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High-Altitude Pulmonary Edema Medication

  • Author: Rohit Goyal, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
 
Updated: Dec 31, 2015
 

Medication Summary

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.[17] 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.[18] Other preventive measures include avoiding overexertion and respiratory depressants (eg, alcohol, sedatives) and eating a high-carbohydrate diet.

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Calcium channel blockers

Class Summary

Nifedipine is used for its pulmonary vasodilating effects.

Nifedipine (Procardia, Adalat)

 

Used in HAPE for pulmonary vasodilation. Often improves SaO2 modestly within a few min.

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Carbonic anhydrase inhibitors

Class Summary

These agents are helpful in the prevention of HAPE.

Acetazolamide (Diamox)

 

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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Corticosteroids

Class Summary

Have profound and varied metabolic effects. They suppress inflammation and the immune response.

Dexamethasone (Decadron)

 

Alleviates vasogenic cerebral edema and improves endothelial integrity.

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Contributor Information and Disclosures
Author

Rohit Goyal, MD Fellow, Division of Pulmonary Medicine, Lenox Hill Hospital, New York University School of Medicine

Rohit Goyal, MD is a member of the following medical societies: American College of Chest Physicians, American Medical Association, American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Samia Qazi, MD, MD 

Samia Qazi, MD, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Laurie Ward, MD 

Laurie Ward, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation

Disclosure: Nothing to disclose.

Qazi Qaisar Afzal, MD Clinical Instructor, Department of Medicine, State University of New York at Stony Brook

Qazi Qaisar Afzal, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Mir Omar Ali, MD Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital, New York University

Mir Omar Ali, MD is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mir Mustafa Ali Deccan College of Medical Sciences, Owaisi Hospital and Research Center, Princess Esra Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Gregory Tino, MD Director of Pulmonary Outpatient Practices, Associate Professor, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Medical Center and Hospital

Gregory Tino, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

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