Acetazolamide 250mg tablets (also known as Diamox) are available to buy from The Independent Pharmacy Online Doctor service, following a free consultation, to help to prevent and treat altitude sickness. To find out more about acne and see all the available treatments, see our Altitude Sickness page.
Acetazolamide has several applications but is widely used to prevent or reduce the symptoms of altitude sickness. Acetazolamide can actively reduce the nausea, dizziness, headache and shortness of breath associated with rapid ascents (usually anything above 10,000 feet or 3,048 metres).
Acetazolamide 250mg tablets works to treat altitude sickness by increasing the amount of urine produced, consequently altering the acidity of the blood. This leads to a reduction in fluid in the lungs and around the brain. The result is improved breathing and relief from the symptoms of altitude sickness.
Without medication, the symptoms of altitude sickness will usually subside in around 24-48 hours if the proper procedures are followed. Taking Acetazolamide 250mg tablets has been shown to cut recovery time in half (between 12-24 hours).
Taking Acetazolamide will help to decrease the likelihood of experiencing altitude sickness in people who are forced to ascend without the proper acclimatisation. However, Acetazolamide should not be seen as a substitute for acclimatisation. Rapid ascents can still carry dangers with or without Acetazolamide usage.
Sleeping at altitude alters a person’s breathing patterns. It is usually characterised as short, rapid breaths followed by prolonged pauses. This is quite normal and is not considered dangerous. However, it can lead to a poor quality of sleep. Taking Acetazolamide tablets will help improve this pattern of breathing, resulting in a better quality of sleep.
Acetazolamide used to be known as Diamox tablets. However, the brand Diamox has been discontinued. The medication has since been rebranded as Acetazolamide tablets, which was the same active ingredient found in Diamox. Acetazolamide belongs to a category of medicines called diuretics. A diuretic is any substance that increases the production of urine, thus promoting the excretion of water from the body. Acetazolamide is manufactured by MercuryPharma. The tablet itself is white, round and convex with “FW 147” marked on one side. The other side of the tablet is scored into quarters. Acetazolamide is a prescription only medicine (POM).
The majority of trekkers and climbers do not need to take Acetazolamide tablets (Diamox). Whilst altitude problems are unlikely below 2,500 metres (8,000 feet), it should be noted that anyone can suffer from altitude sickness, there is not a predisposing type and no-one is immune from it.
How to reduce the risk of altitude sickness
There are various ways to minimise the risk of altitude sickness by following established protocols which are:-
Acclimatise by ascending slowly with overnight stops at regular intervals.
If you are planning to climb over 3,000 metres (10,000 feet) you should plan to spend a night at an intermediate elevation which is below 3,000 metres before starting your ascent.
When reaching levels above 3,000 metres, only ascend a rate of 300-500 metres (1,000-1,500 feet) per day and then stop at your next sleep height.
For every 1,000 metres (3,000 feet) of ascent, plan to stop for two consecutive nights sleep before climbing any higher.
If you plan to climb more than 500 metres (1,500 feet) during one day, then descend back 500 metres to sleep.
Symptoms of mild early acute mountain sickness
If you experience any or all of the following symptoms, you should stop ascending until you feel better. These symptoms may include:-
Headache not relieved by Paracetamol and drinking water.
Fatigue and general weakness.
Dizziness and a feeling of being light-headed.
If you develop any or all of these symptoms you should stop ascending until they have passed; most symptoms usually resolve within twenty-four to forty-eight hours. If you descend the symptoms may disappear more quickly. It helps to drink plenty and always avoid alcohol and sedatives. Ascent can continue when the symptoms have passed.
Emergency situations requiring immediate descent
There are two situations where immediate descent must be made to prevent danger to life and these are:-
1.Fluid on the lungs
The symptoms for this are loss of breath, difficult breathing, extreme fatigue, breathing which has a rattling, noisy sound, repeated coughing, blue or grey lips and fingernails, drowsiness, collapse and confusion. This condition is known as HAPE (High Altitude Pulmonary Oedema). The key feature is an extreme shortness of breath – essentially being short of breath when everyone else has got their breath back.
2.Fluid on the brain
The symptoms for this may include lethargy, changes in behaviour and loss of coordination (inability to walk in a straight line). The key feature is cognitive impairment – an inability to think straight and carry our normal tasks. This condition is known as HACE (High Altitude Cerebral Oedema) and can progress to coma and death.
HACE and HAPE are both medical emergencies requiring immediate descent even if this is at night. The descent needs to be at least 500-1,000 metres (1,500-3,000 feet) and as soon as possible. Delay can be fatal. Further treatment may include oxygen, steroids and hyperbaric oxygen which is oxygen delivered in a high pressure chamber but immediate descent remains imperative.
Key points to note about HACE and HAPE
Both conditions can be rapid onset and so can occur without warning.
Both conditions can develop rapidly over a period of hours.
HACE and HAPE most commonly start at night although they can come on in the day.
There may be no preceding symptoms or warnings.
Both conditions can affect people who have previously ascended to the same height without any problems.
These conditions can affect people who have followed the guidelines for acclimatisation.
HACE and HAPE can affect people who have been prescribed Acetazolamide.
The conditions can affect both fit and unfit people alike and also people indigenous to the area including mountain guides.
The dose of Acetazolamide will depend on how severe your mountain sickness is and the symptoms you are experiencing. You or a member of your group will need to decide on the most appropriate treatment. If you have a doctor or other healthcare professional on your trip, you should seek their advice.
1. For the treatment of mild early acute mountain sickness (headache, fatigue, light headedness, difficulty with sleep): Acetazolamide 250mg (one tablet) twice daily until symptoms resolve, when planned ascent can be resumed.
2. Where rapid ascent without proper acclimatisation cannot be avoided: Acetazolamide 250mg (one tablet) twice daily, started the day before ascent or as soon as possible after starting to ascend and continue for 2-3 days after final altitude is reached.
3. For disturbed breathing pattern during sleep: Acetazolamide 125mg (half a tablet) twice daily. Continue descent to an altitude where sleep is no longer a problem.
Remember: even if you take Acetazolamide, it is still important to properly acclimatise. You should never ascend further until your symptoms have completely gone and you are properly acclimatized to your current altitude. Do not use Acetazolamide to push through the symptoms of altitude sickness and continue to climb, this is extremely dangerous and can be fatal.
The following side effects can occur when taking Acetazolamide:
Dizziness, lightheadedness, and an increased amount of urine, blurred vision, dry mouth, drowsiness, loss of appetite, stomach upset, headache and tiredness.
These side effects are most likely at the start of treatment as your body gets used to the medicine.
Tell your doctor immediately if any of these very unlikely but serious side effects occur: increased body hair, hearing loss, ringing in the ears, unusual tiredness, persistent nausea/vomiting, severe stomach/abdominal pain.
Seek immediate medical attention if any of these unlikely but very serious side effects occur: easy bleeding/bruising, fast/irregular heartbeat, signs of infection (e.g., fever, persistent sore throat), mental/mood changes (e.g., confusion, difficulty concentrating), severe muscle cramps/pain, tingling of the hands/feet, blood in the urine, dark urine, painful urination, yellowing of the eyes/skin.
A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include:blisters/sores in the mouth, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
If you experience any adverse effects from taking Acetazolamide it is important your trip doctor know immediately. In a medical emergency you should contact the emergency services or go straight to a hospital or medical centre.
Acetazolamide is not suitable for use if you:
- Are allergic or sensitive to or have had a bad reaction to sulphonamides in the past.
- Are elderly.
- Have adrenal gland problems.
- Have chronic obstructive pulmonary disease.
- Have closed angle glaucoma.
- Have had kidney stones.
- Have kidney or liver problems.
Each tablet contains the active ingredient acetazolamide 250mg.
It also contains: lactose monohydrate, corn starch, gelatin, glycerin, water, talc,sodium starch glycolate type A potato, magesium stearate.