Altitude Illness - Cerebral Syndromes Medication
- Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Rick Kulkarni, MD more...
Medication Summary
Treatment of HACE is indicated immediately upon diagnosis. AMS may be treated at the discretion of the patient and physician. Mild analgesics (eg, aspirin, acetaminophen, ibuprofen) are indicated for symptomatic treatment of headache. Routine prophylaxis of AMS with acetazolamide can be considered in those without contraindications; see Deterrence/Prevention section for further details.
Carbonic anhydrase inhibitors
Class Summary
These agents are thought to improve acclimatization by increasing renal bicarbonate excretion at high altitude. They act as a respiratory stimulant at high altitude.
Acetazolamide (Diamox)
Carbonic anhydrase inhibitor for accelerating acclimatization to altitude in AMS. Helps prevent AMS in forced rapid ascent or in patients with history of repeated AMS. Improves symptomatic periodic breathing and hypoxia experienced at high altitudes. Not indicated for general prophylaxis of AMS. Treatment of AMS may be discontinued when patient is asymptomatic.
Corticosteroids
Class Summary
These agents are used for their potent anti-inflammatory activity in vasogenic brain edema.
Dexamethasone (Decadron, Dexasone)
DOC for patients with HACE. May improve AMS and HACE by alleviating vasogenic cerebral edema and improving endothelial integrity; prevents AMS but does not improve acclimatization. Rebound AMS may occur if drug discontinued at altitude.
Antiemetics
Class Summary
These agents are useful in the treatment of symptomatic nausea caused by AMS.
Prochlorperazine (Compazine, Stemetil)
May relieve nausea and vomiting by blocking postsynaptic mesolimbic dopamine receptors through anticholinergic effects and depressing reticular activating system; additionally, has the advantage of augmenting hypoxic ventilatory response, acting as a respiratory stimulant at high altitude.
Promethazine (Phenergan)
Used for the symptomatic treatment of nausea in AMS.
Sedative hypnotics
Class Summary
These agents are useful for the nearly-universal sleep difficulties at high altitude.
Temazepam (Restoril)
Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.
Appears safe for well persons but should be avoided in those with AMS due to concerns about exaggerated hypoxemia during sleep.
Zolpidem (Ambien)
Structurally dissimilar to benzodiazepine but similar in activity with the exception of having reduced effects on skeletal muscle and seizure threshold. Does not depress ventilation at high altitude.
Analgesics
Class Summary
These agents are indicated for the treatment of mild to moderate pain and headache.
Ibuprofen (Motrin, Advil, Nuprin, Midol)
May be used for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Acetaminophen (Tylenol, Aspirin Free Anacin)
DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking PO anticoagulants.
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