Abstract

BACKGROUND: Acute mountain sickness is a common occurrence with travel to high altitude. Although previous studies of ibuprofen have shown efficacy for acute mountain sickness prevention, recommendations have been limited, as it has not been compared directly with acetazolamide, until this study.METHODS: Adult volunteers were randomized to ibuprofen 600 mg, three times daily, 4 hours before ascent or acetazolamide 125 mg, twice daily, started the night before ascent to 3810m in the White Mountains of California. The main outcome measure was acute mountain sickness incidence, using the Lake Louise Questionnaire (LLQ), with a score of >3 with headache. Sleep quality and headache severity were measured with the Groningen Sleep Quality Survey (GSQS) and a modified visual analogue scale (mVAS).RESULTS: Ninety-two participants completed the study: 45 (49%) ibuprofen and 47 (51%) acetazolamide. The incidence of acute mountain sickness was 56.5%, with ibuprofen 11% greater than acetazolamide, surpassing the predetermined 26% noninferiority margin (62.2% vs. 51.1%, 95% CI: - 11.1% to 33.5%). No difference was found in the total LLQ scores or subgroup symptoms between drugs (p=0.8). The GSQS correlated with LLQ sleep (r=0.77, 95% CI: 0.67 to 0.84) as was the mVAS with total LLQ severity (r?=?0.57, 95% CI: 0.42 to 0.7). The acetazolamide group had higher SpO2 than ibuprofen (88.5% vs. 85.6%, p=0.001).CONCLUSION: Ibuprofen was slightly inferior to acetazolamide for acute mountain sickness prevention and should not be recommended over acetazolamide for rapid ascent. Average symptoms and severity were similar between drugs, suggesting prevention of disease.

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