Altitude Illness - Cerebral Syndromes Medication

Updated: Jun 07, 2016
  • Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Joe Alcock, MD, MS  more...
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Medication

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.

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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)

Acetazolamide is a carbonic anhydrase inhibitor for accelerating acclimatization to altitude in AMS. It  helps prevent AMS in forced rapid ascent or in patients with a history of repeated AMS. Acetazolamide improves symptomatic periodic breathing and hypoxia experienced at high altitudes. It is not indicated for general prophylaxis of AMS. Treatment of AMS may be discontinued when the patient is asymptomatic.

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Corticosteroids

Class Summary

These agents are used for their potent anti-inflammatory activity in vasogenic brain edema.

Dexamethasone (Decadron, Dexasone)

Dexamethasone is the drug of choice for patients with HACE. It may improve AMS and HACE by alleviating vasogenic cerebral edema and improving endothelial integrity; it prevents AMS but does not improve acclimatization. Rebound AMS may occur if the drug discontinued at altitude.

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Antiemetics

Class Summary

These agents are useful in the treatment of symptomatic nausea caused by AMS. Off-label use of oral disintegrating ondansetron for emesis associated with altitude illness was described in a case report. [6]

Prochlorperazine (Compazine, Stemetil)

Prochlorperazine may relieve nausea and vomiting by blocking postsynaptic mesolimbic dopamine receptors through anticholinergic effects and depressing the reticular activating system; additionally, it has the advantage of augmenting hypoxic ventilatory response, acting as a respiratory stimulant at high altitude.

Promethazine (Phenergan)

Promethazine is used for the symptomatic treatment of nausea in AMS.

Ondansetron (Zofran, Zuplenz)

Ondansetron is a serotonin 5-HT3 receptor blocking agent with a rapid onset of action. It binds to 5-HT3 receptors both in the periphery and in the CNS, with primary effects in the GI tract. It has no effect on dopamine, muscarinic, or histamine receptors and therefore does not cause extrapyramidal symptoms, respiratory depression, or drowsiness. A case report describes off-label use of ondansetron 4 mg oral disintegrating tablet plus dexamethasone for emesis caused by altitude illness.

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Sedative hypnotics

Class Summary

These agents are useful for the nearly-universal sleep difficulties at high altitude.

Zolpidem (Ambien)

Zolpidem is structurally dissimilar to a benzodiazepine but is similar in activity with the exception of having reduced effects on skeletal muscle and seizure threshold. It does not depress ventilation at high altitude.

Eszopiclone (Lunesta)

Eszopiclone is a nonbenzodiazepine hypnotic pyrrolopyrazine derivative of the cyclopyrrolone class. The precise mechanism of action is unknown, but this agent is believed to interact with GABA receptors at binding domains close to or allosterically coupled to benzodiazepine receptors.

Temazepam (Restoril)

Temazepam depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing the activity of GABA. It appears safe for well persons but should be avoided in those with AMS, owing to concerns about exaggerated hypoxemia during sleep.

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Analgesics

Class Summary

These agents are indicated for the treatment of mild to moderate pain and headache.

Ibuprofen (Motrin, Advil, Nuprin, Midol)

Ibuprofen may be used for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Acetaminophen (Tylenol, Aspirin Free Anacin)

Acetaminophen is the drug of choice for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.

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