Acute mountain sickness can be helped by ibuprofen

Acute mountain sickness can be debilitating when severe and risk the fatal complication of cerebral edema. A study just published in the Annals of Emergency Medicine offers evidence that acute mountain sickness can be relieved by the relatively benign non-steroidal anti-inflammatory drug ibuprofen. The authors note:

"Acute mountain sickness occurs in more than 25% of the tens of millions of people who travel to high altitude each year. Previous studies on chemoprophylaxis with nonsteroidal anti-inflammatory drugs are limited in their ability to determine efficacy. We compare ibuprofen versus placebo in the prevention of acute mountain sickness incidence and severity on ascent from low to high altitude."

This was a worthy focus of investigation because there is evidence that acute mountain sickness has an inflammatory component. They gave healthy adult volunteers living at low altitude either ibuprofen 600 mg or placebo 3 times daily, starting 6 hours before ascent from 1,240 m (4,100 ft) to 3,810 m (12,570 ft). The main outcome measures were acute mountain sickness incidence and severity. Ibuprofen significantly reduced acute mountain sickness:

"Eighty-six participants completed the study; 44 (51%) received ibuprofen and 42 (49%) placebo. There were no differences in demographic characteristics between the 2 groups. Fewer participants in the ibuprofen group (43%) developed acute mountain sickness compared with those receiving placebo (69%) (odds ratio 0.3, 95% confidence interval 0.1 to 0.8; number needed to treat 3.9, 95% confidence interval 2 to 33). The acute mountain sickness severity was higher in the placebo group (4.4 [SD 2.6]) than individuals receiving ibuprofen (3.2 [SD 2.4]) (mean difference 0.9%; 95% confidence interval 0.3% to 3.0%)."

Dexamethasone is used for acute mountain sickness but it can cause hyperglycemia, adrenal suppression, delirium, depression, insomnia, and mania. The side effects of acetazolamide (nausea, dizziness, and fatigue) can cause as much discomfort as acute mountain sickness itself. So ibuprofen's more benign side-effect profile and availability make it an appealing choice by comparison. But it also would be good know if any of the natural anti-inflammatory agents in common use that have side 'benefits' instead of side-effects would work as well for acute mountain sickness. I myself used one years ago in Lhasa, Tibet with great relief, but this is a matter that has to be studied. The authors conclude:

"Compared with placebo, ibuprofen was effective in reducing the incidence of acute mountain sickness."