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Efficacy and harm of pharmacological prevention of acute mountain sickness: quantitative systematic review

BMJ 2000; 321 doi: (Published 29 July 2000) Cite this as: BMJ 2000;321:267
  1. Lionel Dumont (lionel.dumont{at}, staff anaesthesiologista,
  2. Chahé Mardirosoff, staff anaesthesiologistb,
  3. Martin R Tramèr, staff anaesthesiologista
  1. a Division of Anaesthesiology, Department APSIC, University of Geneva Hospitals, CH-1211 Geneva 14, Switzerland
  2. b Département d'Anesthésie-Réanimation, Hôpital Sud-Léman-Valserine, 74164 Saint-Julien en Genevois, France
  1. Correspondence to: L Dumont
  • Accepted 14 April 2000


Objective: To quantify efficacy and harm of pharmacological prevention of acute mountain sickness.

Data sources: Systematic search (Medline, Embase, Cochrane Library, internet, bibliographies, authors) in any language, up to October 1999.

Study selection: Randomised placebo controlled trials.

Data extraction: Dichotomous data on efficacy and harm from 33 trials (523 subjects received 13 different interventions, 519 a placebo).

Data synthesis: At above 4000 m the mean incidence of acute mountain sickness with placebo was 67% (range 25% to 100%); incidence depended on the rate of ascent, but not on the altitude or the mode of ascent. Across all ascent rates, dexamethasone 8–16 mg prevented acute mountain sickness (relative risk 2.50 (95% confidence interval 1.71 to 3.66); number needed to treat (NNT) 2.8 (2.0 to 4.6)), without evidence of dose responsiveness. Acetazolamide 750 mg was also efficacious (2.18 (1.52 to 3.15); NNT 2.9 (2.0 to 5.2)), but 500 mg was not. In two trials, adverse reaction (including depression) occurred after dexamethasone was stopped abruptly (4.45 (1.08 to 18); NNT 3.7 (2.5 to 6.9)). With acetazolamide, paraesthesia (4.02 (1.71 to 9.43); NNT 3.0 (2.0 to 6.0)) and polyuria (4.24 (1.92 to 9.37); NNT 3.6 (2.5 to 6.2)) were reported. Data were sparse on nifedipine, frusemide (furosemide), dihydroxyaluminium-sodium, spironolactone, phenytoin, codeine, phenformin, antidiuretic hormone, and ginkgo biloba.

Conclusions: At above 4000 m, with a high ascent rate, fewer than three subjects need to be treated with prophylactic dexamethasone 8–16 mg or acetazolamide 750 mg for one subject not to experience acute mountain sickness who would have done so had they all received a placebo. Acetazolamide 500 mg does not work.


  • Funding MRT received a Prosper grant (No 3233-051939-97) from the Swiss National Science Foundation.

  • Competing interests None declared.

  • Accepted 14 April 2000
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