/ Taking Altitude Sickness Tablets to Nepal

This topic has been archived, and won't accept reply postings.
tonto169 - on 09 Apr 2017
Hey,

I was wondering if I would have any issues taking Diamox with me to Nepal? I know nothing about taking medicine abroad and was hoping someone might be able to help or point me in the direction on a website that might!

Thanks
ianwade - on 09 Apr 2017
In reply to tonto169:

Hello there,

You can buy acetazolomide or diamox as its more commonly know in pretty much any pharmacy or supermarket in Kathmandu and its much cheaper than getting a prescription of it from your GP over here.Have a great trip and remember taking diamox should really be a last resort rather than a prophylactic its better to acclimatise slowly, get plenty to drink every day, not beer, and get plenty of rest.

Ian.
tonto169 - on 09 Apr 2017
In reply to ianwade:

Ian,

Thanks for the advice. I already have the pills my doctor chucked them my way (I get my prescriptions for free through work) just didn't want to sweat out arrivals like I had a kilo of Colombias finest in my bag!!
Andy Nisbet - on 09 Apr 2017
In reply to tonto169:
I've never had a problem (put them in your hold luggage). In theory they could ask to see a note from your doctor but I'd be amazed if anyone did. I've taken out large first aid kits for trekking groups and never had any interest shown.
Post edited at 19:31
splat2million on 10 Apr 2017
In reply to tonto169:

You'll be fine. Customs in Kathmandu will know what altitude sickness tablets are.

Make sure they're in a bag that is clearly a first-aid / medical kit. Most places are fine with most drugs carried in this way. (The Middle-East is the exception - don't take any drugs there without a lot of research and paperwork).

As an aside, make sure you know how and when to use them if you are carrying them. It is, of course, not a substitute for good acclimatisation and a sensible ascent profile, but can be of a lot of benefit if you do find yourself suffering.
kenr - on 11 Apr 2017
In reply to ianwade:
> taking diamox should really be a last resort rather than a prophylactic
Not sure where this "really" comes from.
Acetazolamide has been tested in well-controlled scientific studies from decades ago as a prophylactic -- at least for altitudes up to 4000 meters or so.
Like start taking it two (or three?) days before going up to altitude.

I've taken it prophylacticly like that for about hundred trips in the 3000-4000 meter range over the past thirty years, and found that only good ever resulted.

If I waited for the supposedly better "slow" acclimatization, I would have missed out on a lot of great mountain days at the start of many of those hundred trips.
. . . (but perhaps "slow is better" holds true for 5000 meters and higher).

Ken

P.S. In the past five years or so I've supplementing my prophylactic use of acetazolamide with another protocol with different substances, but if I disclosed that protocol here I bet I'd get lots of criticism.
Andy Nisbet - on 11 Apr 2017
In reply to kenr:

True, but it's also likely (unproven scientifically) that by effectively conning your body into thinking there's more oxygen around than there is, it slows down acclimatisation in the long term. So great for short trips but doubtful if you're acclimatising at a suitable rate for you. There's also therefore an argument for only taking it on the summit 2 or 3 days (or even 1 day).
In reply to kenr:
> P.S. In the past five years or so I've supplementing my prophylactic use of acetazolamide with another protocol with different substances, but if I disclosed that protocol here I bet I'd get lots of criticism.

Anything mentioned in here?!

Drug Use and Misuse in the Mountains:
A UIAA MedCom Consensus Guide
for Medical Professionals

http://online.liebertpub.com/doi/pdfplus/10.1089/ham.2016.0080
Post edited at 12:04
kenr - on 11 Apr 2017
In reply to Andy Nisbet:
> conning your body into thinking there's more oxygen around
> than there is, it slows down acclimatisation in the long term.

Evidence?
. (I doubt the claim is correct).

There are at least two important kinds of acclimatizion:
* to reduced Oxygen.
* to reduced Carbon Dioxide

Acetazolamide / Diamox has very little to do with Oxygen.
It's _mainly_ about buffering Carbonic acid and helping the body deal with respiratory alkalosis.

Ken
kenr - on 11 Apr 2017
In reply to Tom Briggs - Jagged Globe:
> Anything mentioned here?

No. Nothing resembling any of those ideas.
. (hint: Not every acclimatizion protocol needs to use a "drug".

Rather useful article. Thanks for linking it.

I notice that it concludes that _preventive_ use of Acetazolamide is highly effective.

Ken
Andy Nisbet - on 11 Apr 2017
In reply to kenr:

Yes, I know the biochemistry. It seems common sense to me that if the body is less short on oxygen, then it won't adapt as urgently. But I haven't looked for any scientific evidence. However I do know that like me, some folk take Diamox only for a summit boost.
Lion Bakes on 11 Apr 2017
In reply to kenr:

> .I've taken it prophylacticly like that for about hundred trips in the 3000-4000 meter range over the past thirty years, and found that only good ever resulted.

You'd probably have been fine without. I've done far more trips without any drugs at those altitudes and never had an issue.

1
splat2million on 11 Apr 2017
In reply to Lion Bakes:

> You'd probably have been fine without. I've done far more trips without any drugs at those altitudes and never had an issue.

Everyone is different - especially when it comes to altitude acclimatisation. I've seen people almost incapacitated by altitude sickness at 3500m and others barely even notice the altitude on top of Kilimanjaro only 4 days from being at sea level. You can't tell someone else how they would be at altitude based on your own experience.

Scientifically, acetazolamide does work prophylactically (Luks AM, McIntosh SE, Grissom CK, et al. Wilderness medical society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med 2014;25:S4–14. doi:10.1016/j.wem.2014.06.017). I don't think there is any evidence about it harming long term acclimatisation (though I doubt there are any good studies looking at this - happy to be corrected) but I have heard anecdotes of people suffering if they stop taking it while still at altitude.

If you are very experienced at altitude then you'll know how you respond, but for someone who's not been before it's much more difficult to know what to do. In my opinion if you don't know how you are at altitude, and have put lots of money in to a trip, why not take diamox either prophylactically (if you are very concerned about getting any symptoms) or as standby treatment. Provided you aren't being silly about your ascent profile and using it to allow a shorter trip than is safe.

I wouldn't personally take it prophylactically in Nepal because it'd spoil the taste of the beer in the tea-houses.
Lion Bakes on 11 Apr 2017
In reply to tonto169:
What we can say is that tens of thousands have been at those altitudes without drugs and without issues. Or is taking unnecessary drugs just their way of getting high?
Post edited at 21:00
kenr - on 11 Apr 2017
In reply to Lion Bakes:
> You'd probably have been fine without.

No.

_You_ would have been fine without. But not me.

I've gone up to even 2750 meters from sea-level _without_ prophylactic acetazolamide at least three times, and each time been rather lethargic and nauseous -- to the point where I could not perform effectively.

Human biochemistry varies widely.
If you want to say that taking Acetazolomide to compensate for my less-effective biochemistry is "cheating" -- or if you want to feel superior because you did X achievement without it, that's your business.

My view is that mountaineering nowadays is not fundamentally a _competition_,
rather an interesting personal game. I just need to be clear for myself about what rules make it a fun interesting game for me (not for you).

Ken
kenr - on 11 Apr 2017
In reply to Lion Bakes:
> What we can say is that tens of thousands have been at those altitudes
> without drugs and without issues.

Good. So now there's no need for _me_ to prove that it's possible.

The issue for me is not whether it would be _possible_ for me to perform X achievement at Z altitude if I spend more days beforehand waiting.

What matters for me is that I have N days in my special trip, and each day _costs_ me in time and money (and risk) -- so will taking acetazolamide (along with my other protocol) preventively get more and better achievements on my special trip (usually with a limited time-window of weather + conditions).

Ken
Post edited at 21:26
david100 - on 11 Apr 2017
In reply to kenr:

The reason some people would not recommend acetazolamide for prophylaxis of altitude sickness will be due to the admittedly rare possibility of serious side effects.
I have just looked in my bnf for acetazolomide and here are some of the interesting ones.

(uncommon)
blood disorders
bone marrow suppression
renal failure
toxic epidermal necrosis
(rare)
hepatitis
fulminant hepatic necrosis
splat2million on 11 Apr 2017
In reply to david100:

That's a bit like saying I don't recommend paracetamol for a bit of a headache due to the possibility of it's side effects:
(Rare)
Acute generalised exanthematous pustulosis; malaise; skin reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis
(Frequency not known)
Blood disorders; leucopenia; neutropenia; thrombocytopenia

And whatever you do don't take ibupforen:
(Uncommon)
alveolitis; aseptic meningitis; hepatic damage; interstitial fibrosis associated with NSAIDs can lead to renal failure; pancreatitis; papillary necrosis associated with NSAIDs can lead to renal failure; pulmonary eosinophilia; Stevens-Johnson syndrome; toxic epidermal necrolysis; visual disturbances
(Frequency not known)
angioedema; blood disorders; bronchospasm; colitis; Crohn’s disease; depression; diarrhoea; dizziness; drowsiness; fluid retention (rarely precipitating congestive heart failure); gastro-intestinal bleeding; gastro-intestinal discomfort; gastro-intestinal disturbances; gastro-intestinal ulceration; haematuria; headache; hearing disturbances; hypersensitivity reactions; insomnia; nausea; nervousness; photosensitivity; raised blood pressure; rashes; renal failure; tinnitus; vertigo

Serious side effects are very rare with diamox in otherwise healthy people. The benefits are potentially very significant. I believe people should be properly counselled by a professional and if appropriate encouraged to make an informed decision about whether to take it or not. It can be a very useful drug for some people at altitude.
david100 - on 11 Apr 2017
In reply to splat2million:

Whenever possible i do not take paracetamol or ibuprofen for the reasons you quoted above. I had to relent for a day recently though though because I had stitches taken out after surgery. I am such a wuss.
kenr - on 13 Apr 2017
In reply to david100:
> not recommend acetazolamide for prophylaxis of altitude sickness
> due to the admittedly rare possibility of serious side effects.

But when out in the mountains at high altitude, _not_ taking acetazolamide could also have serious side effects.
Because difficulty in acclimatizing is about more than just discomfort.
Because time and speed matter.
. . . like . . .
Not taking acetazolamide might make one member of the party slower on ascent, and then the descent takes place later in the afternoon, and then the party is still on the slope where and when the big wet-snow avalanche comes down.
. . . like . . .
It's a stable day to move camp up to the next higher level, but some members not taking acetazolamide are not ready to move up that high. The weather forecast for the next three days is unfavorable. So the decision is stay and wait that day. Next day the weather turns worse, so the acclimatization schedule for the trip is now delayed.

Ken

P.S. Perhaps for those seriously worried about side effects from taking acetazolamide (which could be tested in a sophisticated full-support medical infrastructure at sea-level before departing for the trip), there's a simpler more important principle for avoiding unexpected risks to health:
Don't bother trying to climb mountains at high altitude in far-away regions.
Post edited at 01:31
cragtaff - on 16 Apr 2017
In reply to tonto169:

When athletes take pharmaceutical substances (for non medical reasons) to achieve their goals they are rightly criticised for it, but if mountaineers want to take chemical substances (for non medical reasons) just for the convenience of getting to their goals its OK.

Is it?

Surely we are taking something away from the challenge and achievement of climbing?


This topic has been archived, and won't accept reply postings.