• L Dumont, C Mardirosoff, and M R Tramèr.
• Division of Anaesthesiology, Department APSIC, University of Geneva Hospitals, CH-1211 Geneva 14, Switzerland. lionel.dumont@hcuge.ch
• BMJ. 2000 Jul 29; 321 (7256): 267-72.

ObjectiveTo quantify efficacy and harm of pharmacological prevention of acute mountain sickness.Data SourcesSystematic search (Medline, Embase, Cochrane Library, internet, bibliographies, authors) in any language, up to October 1999.Study SelectionRandomised placebo controlled trials.Data ExtractionDichotomous data on efficacy and harm from 33 trials (523 subjects received 13 different interventions, 519 a placebo).Data SynthesisAt 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.ConclusionsAt 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.

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