Ibuprofen vs. Acetazolamide in the prevention of Acute Mountain Sickness
Date First Published:
January 5, 2023
Last Updated:
December 20, 2023
Report by:
Dr Mark Willis, General Practitioner (NHS)
Search checked by:
Dr Mark Willis, NHS
Three-Part Question:
[In healthy adults ascending to altitude >(2500m)], is [Ibuprofen better than Acetazolamide] at [preventing Acute Mountain Sickness]
Search Strategy:
PubMed search ((ibuprofen) AND (acetazolamide)) AND (AMS OR Acute Mountain Sickness OR HAI OR High Altitude Illness)
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide Patrick Burns , Grant S Lipman , Keiran Warner , Carrie Jurkiewicz , Caleb Phillips , Linda San Feb-19 United States of America | Ninety-healthy adult volunteers who normally resided at low altitude | Randomised-controlled, non-inferiority study assessing whether ibuprofen was as effective as acetazolamide for the prevention of AMS (LLQ>3 plus headache). | Outcome: Ibuprofen was slightly inferior to acetazolamide for acute mountain sickness prevention and should not be recommended over acetazolamide for rapid ascent. | Key Result: The total incidence of acute mountain sickness was 56.5%, with the incidence for the ibuprofen group being 11% greater than that for acetazolamide, surpassing the predetermined 26% noninferiority margin (62.2% vs 51.1%; 95% confidence interval [CI], -11.1 to 33.5). | |
| Prospective, double-blind, randomized, placebo-controlled comparison of acetazolamide versus ibuprofen for prophylaxis against high altitude headache: the Headache Evaluation at Altitude Trial (HEAT Jeffrey H Gertsch, Grant S Lipman, Peter S Holck, Andrew Merritt, Allison Mulcahy, Robert S Fisher Sep-10 | 343 healthy non-Nepali males and females volunteers. | A prospective, double-blind, randomized, placebo-controlled trial in the Nepal Himalaya designed to compare the effectiveness of ibuprofen and acetazolamide for the prevention of HAH and AMS (LLQ >30 plus headache) | Outcome: Ibuprofen was similar to acetazolamide in preventing symptoms of AMS | Intent to treat vs measured outcomes. Large proportion lost to follow up. | |
| Key Result: AMS incidence was similar when treated with acetazolamide (18.8%) or ibuprofen (13.7%; P = .34), and both agents were significantly more effective than placebo (28.6%; P = .03) |
References:
- Patrick Burns , Grant S Lipman , Keiran Warner , Carrie Jurkiewicz , Caleb Phillips , Linda San. Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide
- Jeffrey H Gertsch, Grant S Lipman, Peter S Holck, Andrew Merritt, Allison Mulcahy, Robert S Fisher. Prospective, double-blind, randomized, placebo-controlled comparison of acetazolamide versus ibuprofen for prophylaxis against high altitude headache: the Headache Evaluation at Altitude Trial (HEAT