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Interventions for preventing high altitude illness: Part 2. Less commonly-used drugs.

Alejandro Gonzalez Garay1, Daniel Molano Franco, Víctor H Nieto Estrada

  • 1Methodology Research Unit, National Institute of Pediatrics, Insurgentes Sur 3700 - C, Col. Insurgentes Cuicuilco, Coyoacan, Mexico City, Distrito Federal, Mexico, 04530.

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This review found limited evidence for less common drugs to prevent high altitude illness (HAI). Sumatriptan showed potential for acute mountain sickness (AMS) prevention, but more research is needed on efficacy and safety.

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Area of Science:

  • Medical research
  • Pharmacology
  • Altitude medicine

Background:

  • High altitude illness (HAI) encompasses syndromes like acute mountain sickness (AMS), cerebral edema (HACE), and pulmonary edema (HAPE) above 2500 meters.
  • Preventive strategies for HAI are crucial for travelers ascending to high elevations.
  • This review focuses on less commonly used pharmacological interventions for HAI prevention.

Purpose of the Study:

  • To evaluate the clinical effectiveness and adverse events of five less common drug classes for preventing acute HAI.
  • To assess these interventions in individuals at risk of developing altitude-related illnesses.

Main Methods:

  • Systematic search of multiple databases including CENTRAL, MEDLINE, Embase, LILACS, and WHO ICTRP up to May 2017.
  • Inclusion of randomized controlled trials (RCTs) using specific drug classes (e.g., serotonin agonists, NMDA antagonists) administered before ascent.
  • Standard Cochrane methodological procedures for data collection and analysis.

Main Results:

  • Eight RCTs with 334 participants were included; 24 studies are ongoing or awaiting classification.
  • Sumatriptan showed a reduced risk of AMS versus placebo (low quality evidence), with no reported HAPE, HACE, or adverse events.
  • Magnesium citrate did not significantly reduce AMS risk and increased loose stools; spironolactone showed inconsistent results for AMS; acetazolamide reduced AMS risk compared to spironolactone (low quality evidence).

Conclusions:

  • There is a scarcity of evidence for the effectiveness and safety of these less common drugs in preventing HAI.
  • Clinical benefits and harms, such as for sumatriptan, remain unclear due to limited and low-quality evidence.
  • Larger, methodologically sound studies are required to establish the efficacy and safety of these pharmacological agents.