Preventing Acute Mountain Sickness

To the editor:

The summary of the paper on preventing acute mountain sickness by Meurer and Slawson¹ in the November issue of JFP encouraged me to send this letter about another method I have used since 1976.

This alternate method from the Medical Journal of Australia (July 31, 1976:168) uses spironolactone 25 mg 3 times daily starting 2 days before the ascent and during the periods at altitudes above 3000 m. It was tried out on a trekking expedition of 13 adults (men and women) to Nepal in 1974 to altitudes between 4300 m and 5500 m with no altitude sickness among those using spironolactone. A similar expedition to Nepal in 1972 was also reported.

I have used this method when at high altitudes in Mexico and at some of the national parks in the Rocky Mountains. I remained symptom free. My wife, who refused this treatment, had a headache and shortness of breath. A medical colleague and his wife who ski annually in Colorado had always been incapacitated for more than a day because of the altitude. With this treatment they can ski as soon as they arrive at the resort.

Walter Schnur, MD
Cincinnati, Ohio

REFERENCE

1. Meurer LN, Slawson JG. Which pharmacologic therapies are effective in preventing acute mountain sickness? J Fam Pract 2000; 49:981.

The preceding letter was referred to Dr Meurer who responded as follows:

I appreciate the letter by Dr Schnur regarding his use of spironolactone for the prevention of acute mountain sickness. It is exactly these observations from personal experiences that form the basis for research. Dr Schnur also cites a case series in which 13 adults successfully ascended to significant altitudes without incident using spironolactone.

To fully evaluate the effectiveness of spironolactone in this setting it is important to review clinical trial data, the strongest of which would be from randomized controlled trials. In their meta-analysis, Dumont and colleagues¹ described 2 studies that compared spironolactone with placebo. They report that in 1 study,² spironolactone was more efficacious than placebo for preventing nausea in 19 subjects but was not found to prevent headache or insomnia. In another study of 12 subjects,³ spironolactone was no different from placebo in preventing acute mountain sickness. The sample sizes of these studies may have been inadequate to demonstrate a statistically significant difference.

As anecdotal experience and observational studies suggest that spironolactone may be effective in preventing altitude sickness, a larger clinical trial might be warranted. Meanwhile, I would suggest using acetazolamide or dexamethasone for which more convincing evidence is available.

Linda N. Meurer, MD, MPH
Medical College of Wisconsin
Milwaukee

REFERENCES

1. Dumont L, Mardirosoff C, Tramer MR. Efficacy and harm of pharmacological prevention of acute mountain sickness: quantitative systematic review. BMJ 2000; 321:267-72.
2. Jain SC, Singh MV, Sharma VM, Rawal SB, Tyagi AK. Amelioration of acute mountain sickness: comparative study of acetazolamide and spironolactone. Int J Biometeorol 1986; 30:293-300.
3. Brookfield DSK, Liston WA, Brown GV. Use of spironolactone in the prevention of acute mountain sickness on Kilimanjaro. East Afr Med J 1977; 54:690-91.