Mt Whitney Zone Forums General Discussion Diamox

What are your suggestions for the proper dosage and when to start taking it before climbing Whitney

Beer1, the prescription will likely be for 1 250 mg tablet twice a day, beginning several days before ascending to elevation and continuing several days after descending. At least that's what it was for my wife and daughter for their first attempt to hike above 12,000 feet this year. Most people on this board will tell you to moderate that dosage and schedule, and I agree.

The tabs are scored in quarters, so you can chop them down to 125 mg or 62.5 mg. The dosage needed can vary by individual, but the main thing to be aware of is that the noticeable side effects (frequent urination, tingling in the extremeties, and taste sensitivity) increase with the dosage. Most folks I know who use Diamox in the mountains take either 62.5 or 125 mg twice a day beginning the day before ascent above 11-12K', and stopping the regimen once below the target elevation.

I used the stuff myself for the first time just last month. Elevation has never affected me as long as I acclimate at least 2 nights at/above 8000 feet. This time, though, with my wife and daughter attempting elevations they had never hiked to before, I elected to go on Diamox with them - just to be sure I had the best available capacity if either of them got in trouble in some way.

We all took 125 mg the night before acsending above 12,000 feet, and for the duration that we were above that elevation. We did this for Mt. Dana (13K') as well as Mt. Whitney. None of us experienced any AMS symptoms, nor did we feel any of the bothersome side effects of the drug. I should note, though, that we spent 1 night at 8000 feet just before Dana, and a total of 5 nights above 8000 feet immediately before Whitney. Diamox is a great aid, but it ain't a magic bullet - be sure not to bypass acclimation. We ran into several folks on Whitney who were retreating with AMS who were on Diamox. If you combine Diamox with proper acclimation, you've covered your bets as best you can.

Still, be sure to discuss with your physician - your mileage may vary.

Note. Diamox comes in 125 mg tablets too. So, in my case, I take just a half a tablet at a time. Based on my weight and sex, a high altitude specialist recommended 62.5 mg twice a day (although I have now reduced that substantially based on my personal experience). As you will see if you search on "diamox," there is a lot of debate here as to dosage, and whether prophylactic use is appropriate. An issue for you and your doctor....

There is a certain amount of confusion over the optimal dosing regimen.

The trend for hikers has certainly trended towards a lower and lower amount over the last 20 years.

What is published in the actual package inserts of the medications is probably the original info, and it is probably related to helicoptor military operations, where you had people being inserted into higher altitudes in very short times, not hiking in.

One advantage of the lower dosing, is the freedom it gives with respect to the frequency. The manufacturer states:

"The dosage employed in the treatment of chronic simple (open-angle) glaucoma ranges from 250 mg to 1 g of acetazolamide per 24 hours, usually in divided doses for amounts over 250 mg."

So for doses of 250/day or less, it can be administered in a once a day dose, which is more convenient.

For the last couple of years, I've recommended, and used myself, a 1/2 tab of a 125 at bedtime (to maximize the impact on the disturbed breathing involved with AMS, probably the most commom form of AMS symptom, which is well known to be best treated with diamox)

As for onset and duration of treatment, the manufacturer also states:



And I think that is a good guideline to follow, with the one caveat:
if a person has never taken the medication before, I think it is a good idea to take a dose or two a few weeks before a trip to make sure that one will not have some sort of unusual or bizarre reaction, that would screw up one's trip!

Diamox does contain the molecule sulfa, but it is NOT the same as a sulfa antibiotic, and people who are allergic to sulfa antibiotics generally are not at greater risk of reactions, than any other people who get allergic reactions to things OTHER than sulfa. However, they should know this, and if considering taking Diamox, should take a dose in civilization, not out in the boondocks.

Also, the generic acetazolamide is every bit as good as the brand name Diamox.

Ken, as you and I and others have discussed here,side effects often limit the dose. For me personally anything over 125 twice daily causes significant and bothersome paresthesias (tingling) in the hands,feet, and face to the point of interfering with sleep. The one time I took the sustained release 500 I vowed never to do it again . Others of course will vary, but the 1000/day seems unimaginable

Hi Harvey,
I had heard that paresthesias could be caused by Hypocalcemia and then I read that in some cases diamox can cause Hypocalcemia. Speculating on a connection between the Hypocalcemia and paresthesia, this past trip I decided to eat a tums a bit after I took my diamox (125mg twice a day). This is the first time that I haven't had tingling in my feet and fingers. I'm guessing that I just got lucky, but I'm going to try taking tums when I take diamox again to see if the tingling stays away (really more pins and needles, than tingling, but who's counting).

it's funny, after the first time taking diamox, I really hated the taste of sodas. Now I really enjoy it. It seems to give it an extra sharp burn.

Ditto - same for me.

Now I just take the one 62.5 mg dose at night before sleeping at altitude, and I no longer take any at all in the days prior to reaching altitude. I take it specifically to address periodic breathing (Cheyne Stokes), the issue to which Ken alludes, since I experienced that phenomenon once on White Mountain, and prefer to avoid it in the future. So far, so good. Even at 62.5 mg/day, I still get some hand tingling....

Exactly my experience.

You guys make me feel so lucky. I've been above 14,000 feet 244 times and never had a problem. I'll admit to using a little Diamox to help me sleep on Denali, but I felt pretty good at 20,320.

Oh bobby, if only we all were so tough as thee I've been above 14k 245 times, but who's counting?

Burchey:

I know you're jerkin' my gherkin a little because I teased you on another thread, but I'll give you a straight answer anyway.

If you get AMS, push on to the summit, and make it out OK, you're tough. If you get AMS, push on anyway, and need help getting back down, you're stupid. If you don't get AMS in the first place, you're lucky.

People who are fitter and stronger than I am get AMS and perform poorly at altitude. I occasionally get a hint of a headache, but a few extra deep breaths make it go away. One of the reasons I play at altitude so much is that I just naturally don't have problems with altitude. This thread made me appreciate my good fortune.

Got it. Thought you were just taking advantage of another opportunity to remind us how awesome you are. We are very aware. Saw your trip report for the Willy/Tylly in one day - beating your old record.

BTW, who keeps exact track of how many times they've been above X altitude?

Unfortunately I do, much to the annoyance of my climbing buddies. I only keep track of climbed peaks/mts over 14k, and now some of them have started doing it too. Peaks/Mts range from Sunshine, CO 14,001' to Kilimanjaro 19,340'

Maybe I'm the oddball. I couldn't tell you how many women I've been with either, unless I think really hard and count. That's not bragging either, it isn't that many. I'm just not into tracking, I guess. To each his own.

Bob, do you use any sort of pre-climb aclimatization program? (one night at 10k....two nights?) I am curious, because, I too do quite well at altitude if I sleep high the night before (I have done 13,800 from sea level as a turn and burn (day hike) but I had been at altitude the weekend before)

I returned last night from a trip to Thousand Island Lake, and was really surprised at my AMS symptoms.

We stayed 36 hours in Mammoth, 8000' with no symptoms. Then traveled into T.I.L. at 9800'. I had symptoms for another 24 hours! They weren't that bad, but I felt wasted -- tired, with occasional slight nausea. I was able to eat, though.

Finally, Saturday morning, over 72 hours after being at or above 8000', I felt good. I was able to climb Banner Peak, ~13000' symptom-free.

I have used Diamox in the past, because I usually get the symptoms. But this trip, with the initial stay at 8k, and the fact we were only going to ~10k, I thought I'd skip it.

Next time, I'll know better!

Someone hacked Steve's login. I'm just sayin'.

Burchey..... Is that counting on one hand or two? Just kidding. And yes, I can count how many times I've been over 14,000. 3 times. So.....I'm just a tiny bit behind......summits that is. :-)

Hi Beer1,

I believe that beer (because of its heavy weight) is OK only for car camping.
For a walk in campsite I would recommend a more concentrated medicine like whiskey or cognac.
Actual dosage depends on your personal physiology but it should be sufficient to have good sleep.

Note: Actually I know a few people who believe that such beverages is a good AMS prevention medicine. What's important - it works for these people!