Dosage of Acetazolamide for AMS Prophylaxis
I got a pretty heated e-mail about my advice to use a 125 mg BID (twice per day) dose of acetazolamide for AMS prevention. This dosage is in contrast to the 250 mg BID dose, generally used.
The e-mail was in good fun, but it made me want to cite the articles that I consider to be the resources on the subject. Recognizing there is controversy in this issue, I stand by my advice to start prophylaxis at the 125mg dose, BID. Here’s my source:
http://www.liebertonline.com/doi/abs/10.1089/ham.2006.7.17 A great RCT that looked at the 125 vs. 375 mg BID doses, the PACE (The Prophylactic Acetazolamide Dosage Comparison for Efficacy Trial) trial.
With regard to side effects of acetazolamide; they are dose dependent. The more you take, the worse the paresthesia/numbness, the metallic taste is stronger, etc…
Having stated my opinion, one must also be able to spot AMS that can occur even on the medication. Stopping ascent, resting, fluids and considering stepping up to the treatment dose of acetazolamide are good things to start thinking about.
I am always up for some education, if you have any other information, let me hear about it!
I already know about several, but this is one of the better 250mg BID articles
I found this from the BMJ Clinical Evidence, which offers a good summary of AMS prophylaxis. It mentions Acetazolamide as having dose dependent side-effects and cited the PACE trial, linked above.