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BMJ (Clinical Research Ed.) Jul 2000To quantify efficacy and harm of pharmacological prevention of acute mountain sickness. (Review)
Review
OBJECTIVE
To quantify efficacy and harm of pharmacological prevention of acute mountain sickness.
DATA SOURCES
Systematic search (Medline, Embase, Cochrane Library, internet, bibliographies, authors) in any language, up to October 1999.
STUDY SELECTION
Randomised placebo controlled trials.
DATA EXTRACTION
Dichotomous data on efficacy and harm from 33 trials (523 subjects received 13 different interventions, 519 a placebo).
DATA SYNTHESIS
At above 4000 m the mean incidence of acute mountain sickness with placebo was 67% (range 25% to 100%); incidence depended on the rate of ascent, but not on the altitude or the mode of ascent. Across all ascent rates, dexamethasone 8-16 mg prevented acute mountain sickness (relative risk 2.50 (95% confidence interval 1.71 to 3.66); number needed to treat (NNT) 2.8 (2.0 to 4.6)), without evidence of dose responsiveness. Acetazolamide 750 mg was also efficacious (2.18 (1.52 to 3.15); NNT 2.9 (2.0 to 5.2)), but 500 mg was not. In two trials, adverse reaction (including depression) occurred after dexamethasone was stopped abruptly (4.45 (1.08 to 18); NNT 3.7 (2.5 to 6.9)). With acetazolamide, paraesthesia (4.02 (1.71 to 9.43); NNT 3.0 (2.0 to 6.0)) and polyuria (4.24 (1.92 to 9.37); NNT 3.6 (2.5 to 6.2)) were reported. Data were sparse on nifedipine, frusemide (furosemide), dihydroxyaluminium-sodium, spironolactone, phenytoin, codeine, phenformin, antidiuretic hormone, and ginkgo biloba.
CONCLUSIONS
At above 4000 m, with a high ascent rate, fewer than three subjects need to be treated with prophylactic dexamethasone 8-16 mg or acetazolamide 750 mg for one subject not to experience acute mountain sickness who would have done so had they all received a placebo. Acetazolamide 500 mg does not work.
Topics: Acetazolamide; Acute Disease; Altitude Sickness; Calcium Channel Blockers; Confidence Intervals; Dexamethasone; Diuretics; Glucocorticoids; Humans; Nifedipine; Randomized Controlled Trials as Topic; Risk
PubMed: 10915127
DOI: 10.1136/bmj.321.7256.267