Metoclopramide, ibuprofen may be alternatives to acetazolamide for altitude sickness

Last Updated: 2016-08-05

By Rob Goodier

NEW YORK (Reuters Health) - The antiemetic drug metoclopramide may reduce symptoms of acute mountain sickness (AMS) and serve as an alternative for those who cannot take the common first-line treatment acetazolamide, a new study suggests.

The double-blinded, randomized trial compared metoclopramide to ibuprofen, finding that both significantly reduced headache and nausea at altitude, according to data presented August 2 at the World Congress of Mountain and Wilderness Medicine in Telluride, Colorado.

Dr. Hillary Irons of the University of Massachusetts in Worcester led the study when she was a fellow in wilderness medicine at Massachusetts General Hospital in Boston. She and her team compared 10mg metoclopramide to 400mg ibuprofen in AMS patients on high-altitude approaches to Mount Everest in Nepal, i.e., above 4200m (13,800 ft).

Eligibility criteria were a gain of at least 1000 vertical feet over 24 hours with a headache and one other AMS symptom. Patients with severe AMS were excluded.

The researchers assessed vital signs, Lake Louise Scores (a self-reported survey of AMS symptoms), and Visual Analog Scale scores for headache and nausea, immediately prior to treatment and then serially for the next two hours.

Signed rank and Wilcoxon rank-sum tests found that both drugs significantly reduced headache and nausea. Ibuprofen was more effective at reducing headache and dizziness while metoclopramide was better at reducing nausea.

Using the Lake Louise Score, there was a significant decrease in headache, dizziness, and total score with ibuprofen compared to metoclopramide.

These drugs may be substitutes for patients with contraindications to acetazolamide, which can include kidney and liver disease and hyperchloremic acidosis, the researchers suggest.

But "while this may be an option in the future, we do not yet have enough evidence to recommend either over acetazolamide, which aids acclimatization. However, they might be helpful if a patient cannot take acetazolamide or for the symptoms of AMS (especially headache and nausea specifically) while the person acclimatizes," Dr. Irons told Reuters Health by email.

SOURCE: http://bit.ly/2aWwHx9

7th World Congress of Mountain and Wilderness Medicine 2016.