Pharmacological prevention of altitude illness, so a few words about Acetazolamide

Kinga Kocur; Oskar Fogiel; Dominika Mularska; Jan Machalica; Katarzyna Camlet

doi:10.56782/pps.357

Published : 2025-08-06

No. 2025 (Early Access)

Pharmacological prevention of altitude illness, so a few words about Acetazolamide

Kinga Kocur

Oskar Fogiel

Dominika Mularska

Jan Machalica

Katarzyna Camlet

DOI: https://doi.org/10.56782/pps.357

Abstract

High-altitude illness is a condition occurring in individuals at high altitudes (above 2500 meters above sea level) resulting from inadequate acclimatization to the unique environment. Initially, the illness manifests as a set of nonspecific symptoms of acute mountain sickness (AMS). Rapid ascent to altitudes above 4000 meters can lead to severe complications, such as high-altitude cerebral edema (HACE) or high-altitude pulmonary edema (HAPE). With appropriate prevention measures, gradual ascent, and the use of medications such as acetazolamide, the risk of developing AMS can be significantly reduced. The mechanism of action of acetazolamide involves increased excretion of bicarbonates by the kidneys, leading to acidification of the blood (a decrease in blood pH). This process stimulates the respiratory center, increasing minute ventilation and improving oxygenation at high altitudes. Clinical studies have demonstrated that using acetazolamide at doses of 125 mg twice daily is effective in preventing AMS. Acetazolamide is well-tolerated, although it may cause side effects such as paresthesia, taste disturbances, or mild diuretic effects. Its use can significantly enhance the body's ability to adapt to high altitudes. In life-threatening conditions such as HAPE and HACE, the treatment primarily relies on other methods. Due to the increasing prevalence of travel to high-altitude regions, physicians and rescue workers are encountering this issue more frequently. The aim of this study is to compile current knowledge on the use of acetazolamide in altitude sickness.

Keywords:

acetazolamide, altitude illness, acute mountain sickness, HAPE, HACE

Similar Articles

Natalia Cichoń, Dominika Lach, Joanna Saluk-Bijak, Michał Bijak, ANTICOAGULANT THERAPY IN ACUTE CORONARY SYNDROMES AND ISCHEMIC STROKE , Prospects in Pharmaceutical Sciences: Vol. 15 No. 5 (2017)
Natalia Cichoń, Dominika Lach, Michał Bijak Bijak, Paulina Rzeźnicka, Joanna Saluk, SIMILARITIES AND DIFFERENCES IN ANTIPLATELET THERAPY IN ACUTE CORONARY SYNDROMES AND ISCHEMIC STROKE , Prospects in Pharmaceutical Sciences: Vol. 14 No. 4 (2016)
Michał Dacka, Mateusz Sobczyk , Paulina Dąbrowska , Kamila Giżewska , Michał Żuber , Role of calcitonin gene-related peptide (CGRP) receptor antagonist in acute and preventive treatment of migraine , Prospects in Pharmaceutical Sciences: Vol. 22 No. 3 (2024)
Dominika Mularska, Oskar Fogiel, Kinga Kocur, Małgorzata Rak, Natalia Pawlas, Insulin to the rescue: a review of recent reports on insulin treatment in emergencies and poisonings , Prospects in Pharmaceutical Sciences: Vol. 23 No. 3 (2025)
Grzegorz Ślifirski, Tomasz Słowiński, Jacek Stefanowicz, NOVEL TRENDS IN ANTIPSYCHOTIC DRUG DEVELOPMENT , Prospects in Pharmaceutical Sciences: Vol. 13 No. 4 (2015)
Katarzyna Czuba, Magdalena Mazurkiewicz, Kamil Kamiński, Filip Różewski, Dorota Skrajnowska, Andrzej Tokarz, BIOTERRORISM – THREAT, PREVENTIVE ACTIONS, INTERNATIONAL LAW , Prospects in Pharmaceutical Sciences: Vol. 9 No. 2 (2011)
Dominika Winiarz, Kamila Domańska, Kinga Paluch, Dorota Dorota Skrajnowska, PROBIOTICS AND HEALTH - TODAY AND TOMORROW , Prospects in Pharmaceutical Sciences: Vol. 15 No. 10 (2017)
Katarzyna Camlet, Kinga Kocur, Mateusz Ziomek, Anna Ziobro, Jakub Jurek, Anna Lis, Paulina Lis, Wojciech Kaźmierski, Is an acute overdose of zolpidem fatal? , Prospects in Pharmaceutical Sciences: Vol. 22 No. 3 (2024)
Anna Lis, Paulina Lis, Wojciech Kaźmierski, Kinga Kocur, Katarzyna Camlet, Jakub Jurek, Mateusz Ziomek, Anna Ziobro, Sodium bicarbonate - known medication, new prospects? , Prospects in Pharmaceutical Sciences: Vol. 22 No. 3 (2024)
Kinga Grużewska-Piotrowska, Agnieszka Grużewska, Medication overuse headache as a consequence of taking painkillers – a review of current literature , Prospects in Pharmaceutical Sciences: Vol. 21 No. 3 (2023)

You may also start an advanced similarity search for this article.

Details

References

Statistics

Authors

Download files

PDF

Citation rules

Kocur, K., Fogiel, O., Mularska, D., Machalica, J., & Camlet, K. (2025). Pharmacological prevention of altitude illness, so a few words about Acetazolamide . Prospects in Pharmaceutical Sciences, (2025 (Early Access). https://doi.org/10.56782/pps.357

Altmetric indicators

Cited by / Share

Licence

This work is licensed under a Creative Commons Attribution 4.0 International License.

References

1. van Veelen M.J.; Likar R.; Tannheimer M.; Bloch K.E.; Ulrich S.; Philadelphy M.; Teuchner B.; Hochholzer T.; Pichler Hefti J.; Hefti U.; Paal P.; Burtscher M. Emergency Care for High-Altitude Trekking and Climbing. High Alt Med Biol. 2024 Jul 29. doi: 10.1089/ham.2024.0065. DOI: https://doi.org/10.1089/ham.2024.0065

2. Gatterer H.; Villafuerte F.C.; Ulrich S; Bhandari S.S.; Keyes L.E.; Burtscher M. Altitude illnesses. Nat Rev Dis Primers. 2024 Jun 20;10(1):43. doi: 10.1038/s41572-024-00526-w. DOI: https://doi.org/10.1038/s41572-024-00526-w

3. Prince T.S.; Thurman J.; Huebner K. Acute Mountain Sickness. 2023 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.

4. Plewnia B. W Tatrach padł turystyczny rekord. Polskie góry bardziej popularne od Wielkiego Kanionu. 2025. Available online: https://tvn24.pl/krakow/tatry-w-2024-roku-padl-rekord-liczby-turystow-ile-osob-odwiedzilo-najwyzsze-polskie-gory-st8260104

5. Axiom Alpha. Number of People Who Summited Mount Everest by Year (1983-2022). Available online: https://axiomalpha.com/number-of-people-who-summited-mount-everest-by-year/

6. Wright A.D.; Fletcher R.F. Acute mountain sickness. Postgrad Med J. 1987 Mar;63(737):163–164. doi: 10.1136/pgmj.63.737.163. DOI: https://doi.org/10.1136/pgmj.63.737.163

7. Imray C.; Wright A.; Subudhi A.; Roach R. Acute mountain sickness: pathophysiology, prevention, and treatment. Prog Cardiovasc Dis. 2010 May-Jun;52(6):467-84. doi: 10.1016/j.pcad.2010.02.003. DOI: https://doi.org/10.1016/j.pcad.2010.02.003

8. Luks A.M.; Beidleman B.A.; Freer L.; Grissom C.K.; Keyes L.E.; McIntosh S.E.; Rodway G.W.; Schoene R.B.; Zafren K.; Hackett P.H. Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update. Wilderness Environ Med. 2024 Mar;35(1_suppl):2S-19S. doi: 10.1016/j.wem.2023.05.013. DOI: https://doi.org/10.1016/j.wem.2023.05.013

9. Franek E.; Kokot F. Zasadowica oddechowa. 2018. Available online : https://www.mp.pl/interna/chapter/B16.II.19.2.4.

10. Han C.; Zheng X.X.; Zhang W.F. High altitude retinopathy: An overview and new insights. Travel Med Infect Dis. 2024 Mar-Apr;58:102689. doi: 10.1016/j.tmaid.2024.102689.

11. Clarke A.K.; Cozzi M.; Imray C.H.E.; Wright A.; Pagliarini S. Birmingham Medical Research Expeditionary Society. Analysis of Retinal Segmentation Changes at High Altitude With and Without Acetazolamide. Invest Ophthalmol Vis Sci. 2019 Jan 2;60(1):36-40. doi: 10.1167/iovs.18-24966.

12. Totou S.; Karmiris E.; Kanakis M.; Gartaganis P.; Petrou P.; Kalogeropoulos C.; Kozobolis V.; Stavrakas P. Impact of flight and equivalent short-term high-altitude exposure on ocular structures and function. Med Hypothesis Discov Innov Ophthalmol. 2023 Dec 31;12(3):127-141. doi: 10.51329/mehdiophthal1478.

13. Farzam K.; Abdullah M. Acetazolamide. 2023 Jul 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.

14. Myers W.R.; Bawcom C.; Schraudenbach C.; Bennett B.L. Inappropriate Acetazolamide Use for a Hiker Who Developed Acute Kidney Injury. Wilderness Environ Med. 2024 Sep;35(3):328-331.doi: 10.1177/10806032241249452. DOI: https://doi.org/10.1177/10806032241249452

15. Rothwell A.; Anderson O. Bilateral choroidal effusions after taking acetazolamide for altitude sickness. BMJ Case Rep. 2022 Jan 17;15(1):e246145. doi: 10.1136/bcr-2021-246145. DOI: https://doi.org/10.1136/bcr-2021-246145

16. Liu M.; Jiao X.; Li R.; Li J.; Wang L.; Wang L.; Wang Y.; Lv C.; Huang D.; Wei R, Wang L.; Ji X.; Guo X. Effects of acetazolamide combined with remote ischemic preconditioning on risk of acute mountain sickness: a randomized clinical trial. BMC Med. 2024 Jan 2;22(1):4. doi: 10.1186/s12916-023-03209-7. DOI: https://doi.org/10.1186/s12916-023-03209-7

17. Gao D.; Wang Y.; Zhang R.; Zhang Y. Efficacy of acetazolamide for the prophylaxis of acute mountain sickness: A systematic review, meta-analysis, and trial sequential analysis of randomized clinical trials. Ann Thorac Med. 2021 Oct-Dec;16(4):337-346. doi: 10.4103/atm.atm_651_20. DOI: https://doi.org/10.4103/atm.atm_651_20

18. Shlim D.R. The use of acetazolamide for the prevention of high-altitude illness. J Travel Med. 2020 Sep 26;27(6):taz106. doi: 10.1093/jtm/taz106. DOI: https://doi.org/10.1093/jtm/taz106

19. Toussaint C.M.; Kenefick R.W.; Petrassi F.A.; Muza S.R.; Charkoudian N. Altitude, Acute Mountain Sickness, and Acetazolamide: Recommendations for Rapid Ascent. High Alt Med Biol. 2021 Mar;22(1):5-13. doi: 10.1089/ham.2019.0123. DOI: https://doi.org/10.1089/ham.2019.0123

20. Yang H.L.; Deng M.J.; Zhang W.; Huang S. [The preventive effect of four drugs on acute mountain sickness: a Bayesian network meta-analysis]. Zhonghua Jie He He Hu Xi Za Zhi. 2021 Nov 12;44(11):953-960. doi: 10.3760/cma.j.cn112147-20210330-00211.

21. Lipman G.S.; Jurkiewicz C.; Burnier A.; Marvel J.; Phillips C.; Lowry C.; Hawkins J.; Navlyt A.; Swenson E.R. A Randomized Controlled Trial of the Lowest Effective Dose of Acetazolamide for Acute Mountain Sickness Prevention. Am J Med. 2020 Dec;133(12):e706-e715. doi: 10.1016/j.amjmed.2020.05.003. DOI: https://doi.org/10.1016/j.amjmed.2020.05.003

22. McIntosh S.E.; Hemphill M.; McDevitt M.C.; Gurung T.Y.; Ghale M.; Knott J.R.; Thapa G.B.; Basnyat B.; Dow J.; Weber D.C.; K Grissom C. Reduced Acetazolamide Dosing in Countering Altitude Illness: A Comparison of 62.5 vs 125 mg (the RADICAL Trial). Wilderness Environ Med. 2019 Mar;30(1):12-21. doi: 10.1016/j.wem.2018.09.002. DOI: https://doi.org/10.1016/j.wem.2018.09.002

23. Burtscher M.; Hefti U.; Hefti J.P. High-altitude illnesses: Old stories and new insights into the pathophysiology, treatment and prevention. Sports Med Health Sci. 2021 Apr 16;3(2):59-69. doi: 10.1016/j.smhs.2021.04.001. DOI: https://doi.org/10.1016/j.smhs.2021.04.001

24. Graf L.C.; Furian M.; Bitos K.; Mademilov M.; Abdraeva A.; Buenzli J.; Buenzli S.; Aidaralieva S.; Sheraliev U.; Mayer L.C.; Schneider S.R.; Sooronbaev T.M.; Ulrich S.; Bloch K.E. Effect of altitude and acetazolamide on sleep and nocturnal breathing in healthy lowlanders 40 y of age or older. Data from a randomized trial. Sleep. 2023 Apr 12;46(4):zsac269. doi: 10.1093/sleep/zsac269. DOI: https://doi.org/10.1093/sleep/zsac269

25. Mutschler T.; Furian M.; Lichtblau M.; Buergin A.; Schneider S.R.; Appenzeller P.; Mayer L.; Muralt L.; Mademilov M.; Abdyraeva A.; Aidaralieva S.; Muratbekova A.; Akylbekov A.; Shabykeeva S.; Sooronbaev T.M.; Ulrich S.; Bloch K.E. Effect of altitude and acetazolamide on postural control in healthy lowlanders 40 years of age or older. Randomized, placebo-controlled trial. Front Physiol. 2024 Jan 4;14:1274111. doi: 10.3389/fphys.2023.1274111. DOI: https://doi.org/10.3389/fphys.2023.1274111

26. Nimje M.A.; Patir H.; Tirpude R.; Kumar B. Elucidating the combined effect of intermittent hypoxia training and acetazolamide on hypoxia induced hematological and physiological changes. Curr Res Physiol. 2022 Jul 18;5:327-337. doi: 10.1016/j.crphys.2022.07.004. DOI: https://doi.org/10.1016/j.crphys.2022.07.004

27. Bhattachar S.; Malhotra V.K.; Yanamandra U.; Singh S.; Sikri G.; Patrikar S.; Kotwal A. Ibuprofen Compared to Acetazolamide for the Prevention of Acute Mountain Sickness: A Randomized Placebo-Controlled Trial. Cureus. 2024 Mar 12;16(3):e55998. doi: 10.7759/cureus.55998. DOI: https://doi.org/10.7759/cureus.55998

28. Pun M. Rapid Ascent to High Altitude: Acetazolamide or Ibuprofen? American Journal of Medicine. 2021, Volume 134, Issue 3, Pages e230-e230. doi: https://doi.org/10.1016/j. DOI: https://doi.org/10.1016/j.amjmed.2020.03.023

29. Schilling M.; Irarrázaval S. Ibuprofen versus acetazolamide for prevention of acute mountain sickness. Medwave. 2020 Jun 11;20(5):e7733. Spanish, English. doi: 10.5867/medwave.2020.05.7732. DOI: https://doi.org/10.5867/medwave.2020.05.7732

30. Burns P, Lipman GS, Warner K, Jurkiewicz C, Phillips C, Sanders L, Soto M, Hackett P. Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide. Am J Med. 2019 Feb;132(2):247-251. doi: 10.1016/j.amjmed.2018.10.021. DOI: https://doi.org/10.1016/j.amjmed.2018.10.021

31. Kaeley N.; Datta S.S.; Sharma A; Jithesh G.. Hiccups and Slurring of Speech: Atypical Presentation of High-Altitude Cerebral Edema. Cureus. 2023 Feb 14;15(2):e34997. doi: 10.7759/cureus.34997. DOI: https://doi.org/10.7759/cureus.34997

32. Berger M.M.; Sareban M.; Schiefer L.M.; Swenson K.E.; Treff F.; Schäfer L.; Schmidt P.; Schimke M.; Paar M.; Niebauer J.; Cogo A.; Kriemler S.; Schwery S.; Pickerodt P.A; Mayer B.; Bärtsch P.;, Swenson E.R. Effects of acetazolamide on pulmonary artery pressure and prevention of high-altitude pulmonary edema after rapid active ascent to 4,559 m. J Appl Physiol (1985). 2022 Jun 1;132(6):1361-1369.doi: 10.1152/japplphysiol.00806.2021. DOI: https://doi.org/10.1152/japplphysiol.00806.2021

33. Park A.; Brillhart A.; Sethi S.; Abramor B.; Duplessis R.; Pronce R.; Seufferheld J.;, Schlein S. Characteristics of Climbers with High Altitude Pulmonary Edema on Mount Aconcagua. Wilderness Environ Med. 2024 Dec 18:10806032241303438. doi: 10.1177/10806032241303438. DOI: https://doi.org/10.1177/10806032241303438

34. Hundt N.; Apel C.; Bertsch D.; Cerfontaine C.; van der Giet M.; van der Giet S.; Graß M.; Haunolder M.; Heussen N.M.; Jäger J.; Kühn C.; Morrison A.; Museo S.; Timmermann L.; Wernitz K.; Gieseler U.; Küpper T. Variables Influencing the Pressure and Volume of the Pulmonary Circulation as Risk Factors for Developing High Altitude Pulmonary Edema (HAPE). Int J Environ Res Public Health. 2022 Oct 26;19(21):13887. doi: 10.3390/ijerph192113887. DOI: https://doi.org/10.3390/ijerph192113887

35. Han C.; Zheng X.X.; Zhang W.F. High altitude retinopathy: An overview and new insights. Travel Med Infect Dis. 2024 Mar-Apr;58:102689. doi: 10.1016/j.tmaid.2024.102689. DOI: https://doi.org/10.1016/j.tmaid.2024.102689

36. Clarke A.K.; Cozzi M.; Imray C.H.E.; Wright A.; Pagliarini S. Birmingham Medical Research Expeditionary Society. Analysis of Retinal Segmentation Changes at High Altitude With and Without Acetazolamide. Invest Ophthalmol Vis Sci. 2019 Jan 2;60(1):36-40. doi: 10.1167/iovs.18-24966. DOI: https://doi.org/10.1167/iovs.18-24966

37. Totou S.; Karmiris E.; Kanakis M.; Gartaganis P.; Petrou P.; Kalogeropoulos C.; Kozobolis V.; Stavrakas P. Impact of flight and equivalent short-term high-altitude exposure on ocular structures and function. Med Hypothesis Discov Innov Ophthalmol. 2023 Dec 31;12(3):127-141. doi: 10.51329/mehdiophthal1478. DOI: https://doi.org/10.51329/mehdiophthal1478

Kinga Kocur

kingakocur98@wp.pl

Affiliation:

District Hospital in Oświęcim, 32-600, Oświęcim, Poland Poland

Oskar Fogiel

Affiliation:

Student Scientific Society, Department of Emergency Medicine, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; Students’ Scientific Society, Department of Acute Medicine and Students’ Scientific Society, Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice 41-800 Zabrze, Poland Poland

Dominika Mularska

Affiliation:

Student Scientific Society, Department of Emergency Medicine, Medical University of Silesia in Katowice, 40-055 Katowice, Poland Poland

Jan Machalica

Affiliation:

Stefan Zeromski specialised Hospital in Cracow, 31-913 Cracow, Poland Poland

Katarzyna Camlet

Affiliation:

District Hospital in Zakopane, 34-500, Zakopane, Poland. Poland

Pharmacological prevention of altitude illness, so a few words about Acetazolamide

Kinga Kocur

Oskar Fogiel

Dominika Mularska

Jan Machalica

Katarzyna Camlet

Abstract

Keywords:

Most read articles by the same author(s)

Similar Articles

Kinga Kocur

Oskar Fogiel

Dominika Mularska

Jan Machalica

Katarzyna Camlet