Editing Altitude sickness (section)

=== Medications ===
The drug [[acetazolamide]] (trade name Diamox) may help some people making a rapid ascent to sleeping altitude above {{convert|2700|m|ft|sigfig=1}}, and it may also be effective if started early in the course of AMS.<ref>{{Cite book |author=[[World Health Organization]] |title=International travel and health |chapter=Chapter 3: Environmental health risks |chapter-url=http://whqlibdoc.who.int/publications/2007/9789241580397_3_eng.pdf |page=31 |date=1 January 2007 |access-date=21 November 2009}}</ref> Acetazolamide can be taken before symptoms appear as a preventive measure at a dose of 125&nbsp;mg twice daily. The [[Everest Base Camp]] Medical Centre cautions against its routine use as a substitute for a reasonable ascent schedule, except where rapid ascent is forced by flying into high altitude locations or due to terrain considerations.<ref name="BaseCampMD_prophylaxis">{{Cite web |title=Prophylaxis |url=http://www.basecampmd.com/expguide/amspremed.shtml |publisher=Everest BC Clinic, BaseCampMD.com |access-date=21 November 2009}}</ref> The Centre suggests a dosage of 125&nbsp;mg twice daily for prophylaxis, starting from 24 hours before ascending until a few days at the highest altitude or on descending;<ref name="BaseCampMD_prophylaxis"/> with 250&nbsp;mg twice daily recommended for treatment of AMS.<ref>{{Cite web |title=Treating AMS |url=http://www.basecampmd.com/expguide/diamox.shtml |publisher=Everest BC Clinic, BaseCampMD.com |access-date=21 November 2009}}</ref> The [[Centers for Disease Control and Prevention]] (CDC) suggest the same dose for prevention of 125&nbsp;mg acetazolamide every 12 hours.<ref name="CDC_Yellow Book">{{Cite book |title=CDC Health Information for International Travel 2010 "The Yellow Book" |veditors=Turell D, Brunette G, Kozarsky P, Lefor A |chapter=Chapter 2 The Pre-Travel Consultation – Self-Treatable Diseases – Altitude Illness |vauthors=Hackett P, Shlim D |chapter-url=http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/altitude-illness.aspx |publisher=Mosby |location=St. Louis |year=2009 |isbn=978-0-7020-3481-7|url-access=registration |url=https://archive.org/details/cdchealthinforma0000unse_f7v6}}</ref> Acetazolamide, a mild diuretic, works by stimulating the kidneys to secrete more bicarbonate in the urine, thereby acidifying the blood. This change in pH stimulates the respiratory center to increase the depth and frequency of respiration, thus speeding the natural acclimatization process. An undesirable side-effect of acetazolamide is a reduction in aerobic endurance performance. Other minor side effects include a tingle-sensation in hands and feet. Although a [[sulfonamide]], acetazolamide is a non-antibiotic and has not been shown to cause life-threatening allergic cross-reactivity in those with a self-reported sulfonamide allergy.<ref>{{cite journal |vauthors=Platt D, Griggs RC |title=Use of acetazolamide in sulfonamide-allergic patients with neurologic channelopathies |journal=[[Archives of Neurology]] |volume=69 |issue=4 |pages=527–9 |date=April 2012 |pmid=22158718 |pmc=3785308 |doi=10.1001/archneurol.2011.2723}}</ref><ref>{{cite journal |vauthors=Kelly TE, Hackett PH |title=Acetazolamide and sulfonamide allergy: a not so simple story |journal=[[High Altitude Medicine & Biology]] |volume=11 |issue=4 |pages=319–23 |year=2010 |pmid=21190500 |doi=10.1089/ham.2010.1051}}</ref><ref>{{cite journal |vauthors=Lee AG, Anderson R, Kardon RH, Wall M | title = Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality? |journal=[[American Journal of Ophthalmology]] |volume=138 |issue=1 |pages=114–8 |date=July 2004 |pmid=15234289 |doi=10.1016/j.ajo.2004.02.019 |url=http://www.ajo.com/article/S0002-9394(04)00145-X/abstract}}</ref> Dosage of 1000&nbsp;mg/day will produce a 25% decrease in performance, on top of the reduction due to high-altitude exposure.<ref>{{cite web |url=http://www.usariem.army.mil/pages/download/altitudeacclimatizationguide.pdf |title=Altitude Acclimatization Guide |url-status=dead |archive-url=https://web.archive.org/web/20120324235011/http://www.usariem.army.mil/Pages/download/altitudeacclimatizationguide.pdf |archive-date=24 March 2012}}</ref> The CDC advises that [[Dexamethasone]] be reserved for treatment of severe AMS and HACE during descents, and notes that [[Nifedipine]] may prevent HAPE.<ref name="CDC_Yellow Book"/>

There is insufficient evidence to determine the safety of [[sumatriptan]] and if it may help prevent altitude sickness.<ref>{{Cite journal |last1=Gonzalez Garay |first1=Alejandro |last2=Molano Franco |first2=Daniel |last3=Nieto Estrada |first3=Víctor H. |last4=Martí-Carvajal |first4=Arturo J. |last5=Arevalo-Rodriguez |first5=Ingrid |date=March 2018 |title=Interventions for preventing high altitude illness: Part 2. Less commonly-used drugs |journal=The Cochrane Database of Systematic Reviews |volume=3 |issue=12 |pages=CD012983 |doi=10.1002/14651858.CD012983 |issn=1469-493X |pmc=6494375 |pmid=29529715}}</ref> Despite their popularity, [[antioxidant]] treatments have not been found to be effective medications for prevention of AMS.<ref name="pmid19273551">{{cite journal |vauthors=Baillie JK, Thompson AA, Irving JB, Bates MG, Sutherland AI, Macnee W, Maxwell SR, Webb DJ |display-authors=6 |title=Oral antioxidant supplementation does not prevent acute mountain sickness: double blind, randomized placebo-controlled trial |journal=[[QJM]] |volume=102 |issue=5 |pages=341–8 |date=May 2009 |pmid=19273551 |doi=10.1093/qjmed/hcp026 |doi-access=free}}</ref> Interest in phosphodiesterase inhibitors such as [[sildenafil]] has been limited by the possibility that these drugs might worsen the headache of mountain sickness.<ref name="pmid17408118">{{cite journal |vauthors=Bates MG, Thompson AA, Baillie JK |title=Phosphodiesterase type 5 inhibitors in the treatment and prevention of high altitude pulmonary edema |journal=Current Opinion in Investigational Drugs |volume=8 |issue=3 |pages=226–31 |date=March 2007 |pmid=17408118}}</ref> A promising possible preventive for altitude sickness is [[myo-inositol trispyrophosphate]] (ITPP), which increases the amount of oxygen released by hemoglobin.

Prior to the onset of altitude sickness, [[ibuprofen]] is a suggested non-steroidal anti-inflammatory and painkiller that can help alleviate both the headache and nausea associated with AMS. It has not been studied for the prevention of [[cerebral edema]] (swelling of the brain) associated with extreme symptoms of AMS.<ref>{{Cite web |url=http://med.stanford.edu/ism/2012/march/altitude.html |title=Ibuprofen decreases likelihood of altitude sickness, researchers find |first=John |last=Sanford |date=March 2012 |access-date=19 September 2012 |archive-url=https://web.archive.org/web/20120424180422/http://med.stanford.edu/ism/2012/march/altitude.html |archive-date=24 April 2012 |url-status=dead}}</ref>