[Cory from Wisconsin]

Hello fellow mountaineers and coaches. I’m planning a Kilimanjaro trek with three other buddies (also in this UA training group) this January and I wanted to hear your thoughts on taking Diamox/acetazolomide to help with the acclimatization? I am inclined not to prophylactically take the meds, but I hear the guides will generally push pretty hard for it. And I wanted to know what is generally recommended on higher altitude trips.

To date the highest I’ve been was on Mt Whitney during a winter trip up the Mountaineers Route that included a night at 12.3k prior to the summit. I could feel mild affects of altitude, but didn’t personally need anything to help – although one of my climbing partners did feel a stronger case of AMS, took Diamox upon arrival at camp, and was a new man by morning (presumably a combination of rest, acclimatization, and the meds). I’ve also climbed Rainier and a handful of 14ers without needing help acclimatizing – but I recognize there is a BIG difference between 14k and 19k.

Background on the trek: we are taking the Lemosho Route over 8 days, which is intended to give plenty of time to acclimatize. I also expect that we will be moving rather slow since the larger group we are going with is comprised primarily of folks with no prior mountaineering experience and from the sound of some group calls, limited training experience or no plans to seriously train prior to the trip (but that’s a whole different topic).

So what has been your experience and do you have any recommendations or considerations for us?

Thanks,
Cory

Topic

[george.peridas]

george.peridas on October 23, 2022 at 12:01 am #71784

Cory,

You may want to read this by SteveH: https://uphillathlete.com/forums/topic/denali-climbing-questions-pace-and-gear/

He says the following about Diamox: “A word about Diamox. Diamox is a diuretic prescription medicine that very popular among high-altitude climbers, including Denali climbers. Frankly, I think there is a huge placebo affect at work with Diamox. I’ve been to the top of Denali something more than 20 times, and when I was in my 20’s, my fellow guides and I experimented on different trips with and without Diamox. For me (and keep in mind that different people are likely to react differently to the affects of a drug.) I had to come to the conclusion that Diamox did nothing for me in terms of speeding up or aiding the acclimatization process.”

I also seem to recall that Steve and Scott also did not not think the side effects of the drug were worth it, even if it does something for altitude?

I’ve been up Kili over 6 days, if I recall. What makes a huge difference there, depending on your guiding setup, is porters. I was strolling with a pleasant daypack, while seeing locals all around me slogging uphill with a big pack on their back, another pack on their front, and a cast-iron cooking setup on their head. No fancy gear, they weren’t even wearing sneakers even in some cases. Humbling stuff, makes you reconsider your place in this world…

I agree with you that 14k and 19k are different. In addition to the style question over using diamox, I would try it at least once before your actual trek to see how you feel and react to it?

[george.peridas]

george.peridas on October 23, 2022 at 11:06 am #71790

I will also add that I’ve felt both good and crappy at elevation both with and without diamox. Too many factors entering into it to know whether it helped or not, but I certainly did not notice a straightforward difference between trips where I took it and trips where I dod not. Years ago I just abandoned it and stuck with the simplicity of not tinkering with the body’s chemistry. It hasn’t stopped me from summiting anything in the lower 48. I still remember the tingling in the hands and feet and constant peeing from it though…

[Anonymous]

Anonymous on October 23, 2022 at 10:46 pm #71796

Cory,
Theres a lot of individual variation with Diamox at altitude that’s about the only thing that certain. I’ve probably guided a couple hundred folks who have used it and more that haven’t at various altitudes. Its main benefit in my experience is helping out with those that are suffering from depressed respiratory drive while they’re sleeping and/or periodic breathing episodes. No big surprise here as this is its primary role as an altitude drug, it causes the body to have a slightly increased concentration of carbonic acid and fakes the body into thinking it needs to breath a little harder to blow off the excess. For some reason certain people don’t adjust their breathing quite as well as others initially at altitude. Thusly diamox can help folks stave off mild altitude sickness and get better rest. Not everyone battles these issues so it doesn’t help everyone equally. It does also have some side affects. (Actually the desired affect is a side affect in our case as climbers) Most climbers that ascend at a reasonable pace can certainly do without it. If you do use it there is a dosage which will give you the benefits you’re looking for but minimize the tingling of the periphery and the diuretic affect. A lot of folks do well with 125 mg about an hour before bed as a starting point.

[bill]

bill on November 1, 2022 at 5:51 pm #72253

I’ve been in the Himalayas twice, for about about two months each time, spending most of the trip between 12,000 and 18,000 feet. The docs on the team (we were running a medical clinic) weren’t exactly pushing Diamox but they were certainly recommending it for the first week or so of the trip. As a side note, I tend to acclimatize pretty quickly and have never suffered from serious altitude illness. The first trip, I followed their recommendation, the second I did not but started using it when my sleep started to suffer (the respiratory issues Mark mentions above). The Diamox definitely seemed to help with periodic breathing and respiratory depression; I didn’t see much difference between the approaches wrt to these issues. One caution: the diuretic effect is real and you need to plan for it.