The issue of prevention of Acute Mountain Sickness (AMS) has been debated extensively on the high altitude walking tracks around the world and also in the literature. For any of you lucky enough to explore the world above the clouds, the questions surrounding the role of Acetazolomide (Diamox) and Dexamethasone far outweigh the answers. Nevertheless, none of the available agents are without adverse side effects and the exact mechanism of action of many of the proposed agents is less than clear. The current Wilderness Medical Society Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness (2010) provide concise guidelines on the use of Acetazolomide and Dexamethasone and also provide commentary on alternative agents however the role of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are not included.
There has been increasing interest in recent times in the role of simple NSAID agents such as Ibuprofen (Nurofen / Brufen) in the prevention of altitude illness. Ibuprofen is an inexpensive, easily accessible, over-the-counter medication with a relatively good safety profile and minimal side effects when used for short time periods. The most recent edition of Wilderness and Environmental Medicine has a report on the Altitude Sickness in Climbers and Efficacy of NSAIDs Trial (ASCENT). There is also a great editorial by Stanford’s Ken Zafren that provides good context.
Is Ibuprofen effective in preventing AMS? How does it work? Does it accelerate acclimatisation or does it just mask the symptoms? The answers are not yet fully clear but there is certainly promising signs to support the anti-inflammatory role of Ibuprofen in protecting against AMS by dampening down the inflammatory response to altitude induced hypoxia.
Ibuprofen is better tolerated than acetazolomide and has fewer undesirable side effects than dexamethasone. It is certainly effective in treating headaches and the anti-prostaglandin effect may inhibit the altitude induced sympathetic activity and promote aclimatisation.
There is still much more research before anyone can put their hand on their heart and promote Ibuprofen as the preventative cure for AMS. In the meantime the best advice is to enjoy the scenery, take your time and let acclimatization occur (and if you have some Ibuprofen on hand then why not!)