Decompression Sickness Medication

Updated: Mar 05, 2019
  • Author: Stephen A Pulley, DO, MS, FACOEP; Chief Editor: Joe Alcock, MD, MS  more...
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Medication

Medication Summary

There have been several medications and nutritionals mentioned in the study of the management of decompression sickness (DCS). The medications/nutritionals can have adverse effects and interactions that could affect a diver in a negative manner. The reader is cautioned about taking any substance with the end goal of decreasing DCS until more advanced studies are completed and the individual has discussed their use with a physician well versed in diving medicine.

While many of the mechanisms of action are unclear and need further study before general recommendations can be made, the following medications/nutritionals may be helpful in DCS:

  • Aspirin: Aspirin blocks prostaglandin synthetase action, inhibiting prostaglandin synthesis and preventing the formation of platelet-aggregating thromboxane A2. Its mechanism of action in the treatment of DCS unclear. It has been suggested that aspirin could do harm; therefore, it is no longer recommended for routine use in DCS. [151, 152, 153, 154]
  • NSAIDs: There is a benefit for NSAID use in conjunction with HBO therapy. [33]
  • NASIDs can help control pain.
  • Opiates are also available for pain control as needed.
  • Methylprednisolone: Methylprednisolone is useful in treating inflammatory and allergic reactions. By reversing increased capillary permeability and suppressing PMN activity, it may decrease inflammation. Its mechanism of action in the treatment of DCS is unclear.
  • Lidocaine: Lidocaine decreases the permeability to sodium ions in neuronal membranes, inhibiting depolarization and blocking transmission of nerve impulses. Its mechanism of action in DCS is unknown.
  • Ascorbic acid: Ascorbic acid 2 g daily for 6 days before a dive decreased neutrophil activation and microparticle generation. [15]
  • Folic acid and/or cyanocobalamin: A high percentage of the unexplained DCS-injured divers had moderate increases in total plasma homocysteine and deficiencies in folate and vitamin B-12. [225, 226] Simple blood testing can identify issues.
  • Pyridoxine: Increases in total plasma homocysteine may be treated favorably with folate and vitamin B-6 supplements. [225, 226]
  • Fluoxetine: This agent, a common antidepressant medication in the serotonin-specific reuptake inhibitor (SSRI) class, decreases the incidence of DCS and improve motor function recovery by limiting the inflammatory process. [198] Based on rat models, it is believed to decrease inflammation through cytokine interleukin 10 suppression. [200]
  • Simvastatin: Simvastatin decreased the incidence of DCS in a rat population through its anti-inflammatory properties. [201]
  • Nitroglycerin sublingual: The common sublingual medication nitroglycerin (0.4 mg), administered 30 minutes prior to a dive, provided some level of protection by decreasing bubble formation. [196] It is a short-acting nitric oxide donor. Inhibiting nitric oxide synthase increases the number and size of bubbles, and administering a nitric oxide donor decreases the number and size of bubbles. [195] This effect also occurred with a long-acting agent at 20 hours before the dive. Nitroglycerin has many adverse effects. These include dilation of blood vessels, lowering of blood pressure, and headaches. These symptoms could be disabling should they occur during a dive.
  • Arginine: Nitric oxide synthetase converts arginine and oxygen to nitric oxide. One might surmise that taking the common L-arginine amino acid would help drive the equation to nitric oxide. This has not been studied.