Altitude Illness - Pulmonary Syndromes Medication
- Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Rick Kulkarni, MD more...
Medication Summary
Treatment of HAPE is indicated upon diagnosis. High-altitude cough may be treated when the symptoms become severe enough to interfere with the individual's activities.
Calcium channel blockers
Class Summary
Nifedipine is used for its pulmonary vasodilative effects. It inhibits calcium ions from entering the slow channels or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation.
Nifedipine (Adalat, Procardia)
Used in HAPE for pulmonary vasodilation. Often improves SaO2 modestly within a few minutes. Despite theoretical concerns about the SL route, it has been used in hundreds of cases without causing clinically significant hypotension. Does not improve pulmonary hemodynamics as much as oxygen and does not have an additive effect when administered with oxygen. Most useful when oxygen is unavailable and to help prevent exertional exacerbation of HAPE when evacuating a patient. Cap may be punctured; drug solution may be administered SL to reduce BP.
Phosphodiesterase (type 5) enzyme inhibitor
Class Summary
This agent acts to increase available nitric oxide in pulmonary arterial vessels, resulting in vessel relaxation and decreased pulmonary hypertension. It has been found effective for HAPE prophylaxis in HAPE-susceptible patients.
Tadalafil (Cialis)
Phosphodiesterase type 5 (PDE5) selective inhibitor. Inhibition of PDE5 increases cGMP activity, which increases vasodilatory effects of nitric oxide. Sexual stimulation is necessary to activate response. Increased sensitivity for erections may last 36 h with intermittent dosing. Low-dose daily dosing may be recommended for more frequent sexual activity (ie, twice weekly); men can attempt sexual activity at anytime between daily doses. Available as 2.5-mg, 5-mg, 10-mg, and 20-mg tablets.
Corticosteroid
Class Summary
Exact mechanism has not yet been well defined but has been found effective for HAPE prophylaxis in HAPE-susceptible patients.
Dexamethasone (AK-Dex, Alba-Dex, Baldex, Decadron, Dexone)
Mechanism in preventing HAPE is not well defined.
Beta agonists
Class Summary
Sodium-dependent absorption of liquid from the airways may be defective in persons who are susceptible to HAPE; beta-adrenergic agents up-regulate the clearance of alveolar fluid.
Salmeterol (Serevent)
Shown to be effective at preventing HAPE in susceptible persons, possibly by up-regulating clearance of alveolar fluid.
Carbonic anhydrase inhibitors
Class Summary
These agents are possibly beneficial in the prophylaxis of HAPE.
Acetazolamide (Diamox)
Carbonic anhydrase inhibitor diuretic used for its respiratory-stimulant effects. May be administered for prophylactic use in patients with a prior history of HAPE. Not used as treatment for HAPE. For prophylactic use, begin using the day before ascent. Therapy should begin 24-48 h before the ascent and continue during the ascent to at least 48 h after arrival at the highest altitude.
Antitussives
Class Summary
These agents are used for the symptomatic treatment of high-altitude cough.
Hydrocodone and acetaminophen (Lortab, Vicodin)
Drug combination for symptomatic relief of cough and helpful for pain relief of intercostal muscle strain associated with cough. Often more effective than codeine.
Codeine
For symptomatic relief of a cough. Helpful for pain of intercostal muscle strain associated with a cough. Binds to opiate receptors in CNS, causing inhibition of ascending pain pathways, altering perception and response to pain.
Benzonatate (Tessalon Perles)
May help patients with cough refractory to opiates. Suppresses cough by topical anesthetic action on respiratory stretch receptors.
Analgesics
Class Summary
These agents are indicated for the treatment of mild to moderate pain and headache.
Ibuprofen (Motrin, Advil, Nuprin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Acetaminophen (Tylenol)
DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking PO anticoagulants.
Aspirin (Aspirin, Ascriptin, Bayer Aspirin, Bufferin)
Used for the treatment of mild to moderate pain and headache.
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