High-Altitude Pulmonary Edema Medication
- Author: Rohit Goyal, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP more...
Drugs are not as effective as descent from altitude and oxygen in the treatment of high-altitude pulmonary edema (HAPE). Nifedipine, by reducing pulmonary arterial pressure, may be effective in treating HAPE. Experience with other vasodilators such as hydralazine is limited. Some studies have reported good results with furosemide. However, concerns about hypovolemia have constrained its use in the United States. Some studies have reported vascular collapse at doses of 40 mg bid. Acetazolamide may be useful in the earliest stages of the illness. The best management of this uncommon illness is early recognition and descent.
Prophylaxis is indicated for persons who have been identified (from past experience) as being susceptible to developing high-altitude illness or who must ascend rapidly to a high altitude. Acetazolamide and dexamethasone have been shown to be effective agents for prophylaxis against high-altitude illness. These agents must be started 24 h before ascent and continued for 48-72 h at altitude. Acetazolamide, which appears to hasten acclimatization, is considered the drug of choice because of a low incidence of significant adverse effects. Acetazolamide has also been shown to reduce the risk and severity of HAPE in high-risk individuals. One study showed that low-dose acetazolamide administered prior to ascent and on day 1 at 4300 m effectively reduced the incidence and severity of HAPE. Other preventive measures include avoiding overexertion and respiratory depressants (eg, alcohol, sedatives) and eating a high-carbohydrate diet.
Calcium channel blockers
Nifedipine is used for its pulmonary vasodilating effects.
Used in HAPE for pulmonary vasodilation. Often improves SaO2 modestly within a few min.
Carbonic anhydrase inhibitors
These agents are helpful in the prevention of HAPE.
Used in the prevention of HAPE. Not used in the treatment of this condition. Promotes renal excretion of bicarbonate, which stimulates respiration. For the prophylaxis of altitude illness, start 24-48 h before ascent and continue for 48 h after arrival at high altitude.
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