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Ibuprofen reduces altitude sickness, US study says

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Ibuprofen reduces altitude sickness, US study says

Postby Diego Sahagún » Mon Mar 26, 2012 12:57 am

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Re: Ibuprofen reduces altitude sickness, US study says

Postby Buz Groshong » Wed Apr 04, 2012 4:36 pm

The study says it reduces the symptoms; not really news. Nsaids have all been used effectively for headaches. Thanks for posting the link, though.
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Re: Ibuprofen reduces altitude sickness, US study says

Postby peninsula » Wed Apr 11, 2012 4:39 pm

Good ole Vitamin I... never leave home without it!
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Re: Ibuprofen reduces altitude sickness, US study says

Postby philoparts » Thu Apr 12, 2012 12:49 am

The study shows using Ibuprofen as a preventative measure, not necessarily a treatment after symptom onset. Of course, the treatment for AMS is fluids/food, NSAIDS, O2 and descent. So, I'd say if you had experienced AMS before, maybe not a bad thing to try Ibuprofen as a preventative before next time at altitude.
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Re: Ibuprofen reduces altitude sickness, US study says

Postby radson » Thu Apr 12, 2012 8:32 am

philoparts wrote:The study shows using Ibuprofen as a preventative measure, not necessarily a treatment after symptom onset. Of course, the treatment for AMS is fluids/food, NSAIDS, O2 and descent. So, I'd say if you had experienced AMS before, maybe not a bad thing to try Ibuprofen as a preventative before next time at altitude.


I think we should highlight that the treatment or cure for AMS is first and foremost descent. And in the context of more higher altitude pursuits, it is my understanding that Ibuprofen, addresses the headaches caused by AMS and it definitely works in the context of an anti-inflammatory but in doing so is also masking the affliction as does Dexamethesone.

As such Ibuprofen should be used with the caution that the afflicted person may still be at risk of further illness, especially if they decide to continue to ascend based on feeling better from a reduction in the headache.
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Re: Ibuprofen reduces altitude sickness, US study says

Postby peninsula » Thu Apr 12, 2012 2:29 pm

radson wrote:
philoparts wrote:The study shows using Ibuprofen as a preventative measure, not necessarily a treatment after symptom onset. Of course, the treatment for AMS is fluids/food, NSAIDS, O2 and descent. So, I'd say if you had experienced AMS before, maybe not a bad thing to try Ibuprofen as a preventative before next time at altitude.


I think we should highlight that the treatment or cure for AMS is first and foremost descent. And in the context of more higher altitude pursuits, it is my understanding that Ibuprofen, addresses the headaches caused by AMS and it definitely works in the context of an anti-inflammatory but in doing so is also masking the affliction as does Dexamethesone.

As such Ibuprofen should be used with the caution that the afflicted person may still be at risk of further illness, especially if they decide to continue to ascend based on feeling better from a reduction in the headache.


A point of semantics: Anti-inflammatory benefits are directly therapeutic, the analgesic properties of ibuprofen would be "masking" the symptoms. I don't believe the study determined whether is was the analgesic or anti-inflammatory properties of ibuprofen that reduced AMS symptoms. One would assume a likely combination. That said, in the face of serious AMS symtoms, I think everyone agrees descent is the safest choice without question.

As to AMS prevention, there is no denying the best approach is gradual ascent. For me personally, I would rather get on with it, rapidly ascend, and take drugs to vastly improve comfort levels the first 36 hours. Diamox and ibuprofen are my drugs of choice. Diamox helps me to get a good night's sleep the first night with significantly less tendency for headaches the first 36 hours. I start ingesting Diamox 24 hours prior to entry and discontinue it 36 hours after entry (I'm generally reaching peak-trip elevations the first day, so I'd adjust the drug protocol if multiple days of more extreme ascent were anticipated). I experience mild tingling in my fingers, and some mild auditory effects. I drink like a fish when ascending, so regardless of the Diamox, I'm peeing frequently. I also make it a point to take small snacks along the way even though I have no appetite the first several hours. I take the ibuprofen primarily for my knees and back, the drug is amazing in both its anti-inflammatory and analgesic properties when it comes to my aging body and the abuse suffered under the weight of a backpack. If ibuprofen is helping to further reduce headache tendencies, then it is all the more reason to have some onboard.

Too each his or her own, know your body, know your drugs, and enjoy the pursuit!
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Re: Ibuprofen reduces altitude sickness, US study says

Postby philoparts » Thu Apr 12, 2012 5:50 pm

Too each his or her own, know your body, know your drugs, and enjoy the pursuit!


Just because someone starts feeling symptoms of AMS doesn't mean immediate descent. If there are no pre-existing conditions that would cause symptoms, and no signs of HAPE or HACE, you could stay at altitude but not ascend until symptoms resolved. You would treat with NSAIDS, food, and hydration, and hang out for up to 72 hours reasonably before descending if symptoms didn't resolve. The only way to acclimatize is by spending time at altitude or Diamox, so if you were going without meds, you would need to know your limits and not push it once you had symptom onset. I've known people who can tell you almost exactly at what altitude they will start having symptoms if they aren't on Diamox. Of course following the guideline of climb high, sleep low would be your best bet either way.
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Re: Ibuprofen reduces altitude sickness, US study says

Postby DrGranola » Mon Apr 23, 2012 2:45 pm

Ibuprofen is good for all things! I take it for the common head cold... Haha :lol:
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Re: Ibuprofen reduces altitude sickness, US study says

Postby markhallam » Sun Apr 29, 2012 7:36 am

Buz Groshong wrote:The study says it reduces the symptoms; not really news. Nsaids have all been used effectively for headaches. Thanks for posting the link, though.


I couldn't get the link to the article but entirely agree with Buz, that NSAIDS in common with Paracetamol/Acetaminophen, treat headache effectively - and will thus help alleviate symptoms of minor AMS. And of course with any altitude headache worth drinking a reasonable dose of water in case dehydration is contributory. (I quite like what RJ Secor says in his guidebooks, something like: "If I have a headache then I drink a litre of water... if after an hour I still have a headache, then I drink another litre - WHILE DESCENDING... " - sensible - although I'd add a dose of paracetamol and/or an NSAID like Ibuprofen as well.

If anyone is interested to know more then I have written an article for SP (which is now also linked to the British Alpine Club website) on Expedition Medicine, which has reasonably up to date information based on current medical research and UIAA guidelines. Here is the link:

http://www.summitpost.org/expedition-medicine/675753

On a more personal note I climbed Aconcagua in 2011 and all the way up to 6962m didn't suffer so much as a single headache. Interestingly from the moment I set foot in the park I averaged 300m (1000ft) height gain per day, which was pretty well following UIAA guidelines of not raising sleeping height by more than 1000ft per day (e.g. if next camp 3000ft/1000ft higher then recommended doing two 'up & back' trips before spending the night at the new elevation). But a few years before I took my wife up the Monch from the Jungfraujoch; we weren't fully accimatised but got away with it getting to the top at 4099m - just slow. The killer was missing the last train down to the valley and being forced to spend the night in the Monchjock hut at 3500m. Within a few hours we both had raging headaches that no amount of rehydration and minor pain killers would shift (you don't have to worry about 'suppressing symptoms' with minor pain killers!). We had no choice but to stay put until morning - when we limped onto the first train down.

Cheers, Mark
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Re: Ibuprofen reduces altitude sickness, US study says

Postby Diego Sahagún » Sun Apr 29, 2012 12:38 pm

Mark, perhaps you could add in your article Ibuprofen as a drug to take if having altitude sickness (high altitude), you only have recommended it for pain...
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Re: Ibuprofen reduces altitude sickness, US study says

Postby markhallam » Sat May 05, 2012 6:38 am

Diego Sahagún wrote:Mark, perhaps you could add in your article Ibuprofen as a drug to take if having altitude sickness (high altitude), you only have recommended it for pain...


Thanks Diego

If you look at my last entry you will see that I quoted RJ Secor and his 'drink a litre' and 'drink a litre and descend philosophy' on altitude headache - and I added my own comment that 'I'd try an NSAID like Ibuprofen' as well. This was a remark that came from my original Expedition Medicine article. Also in the article I do point out that headache is a symptom of AMS - and headache of course is pain, which elsewhere I point out is treated, at the mild to moderate stage by amongst other things Ibuprofen.

My interpretation having read some of the available evidence, endorsed by the UIAA, but also supported by quite a lot of experience - is that Ibuprofen is a useful drug (in common with other drugs of its type) but only to treat the SYMPTOMS of AMS. I have seen nothing that tells me it treats the underlying physiology - as to a weak extent does acetozolamide (Diamox).

I have to confess that I haven't read the article you found since the link appeared to be broken. If you can send it in another form I would gladly read it. However, as a doctor with some training in critical reading I will have a degree of sceptism for the findings from an isolated study. If it came from such as a newspaper I wouldn't give it the time of day! Not clear for example if your article came from a peer reviewed medical journal. Was the author qualified and/or have something to gain from the study? (e.g. increased ibuprofen sales...). And a very common flaw is having too small numbers in a study (e.g. you may easily demonstrate an improvement in a sample of 5, but this may be due to the vagaries of chance - you may need to study 5000 to really demonstrate something). Top of the hierarchy in terms of best evidence is not isolated studies but actually 'systematic reviews' of many studies (but each one vetted for quality and bias)... the evidence on which the UIAA base their advice will be based on systematic reviews where possible.

Anyway, if there is evidence Ibuprofen directly affects the physiology in AMS then it will turn up in the UIAA medical section and other medical sites, if it hasn't done already. I will be updating my Expedition Medicine article sometime in the next few months - and when I do, you can be sure I will comb the medical sites for any new evidence - and I will be looking out for anything new on Ibuprofen.

Two other points:
- I want to be careful not to dilute the key message which is that having attended to hydration and minor headache, that the only cure for unresolving AMS is DESCENT. And I don't promote any medication (including Diamox) as being an alternative to proper staged accimatisation.
- Remember that even humble Ibuprofen, like aspirin, is a drug with potential for some serious side effects - e.g. gastric ulceration even to the point of serious haemorrhage in some (reason why recommended after food - which maybe a problem if you are feeling a bit sick... ) - and it shouldn't be taken by those with a history of gastric or duodenal ulceration - nor by asthmatics (for different reasons).

best wishes
Mark
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Re: Ibuprofen reduces altitude sickness, US study says

Postby Diego Sahagún » Sat May 05, 2012 3:20 pm

OK, I'll put it again. Thanks Mark
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Re: Ibuprofen reduces altitude sickness, US study says

Postby Diego Sahagún » Sun May 06, 2012 8:12 am

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Re: Ibuprofen reduces altitude sickness, US study says

Postby markhallam » Sun May 06, 2012 9:10 pm

Thanks Diego - I managed to read it this time.
It is an interesting study - does appear to be a peer reviewed journal (of emergency medicine) - but at 80 odd the total sample a little small. However, they do demonstrate clear benefits of taking Ibuprofen - but (with medical research there is always a but!) their outcomes are measured using the Lake Louise assessment scale, which is very much symptom based, with a certain amount of subjective medical observation. So I would still maintain that taking Ibuprofen probably relieves symptoms more than it would directly affect the acclimatisation process. To demonstrate that you would probably need to include more objective measures - perhaps oxygen saturation and other physiological parameters. Anyway I will keep an open mind, keep a look out for other larger studies - and keep on packing ibuprofen in my 1st aid kit when I go high!
Thanks again,
Mark
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Re: Ibuprofen reduces altitude sickness, US study says

Postby TyeDyeTwins » Mon May 07, 2012 6:17 am

I got altitude sickness before, and man was that shit scary! That is the only time where mentally I could go on, but phiscally could not. No wonder it kills climbers! Lack of sleep at a high elevation, lack of water/food, stress ect...led to it. Good old IB and a reduction in altitude helped out a ton. The next time I was well prepared. Trust me....when you are in the full blown madness of Altitude Sickness....just about anything would help.
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