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#18516 - 09/19/11 02:25 PM Diamox - quick question
Rboone Offline


Registered: 09/13/11
Posts: 15
Loc: Orange County, CA
First, while I found plenty of Diamox discussion in my searches of previous threads I didn't find answers to my specific questions. If this is a rehash of old discussion I am truly sorry.

I hiked to the summit of Mt. Whitney 20 years ago as a 20 year old. We went from San Diego to Lone Pine, picked up our permits and headed up to Trail Camp all in the same day. The night at Trail Camp was a bit uncomfortable and I recall having a pretty good altitude headache. The next day we hiked to the summit and back down to the Portal with no problems.

Fast forward to this coming Oct. 2-4 when a friend and I are coming back to revisit the summit. We plan to sleep at one of the camps up the trail the first night and then Trail Camp or somewhere just below it the second night. This should be good acclimatization, something we didn't bother with before.

But still, being older and wiser than before, I got a prescription for Diamox. My pills are 250mg so I cut one into fourths and took 62.5mg. I experienced a little touch of the listed side effects: light headedness and lethargy. The directions that came with the prescrip said that these side effects lesson after a day or so on Diamox. Is this your experience? Also, if I had these slight side effects at sea level here in Orange County would those side effects be worse up the hill? I don't want to feel tired on summit day. Lastly, would you recommend I just avoid taking it unless I get another bad headache? Or, perhaps just start taking it a day or two before we begin our hike so the side effects are minimized or completely eliminated?

I don't expect the headache this time around given a couple days of acclimatization but I want to be prepared.

Thanks for the insight.

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#18518 - 09/19/11 02:47 PM Re: Diamox - quick question [Re: Rboone]
KevinR Offline


Registered: 11/03/09
Posts: 591
Loc: Manchester, NH
While one of my friend's took Diamox after he began to have symptoms of altitude sickness, and claimed it helped him feel better ... if it were me, and I was worried about minimizing/eliminating the symptoms, I would follow the standard advice of taking the stuff in advance. Harvey and/or Ken may jump in here and give you their medical opinion, but personally I think taking it AFTER the onset of symptoms is more hit or miss than building up levels in your bloodstream ahead of time. But, that's me, and YMMV - I'm just an avid hiker, not an MD.

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#18524 - 09/19/11 04:45 PM Re: Diamox - quick question [Re: Rboone]
wbtravis Offline


Registered: 09/22/09
Posts: 1251
Loc: Corner of Jack Benny and Roche...
Everyone is different.

I have to start at 1/4 pill for the first day or I feel real funky. I usually start dosing Wednesday for a trip that takes me to the elevations above 8,000' on Friday. You have to play around to get the dosing right for you. It took me about 5 years to get it right...and it ain't perfect.

Diamox is not a panacea. I still have problems with sleep and appetite but not headaches. If I don't push the first day I'm usually ok. If over exert, I will have problems with sleep and appetite, especially when I'm over 11,000'.

Before I started using Diamox, I had my worse case of AMS after two days of acclimatization. Good luck.

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#18526 - 09/19/11 05:13 PM Re: Diamox - quick question [Re: wbtravis]
Harvey Lankford Offline


Registered: 11/10/09
Posts: 1007
Loc: Richmond, Virginia
Kevin, correct. It works as both a partial preventative for AMS, and as a partial treatment for established AMS. Relative values of those two benefits is subject to lots and lots of debate. Did I mention the word partial?

As for the symptoms with the trial at sea level, you could stop it, then "rechallenge" with another low dose. That way you could better understand if you really had a side effect, or just a bad day.

PS Lots of factors as mentioned: tolerance versus medical benefit. These compete for when to start? day before, or day of ascent. I think most people start day before or night before if they have tolerated it well before. If you get your testing phase out of the way now, there would be little reason to start it 2 days before ascent. Lots of opinions among lay and expert audiences on all of this.


Edited by Harvey Lankford (09/19/11 05:27 PM)

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#18530 - 09/19/11 06:11 PM Re: Diamox - quick question [Re: wbtravis]
Steve C Offline


Registered: 09/22/09
Posts: 7527
Loc: Fresno, CA
wbtravis wrote:
Before I started using Diamox, I had my worse case of AMS after two days of acclimatization.

This summmer, while taking it easy at 10,000', it took a total of 4 nights ( 2 of those at 8,000' ), to feel completely up to par. I thought being at only 10k, I wouldn't need Diamox. But it probably would have helped.

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#18533 - 09/19/11 08:11 PM Re: Diamox - quick question [Re: Rboone]
Akichow Offline


Registered: 04/07/10
Posts: 659
Loc: SF Bay Area
My experience. Am not a medical professional. And I am female, so your experience (depending on your sex, weight, and other considerations) may vary.

Diamox is fast-acting for me. I know this because, back in 2010, after suffering through hours of Cheyne-Stokes at altitude, I took it at 3 a.m., and was sleeping like a baby (finally) within the hour. This suggested to me that Diamox gets in my blood fast. So fast that I do not bother to take it until I reach a high sleeping altitude (no day-before dosing for me).

Caveat: I always build in acclimatization -- two nights at 10,000 or so feet before going higher -- and I don't need Diamox until I am sleeping over 11,000. Further caveat: I do not use Diamox for as prophylaxis for AMS -- though I assume I am getting that benefit there as well -- but to address a specific issue that I experience (periodic breathing at altitude).

I experience minor side effects whenever I take Diamox (I only take 62.5 mg/day, right before going to sleep at altitude). The key side effect that I experience at this low dosage is intermittent hand tingling. I ignore it. It does not interfere with my enjoyment of the mountains, or my physical abilities. It seems to stay with me as long as I am taking the drug (tingling can occur from time to time up to about 12 hours or so until after I stop).

There is a lot of anecdotal evidence on this board, that you have probably seen, of interference of enjoyment at higher dosages. I personally have not experienced the problems described at my low dosage.

I do up the supplemental electrolytes SIGNIFICANTLY while on Diamox. Just in case.


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#18536 - 09/20/11 03:21 AM Re: Diamox - quick question [Re: Akichow]
KevinR Offline


Registered: 11/03/09
Posts: 591
Loc: Manchester, NH
I have a Harvey/Ken/medical researcher question re: AMS - Is the body's reaction to the effects of altitude similar to its reaction to pain? A couple of years ago while in the BC backcountry I broke a tooth, and found a most capable dentist in a nearby town who extracted it for me. She told me to take an NSAID immediately afterward. When I suggested I thought I'd wait until the anesthetic wore off to see if there would be substantial pain, she explained that given the procedure there would likely be pain, and it was important to stop the body's reaction to the pain before it started. Apparently once that reaction is triggered it's much more difficult to stop it. It occurred to me that perhaps the body's reaction to the effects of altitude might be similar in that once the various processes are triggered they were difficult to slow down. Any thoughts?

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#18537 - 09/20/11 04:27 AM Re: Diamox - quick question [Re: KevinR]
Rboone Offline


Registered: 09/13/11
Posts: 15
Loc: Orange County, CA
Thank you all so much for the responses.

Similar to what Akichow mentioned, I felt the small dose of 62.5mg very quickly. It wasn't uncomfortable in the least but I did notice a slight change in the way I felt (symptoms noted previously). Not that it matters but for the record I'm male, 6'1", 170 lbs and arguably in the best shape of my life. But, we all know AMS doesn't care about physical conditioning.

In preparation for my hike I came across several Diamox discussions and was intrigued due to the overnight headache I had the first time around at Trail Camp. Interestingly, after that uncomfortable night of on again off again sleep I felt good to the summit the next day and then back to the Portal. I figure between better acclimatization and Diamox I may be able to eliminate the headache and sleep better which will lead to better enjoyment.

As suggested I think I'll test it again before I go but this time I'll take the 62.5mg twice a day as prescribed for 2-3 doses to see if the mild symptoms disappear. I would much rather take Diamox to prevent a headache than get a headache and then take the Diamox hoping that it knocks it out. We'll see; I'll experiment more before my hike.

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#18539 - 09/20/11 05:49 AM Re: Diamox - quick question [Re: KevinR]
Harvey Lankford Offline


Registered: 11/10/09
Posts: 1007
Loc: Richmond, Virginia
Originally Posted By: KevinR
Apparently once that reaction is triggered it's much more difficult to stop it. It occurred to me that perhaps the body's reaction to the effects of altitude might be similar in that once the various processes are triggered they were difficult to slow down. Any thoughts?


Kev, there was recently posted a case of someone who descended all the way to Lone Pine but continued to deteriorate with HAPE and ended up in hospital, so yes, once things begin to go bad they may deteriorate. While that case was HAPE, the same applies to simple AMS. Some, but not all, cases of AMS do progress/worsen/snowball and complication set in.

It seems that, like with many medical conditions, it is better to prevent than wait and treat. Most advisors will say to have the Diamox onboard early. That is especially good advice with those with previous history of AMS problem who are thus at more risk. Harvey

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#18561 - 09/20/11 05:05 PM Re: Diamox - quick question [Re: Harvey Lankford]
wbtravis Offline


Registered: 09/22/09
Posts: 1251
Loc: Corner of Jack Benny and Roche...
Harvey,

I've had AMS on Mt. Whitney and feel great 1,000' lower but I have had a 4 symptom episode, headache, nausea, malaise and appetite, on White Mountain, which did not clear until I was in Big Pine for over an hour.

Also, I never have a problem with AMS day hiking in the SoCal mountains.

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#18577 - 09/21/11 06:10 AM Re: Diamox - quick question [Re: Rboone]
mweaver Offline


Registered: 09/21/11
Posts: 2
Loc: VA
I've got a Diamox question as well for anyone who is knowledgeable --

I was prescribed Diamox for a Sierra trip but was given the 500 mg extended release capsules. Given the experiences I've read about this high of a dose, I'd like to start with something lower. Is the powder in the capsules edible by itself or will it make me vomit from the flavor? I could further repackage into another capsule, but I'd rather save the effort if possible. Thanks.

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#18579 - 09/21/11 08:31 AM Re: Diamox - quick question [Re: mweaver]
KevinR Offline


Registered: 11/03/09
Posts: 591
Loc: Manchester, NH
The general consensus among those who use Diamox seems to be that an Rx for the 250mg variety, and then taking a quarter of that dose (62.5) by scoring/breaking the tablet, is preferred, i.e., alleviates the symptoms with moderate side effects.

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#18582 - 09/21/11 09:36 AM Re: Diamox - quick question [Re: mweaver]
Steve C Offline


Registered: 09/22/09
Posts: 7527
Loc: Fresno, CA
Mweaver, have you opened a capsule? Is it powder, or tiny round beads?

I think capsules dissolve quickly, and it's the contents inside that release slowly over time.

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#18585 - 09/21/11 10:18 AM Re: Diamox - quick question [Re: Steve C]
mweaver Offline


Registered: 09/21/11
Posts: 2
Loc: VA
I think it's powder, which is why I want to divy it up into more manageable doses. Regardless, my question remains -- for anyone who has done this, how does tolerable is the taste?

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#18586 - 09/21/11 10:35 AM Re: Diamox - quick question [Re: mweaver]
KevinR Offline


Registered: 11/03/09
Posts: 591
Loc: Manchester, NH
Originally Posted By: mweaver
I think it's powder, which is why I want to divy it up into more manageable doses. Regardless, my question remains -- for anyone who has done this, how does tolerable is the taste?


Not to seem like a smart-ass, but ... why are you asking this question? Were you planning on savoring it? Rolling those little balls around in your mouth? smile It's been my experience that when you break open any capsule that most people wash them down about as fast as they can.

Having said that - drugs marked "timed-release" means the compound has been treated with substances to prevent quick dissolving - hence "timed-release". I doubt many would dissolve in your mouth within a short period even if that were your intent.

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#18589 - 09/21/11 12:16 PM Re: Diamox - quick question [Re: KevinR]
Steve C Offline


Registered: 09/22/09
Posts: 7527
Loc: Fresno, CA
Kevin, ever take Flagyl (metronidazole), the medicine prescribed for Giardia and many other general intestinal bacterial problems? That pill, no matter how fast you gulp it down, tastes AWFUL!

mweaver, the standard Diamox tablets don't have that awful taste, so I'd doubt the timed-release powder would. I'd suggest you give it a taste. Probably won't be that bad.

If it is truly bad-tasting, try mixing it with a spoon of applesauce. That works for my 6-y-o.

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#18592 - 09/21/11 01:43 PM Re: Diamox - quick question [Re: Steve C]
KevinR Offline


Registered: 11/03/09
Posts: 591
Loc: Manchester, NH
I have, Steve. However, at the time I was feeling so awful otherwise it was more of a distraction than anything!

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#18602 - 09/21/11 07:00 PM Re: Diamox - quick question [Re: KevinR]
Akichow Offline


Registered: 04/07/10
Posts: 659
Loc: SF Bay Area
Originally Posted By: KevinR
The general consensus among those who use Diamox seems to be that an Rx for the 250mg variety, and then taking a quarter of that dose (62.5) by scoring/breaking the tablet, is preferred, i.e., alleviates the symptoms with moderate side effects.


Hello. Generic form diamox (acetazolamide) comes in 125 mg. I get those, and cut them in half.

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#18611 - 09/22/11 03:45 AM Re: Diamox - quick question [Re: Akichow]
KevinR Offline


Registered: 11/03/09
Posts: 591
Loc: Manchester, NH
Originally Posted By: Akichow
Hello. Generic form diamox (acetazolamide) comes in 125 mg. I get those, and cut them in half.


Thanks for clarifying that. I've not taken it myself, but have a couple of friends who do, and thought it came in a 250mg variety.

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#18612 - 09/22/11 04:17 AM Re: Diamox - quick question [Re: KevinR]
Rboone Offline


Registered: 09/13/11
Posts: 15
Loc: Orange County, CA
I think the generic comes in either 125mg or 250mg. My physician prescribed 250mg. With no previous experience with the drug I think he chose this dose so that I could cut the pills up to experiment with the appropriate dose for me. My pills have the indents making clean cuts into halves or quarters very easy.

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