5
Mechanisms of High Altitude Headache
Moscowitz, 1999
Drug Therapy of AMS
· What is optimal dose of acetazolamide?
Recent meta-analysis said only 750 mg/day
Many experts suggest 250 mg/day
· Does ginkgo work?
· Is theophylline useful?
Efficacy of Low-dose Acetazolamide (125 mg BID) for
the Prophylaxis of Acute Mountain Sickness: A
Prospective, Double-blind, Randomized, Placebo-
controlled Trial
Basnyat et al
HAMB: 4 (1): 45 52, 2003
· RCT, 155/197 trekkers returned questionnaires
· 4243 to 4937m (Pheriche to Lobuje)
· AZ 125 mg bid; LLS
· AMS:
Pl 25%, AZ 12%, NNT = 8
Severe AMS: 30% vs 0%
· Dumont et al
High dose AZ better, NNT = 3
Paresthesiae the same
· Basnyat response
:
Meta-analysis flawed, head-to-head comparison
necessary
· 32 subjects given AZ (125 or 250mg bid) or
PL AFTER arrival to 3630m (La Paz)
· LLS at 0, 6, 24 hrs; <2 hrs after arrival
· 28% had AMS before the study
%AMS
0%
20%
250 mg AZ
0%
27%
125 mg AZ
0%
36%
Placebo
24 hrs
0 hrs
Carlsten et al, HAMB
