002, 04:34 AM: Message edited by: Nettie ]
post #24 of 33
Thread Starter 
Nettie thaank you SO much! Again, this is a no brainer, but after the mess at Crunch, it needs to be said. Please do not take anecdotal stories about sucess with a drug or supplement as medical advice.
post #25 of 33
did you see Horizon the other night about the $1million bet? A guy in America has offered that much to anyone who can prove homeopathic remedies can scientifically be proved to work. The program was very interesting indeed. And the results were amazing.

post #26 of 33
Ummmm - be careful with that info...

It suggests taking gingko to 'relieve side effects' of sone SSRI antidepressants Many of those also have 'bleeding' as a side effect in sime cases 'unexplained' so adding gingko is NOT a good idea....
post #27 of 33
Originally posted by Wear the fox hat:
did you see Horizon the other night about the $1million bet?
Yes, a bit boring; I fell asleep partway through and woke up for the results. I missed bits like writing numbers on labels apparently.

Talk about the misuse of science.

It was more like take three points and try to draw a straight line through them. If you can't, log them and then try again. If you still can't draw a straight line through the points there isn't a relationship,

OR ...

maybe you are using the wrong science.

A bit like scientific studies proving that eating strawberries reduces your risk of certain health problems. OH, not due to the healthier food that people who eat strawberries generally eat then? A valid scientific study, (my ****)?

What Homeopaths don't like to mention is that if they run out of a remedy, they do things like writing the name of the remedy on a label, draw a circle with a cross through it and wrap it around a bottle of water to use instead. And the damn remedy still works according to their criteria. The Complementary Health Practioner's 'intent' works instead. :

The Jury's out. Something is working. The mechanism is unknown. Until a likely mechanism of function is approached you will only have inconclusive scientific results. Too many variables at the moment.

Foxy, fancy borrowing the SCERN accelerator for the Million $ and investigating the apparent link between spacially separated subatomic particles and homeopathy? I think we'll have a winner!

Seems as likely as looking for chemical interactions between non-existant molecules.

When we know more about the brain, our electrochemical system and its, unfortunately complex, interactions with the world around it we might be able to design better experiments. And maybe we will get over the Heisenberg uncertainty principle as well! [img]graemlins/evilgrin.gif[/img]

The opinions stated are not necessarily those of the author (but they might be). I have an open mind and a mostly closed wallet.

Recent investigations appearing to show religious experiences can be induced by stimulating certain areas of the brain or with standing wave energy in rooms are of more interest to me than the latest drug made to make money for a drug company treating Symptoms on manipulated statistical data.
post #28 of 33
Originally posted by disski:
Ummmm - be careful with that info...

It suggests taking gingko to 'relieve side effects' of sone SSRI antidepressants Many of those also have 'bleeding' as a side effect in sime cases 'unexplained' so adding gingko is NOT a good idea....
I presume you mean the information link on Biloba, Disski,

No it only gives some drug interactions for information. It is not a self-medication document.

Being a better informed consumer or patient can ease the load on hard-pressed medical practioners. In some countries herbal remedies are issued by doctors, viz Germany where St John's Wort prescribed most often for depression over other drugs.
I guess you would want as much info about what you put in your mouth beforehand (unless Foxy is buying I guess )
post #29 of 33
In Germany ALL medications are dispensed by a pharmacist - be they 'herbal' & therefore 'natural & safe' or 'medicines' [img]smile.gif[/img]
post #30 of 33
Originally posted by disski:
In Germany ALL medications are dispensed by a pharmacist - be they 'herbal' & therefore 'natural & safe' or 'medicines' [img]smile.gif[/img]
There is a difference between 'dispensed' and 'prescribed'. [img]tongue.gif[/img]
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