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September 16, 1983

Treatment of Acute Mountain Sickness

JAMA. 1983;250(11):1392. doi:10.1001/jama.1983.03340110016014

To the Editor.—  In a recent QUESTIONS AND ANSWERS (1983;249:1770), a question was raised concerning the prophylaxis of and therapy for highaltitude headache. I believe that Dr Dalessio's reply requires clarification and amplification.Headache occurring at high altitude is the most common manifestation of a broader constellation of symptoms, termed acute mountain sickness (AMS), that may include nausea, vomiting, anorexia, lassitude, and insomnia. Acute mountain sickness is the most common form of high-altitude illness, occurring to a variable extent in many sojourners higher than 2,400 m (8,000 ft), often after vigorous exercise or sleep at high altitude.Acetazolamide, a carbonic anhydrase inhibitor, has been shown to provide effective prophylaxis against the symptoms of AMS1,2 but is not of proved therapeutic benefit in established AMS. A reasonable prophylactic regimen might be 250 mg every eight hours for 32 hours before and 40 hours after ascent.1 The mechanism of benefit