Mt Whitney Zone Forums General Discussion Diamox...how much?

Hello Whitney Forum....I am heading up to the Mt. San Jacinto via the Aerial Tram on a short backpack this weekend. I want to test how Diamox affects me before trying it at Whitney next month. (I have a history of AMS) I know dosage differs according to a person's physiology, but I just wanted to know when I should start taking it (2 days before?) and some recommended dose.(I weigh about 200 lbs) Thanks!

Just curious, how much was prescribed?

I was prescribed 125 mg twice per day. I've found that if I take that much, the side effects are really annoying.

I was prescribed the same dosage....what are all the side effects you got?

hand tingling, nausea, diarrhea, and the metallic taste when drinking carbonated drinks.

By cutting the dose in half, most of them went away.

Did the lower dose still help with altitude acclimatization?

Everyone is different on this. I take 62.5 mg once a day, right before bed, starting then first night I sleep at altitude (>11,000' sleeping altitude), and continuing until I think I am acclimatized (a couple of days). I do not take any in the day or so before I get to altitude. That is sufficient for me in the Sierra. You just have to experiment and see what happens.

You are right everyone is different.

San Jacinto and San Gorgonio may not provide you with the information you seek. I can hike both without AMS problems but the Sierra is another issue entirely...for me.

When you start and what dose is also personal but there are standard dosing guidelines...see Dr. Peter Hackett for good information. He will provide you with a base line; however, only experience will provide you with a when and a dosing schedule.

Well, in preparation for my trip, I have already taken three 125 mg capsules (2x a day), just to see how I would do with the recommended dosage, and some side effects have shown themselves (increased urination, slight/brief periods of tingling). I think I am going to try 135/a day, and see how that goes.... Thanks for all your guy's help! This forum is great!

Have you asked the advice of the doctor who prescribed Diamox for you? Better to do that than rely on anecdotal information from non-physicians.

the average health care provider knows a smattering about high altitude, Diamox, and for that matter, a lot of wilderness medicine. They often did not get the training (you can't take every course, or see every condition) or if they did they don't get the ongoing experience to stay proficient. High altitude medical care is a niche. High altitude illnesses rank from headache to death. I've seen the gamut.

not much to add to what has been said. Some need or tolerate tiny doses, some more. The patient is the one who has to learn the individualization.

I have a friend who in 2012 took 1,000 mg daily plus a nuclear weapon dose of steroids (16 mg dex)daily for 3 weeks when he went to 18,000 ft in Nepal. There are legitimate studies that say this helps for altitude of that sort (not Whitney). Claims he had no side effects from either drug. Others might have had a bleeding ulcer or gone into steroid-psychoses with that.

125 mg twice daily is a common compromise dose for Diamox.
It is not a panacea.

True, most physicians have limited knowledge of AMS, but probably know about Diamox and it's usual, non-AMS, applications. Here in Bishop, our docs are familiar with AMS, but in flat-land they might not be. However, it is easy for any doctor to find that information.

Since Diamox is a prescription medication in the USA, any doctor will probably ask why the person wants to take it, and then investigate any possible conflicts with other medications the person is taking.

Anecdotal Diamox testimonies aside, we should not be encouraging taking any prescription medication without a physician's supervision. Self-medicating is not a good idea, nor is changing the prescribed dosage without informing one's doctor.

I hope any physicians reading this thread will give their opinions.

A physician has already weighed in on this thread (not me!). And I don't see anyone suggesting taking Diamox without consulting a physician.

I, for example, consulted two physicians before getting Diamox, including a doctor at Stanford who specializes in wilderness, emergency, and high altitude medicine. He recommended a lower dose than would your average general practitioner (based on my weight and sex, he recommended 62.5 mg twice a day). Even so, over time, as I've done more high altitude, and based in part on information gained here, I've experimented with lower doses and come up with dosing that works for me (62.5 mg once a day right before bed at sleeping altitudes of about 11k-13k, up to about 1.5 times that at sleeping altitudes of 16-17k). I get Cheyenne stokes at higher altitudes and Diamox stops it cold. Your experience may differ.

Now the fact that I share this does not mean I think people should adopt anecdotal experience as dogma for themselves. People should consult their doctors for sure. But it has also been my (non medically informed) perception that Diamox is often way over prescribed (one GP prescribed my friend a dose for treating glaucoma, which was way too high), and that this drug may not be one-size-fits-all in terms of dosing.

So if this thread puts it into people's minds that, yes, you should work with your physician, but consider taking an active rather than passive role on working with your physician to find out what is best for you, then that may be a good thing.

K, your 62.5 might sound to some people like splitting hairs but it is not

Diamox is a favorite topic here. Here are some tidbits

It is rarely used for glaucoma any more

It has a "narrow therapeutic window" meaning a little too much gives side effects, and a small amount too little gives no benefit . For altitude usage , the dose often requires individualization

WADA (World Anti-Doping Agency) lists it as a PED (performance enhancing drug) . However, it's benefit is for those affected by altitude, not everyone .

There are studies that show benefit for only the altered sleep of altitude as mentioned by K, others that show other benefits for helping acclimatization , and other studies showing no benefit to performance up high. Meta-analysis, meaning combining multiple similar studies show it is not a slam dunk drug. As I said earlier, it is not a panacea. If it helps an individual , then only he or she can find that out , not some textbook, internet source, or MDs to whose group I belong.

Whitney, and Everest, get climbed all the time without Diamox.

Some people have a "ceiling" and no amount of drug will change that. More time and natural acclimatization will help, but even then there is a finite limit. We all have one.

Just for fun, cattle are far more sensitive than humans . Even an altitude of just 1500m can kill sensitive individuals. In one five yr study from Colorado, altitude effect on the right side of the heart was the second leading cause of death. Now isn't that a cheery way to end this epistle?

Sorry for the late reply. I have been busy with trying to pack for my trip.

I think it helps, but I don't really have a way to tell. Since the first time I used it, I've been more focused on spending more time at elevation before starting a hike.

Some random thoughts:
If I take 2x125, the side effects outweigh any possible benefit. I now take 62.5 twice per day. A friend of mine that came out from Maine to hike Whitney last year was prescribed 2x250. He took it and had no side effects.

If I take the tram up San Jacinto, I always get a headache. The worse 'altitude' headache I've ever had was at Wellman's Divide, while carrying a 55 lb pack. I had a similar headache last year when carrying my son up to Lone Pine Lake. I've done C2C twice now (starting in Palm Springs and hiking to the top of San Jacinto) headache free. So it seems that speed of ascent is a factor for me, as well as exertion level.

Camping at Chicken Spring Lake a couple weeks ago, I woke up in a panic at least three times is a 3 hour period feeling like I could not breathe. I wonder is this the Cheyenne stokes Akichow mentions above. I did not take Diamox and had slept at only 1k feet the night prior.

Waking up in a panic sure sounds like possible periodic breathing a/k/a Cheyenne Stokes a/k/a altitude-relates sleep apnea.

My first and worst experience with this was at White Mountain TH. Had not used Diamox previously and was carrying it purely "just in case." Kept waking up all night long, heart beating, etc. (had spent the prior night at 10,000' with no problems). Finally, woke up thinking I was drowning/gasping for breath and realized what was going on. Popped a Diamox (125 mg) and within 45 minutes was sleeping like a baby. Since then, I've experimented with dosage at different altitudes and learned a lot about what is too little and what is just right for me -- which appears to be somewhat altitude dependent. But, for dealing with periodic breathing, Diamox really works for me.

On Kilimanjaro, I also used it to successfully head off AMS that very hit hard at 16,000' the afternoon before summit attempt (3 doses of 62.5 mg each, 6 hours apart).

So I use it primarily for periodic breathing, though at very high altitudes (Everest Base Camp/Gorek Shep Kili) it has helped me deal with incipient, or, in that one case on Kili, full blown, AMS.

Meanwhile, where no sleeping at high altitudes (i.e., above 11,000') is required, I've summitted 14,000+ without any need for Diamox at all (e.g., Mt. Shasta). Sleeping altitude is the key issue for me.

Yes, your experience may differ.

Thanks, for the response....Just got back from the SJ Overnighter (successful summit), and I used 125mg/day and had no altitude problems (I start with issues at around 10.5K), so it appears the Diamox worked, and with very few side-effects.

The world can be a lot different at 12,000' or higher...or maybe not. It is for me.

Hey guys,

I'm new here, and have been reading up on a lot of the information already posted regarding Diamox. Super helpful! Thanks so much everyone who has already posted, you guys are awesome.

I'm actually heading to climb Whitney this Saturday, and I'm thinking seriously about taking Diamox. Last summer I got hit real hard with AMS on a trip in Kings Canyon. This past week I climbed Mt. Baldy (~10000 elevation) and starting getting a mild headache near the top that got more severe over time. I fear that without Diamox I might not have a chance at making Whitney.

My first question:
If you are taking Diamox, do you guys know if you shouldn't mix it with ibuprofen? I know ibuprofen and aspirin is also used to fight altitude sickness, but if I'm already taking Diamox is there a risk in mixing these two?

Second question:
I've seen that Dr. Peter Hackett is a pro at this stuff. Has anyone seen a doctor in the Los Angeles area with good knowledge of AMS and Diamox? If not, would you recommend pretty much just talking to any general physician?

Again thanks a ton! I tried to scan through the previous posts so I apologize if I missed some info and am asking repetitive questions.

I am not a doctor. You need to see a doctor to get a prescription for Diamox. You don't have much time, so good luck getting in to see one. Most will not be experienced with Diamox (Acetazolamide), but I think they can look up the dosage and write a prescription.

You should take it starting two days before you hike, small dose twice a day. If the prescription is any higher than 250 mg total per day, I'd be careful. Half of that is my max. It has weird side effects, like tingling/buzzing fingers, and beer and carbonated drinks taste bad.

I think you can take it with the other things you mentioned, but be sure to ask the doctor.

I am a physician in LA, and your best bet would be an Urgent Care Center. Should be in and out in a short time. You might call ahead to confirm that the physician is willing to prescribe Diamox (you actually want the generic, acetazolamide), before you go.

You appear to be at risk, and a good candidate for diamox. I'd start taking it wed nite, 60ish Mg once a day at bedtime.

I'd generally consider IB ok to take for a mild-moderate HA, myself. Beyond that, stop.

Caution is advised for patients receiving dual high-dose aspirin and Acetazolamide, as coma and death have been reported.

Another effective technique advocated by many veterans, is to stop every hour and sit down for 10-15 minutes, it really matters, and is a great opportunity to hydrate, as well.

Hydration is very important....not because it is related to getting AMS, but the syptoms can be similar, and it can create confusion.