Version May 2024
| Condition | Preferred agent | Alternatives | |
| AMS/HACE | Prevention* | Acetazolamide Adults: 125 mg orally every 12 hours Children: 2.5 mg/kg (maximum single dose: 125 mg) orally every 12 hours¶ Duration: Start day before ascent and continue 2 to 3 days at maximum altitude; may use once at night thereafter to improve sleep | Dexamethasone Adults: 2 mg orally every 6 hours or 4 mg orally every 12 hours Children: Acetazolamide preferred; do not use for prophylaxis Duration: Start day of ascent and continue 2 to 3 days at maximum altitude but for no more than 7 days total |
| Treatment of mild AMSΔ | Acetazolamide Adults: 125 to 250 mg orally every 12 hours Children: 2.5 mg/kg (maximum single dose: 250 mg) orally every 12 hours¶ Duration: Continue for 24 hours after symptoms resolve or descent completed | Dexamethasone Adults: 2 to 4 mg orally every 6 hours Children: 0.15 mg/kg (maximum single dose: 4 mg) orally every 6 hours Duration: Continue until 24 hours after symptoms resolve or descent completed but for no more than 7 days total | |
| Treatment of moderate to severe AMS | Dexamethasone◊ Adults: 4 mg orally every 6 hours Children: 0.15 mg/kg (maximum single dose: 4 mg) orally every 6 hours Duration: Continue for 24 hours after symptoms resolve or descent completed but for no more than 7 days total | Acetazolamide Adults: 125 to 250 mg orally every 12 hours Children: 2.5 mg/kg (maximum single dose: 250 mg) orally every 12 hours¶ Duration: Continue for 24 hours after symptoms resolve or descent completed | |
| Treatment of HACE | Dexamethasone◊ Adults: 8 to 10 mg orally/IM/IV once, then 4 mg orally/IM/IV every 6 hours Children: 0.15 mg/kg (maximum single dose: 4 mg) every 6 hours Duration: Continue until 24 hours after symptoms resolve or descent completed but for no more than 7 days total | Acetazolamide Adults: 250 mg orally every 12 hours; may use as adjunct with dexamethasone; not for monotherapy Children: 2.5 mg/kg (maximum single dose: 250 mg) orally every 12 hours¶ Duration: Continue until 24 hours after symptoms resolve or descent completed | |
| HAPE | Prevention* | Nifedipine Adults and children ≥50 kg: 30 mg extended-release orally every 12 hours Duration: Start day before ascent and continue for 5 days at maximum altitude Acetazolamide Pediatric re-entry HAPE prevention only (<50 kg): 2.5 mg/kg (maximum single dose: 125 mg) orally every 12 hours¶ Duration: Start day before ascent and continue 4 to 5 days at maximum altitude | Further research is needed before the medications listed below can be recommended for routine use in HAPE prevention (adult dosing): Tadalafil: 10 mg orally every 12 hours; start day of ascent and continue 3 to 5 days at maximum altitude Sildenafil: 50 mg orally every 8 hours; start day of ascent and continue 3 to 5 days at maximum altitude Dexamethasone: 8 mg orally every 12 hours; start day of ascent and continue 48 to 72 hours at maximum altitude Acetazolamide: 125 to 250 mg orally every 12 hours; start day before ascent and continue 48 to 72 hours at maximum altitude |
| Treatment§ | Nifedipine Adults and children ≥50 kg: 30 mg extended-release orally every 12 hours Amlodipine¥ Children 6 to 17 years old and ≥25 kg: 2.5 to 5 mg orally once daily Children 1 to 5 years old or <25 kg: 0.1 to 0.6 mg/kg/dose orally once daily (maximum 5 mg/day); oral liquid available Duration (both agents): Continue until descent completed, symptoms resolved, and SpO2 normal for altitude | Further research is needed before the medications listed below can be recommended for routine use in HAPE treatment (adult dosing): Tadalafil: 10 mg orally every 12 hours Sildenafil: 50 mg orally every 8 hours Duration: Continue until descent completed, symptoms resolved, and SpO2 normal for altitude | |
AMS: acute mountain sickness; HACE: high-altitude cerebral edema; HAPE: high-altitude pulmonary edema; IM: intramuscularly; IV: intravenously; NSAID: nonsteroidal antiinflammatory drug; HAI: high-altitude illness; SpO2: oxygen saturation.
* Gradual ascent is the best strategy for prevention of HAI. Early recognition of symptoms and prompt treatment are critical to reduce risk of progression to serious HAI (such as HAPE and HACE). Reserve pharmacologic prophylaxis for patients who have a history of HAPE or recurrent AMS and patients at high risk (as well as selected patients at moderate risk) of developing AMS/HACE according to criteria listed in the separate UpToDate content. Refer to UpToDate content on unique pediatric considerations for discussion on prevention in children. Provision of these medications for "rescue" treatment is also reasonable.
¶ For immediate administration in children, a liquid acetazolamide solution can be made by crushing a 125 mg or 250 mg tablet and suspending it in cherry, chocolate, or other flavored syrup to hide the bitter taste. A flavored oral suspension useful in patients who cannot swallow pills or for measurement of doses used in smaller children (eg <125 mg) can also be compounded by a pharmacy. Detail is available in the acetazolamide pediatric drug monograph.
Δ May not require pharmacologic treatment. Rest, halt ascent, and symptomatic treatment (eg, acetaminophen or NSAID for headache and ondansetron for nausea/vomiting) may be sufficient. Refer to accompanying UpToDate text.
◊ Treatment with dexamethasone alleviates symptoms of AMS/HACE but does not improve acclimatization. Dexamethasone is not a substitute for immediate descent in HACE.
§ May not require any pharmacologic intervention. In proper setting, rest and supplemental oxygen may be sufficient. Refer to accompanying UpToDate text.
¥ In children, descent and/or supplemental oxygen are preferred treatment and often effective without pharmacologic therapy. Compared with nifedipine, amlodipine offers advantages for small children because of once daily dosing and availability as liquid or appropriately sized tablets, but it has not been studied specifically in children for HAPE treatment. Dosing is based on pediatric pulmonary hypertension management guidelines and expert opinion.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
