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March 20th, 2012
12:07 PM ET
Ibuprofen may ward off altitude sicknessIbuprofen has been used for decades to treat pain. Now, research suggests the drug's anti-inflammatory properties also may help prevent the piercing headaches and other symptoms of altitude sickness. A small new study, published this week in the Annals of Emergency Medicine, found that people who took four 600-milligram doses of ibuprofen over a 24-hour period in which they ascended to 12,570 feet above sea level were less likely to experience altitude sickness than people taking a placebo. Sixty-nine percent of the participants who took placebo during the ascent developed the headaches, nausea, dizziness, and fatigue that characterize altitude sickness, also known as acute mountain sickness. By contrast, just 43% of people who took ibuprofen developed the condition. The prospect of using an over-the-counter pain reliever to stave off altitude sickness is appealing, the researchers say, because the only two drugs currently approved to prevent and treat the condition, acetazolamide and dexamethasone, are prescription-only and carry a risk of side effects. In fact, many doctors are reluctant to prescribe acetazolamide or dexamethasone unless a person has experienced altitude sickness before, says Robert Roach, Ph.D., director of the Altitude Research Center at the University of Colorado Denver School of Medicine, who was not involved in the study. Ibuprofen appears to be nearly as effective as acetazolamide and dexamethasone, so it may be an option for people traveling to high altitudes who don't yet know if they're susceptible, Roach adds. In general, he says, 20% to 30% of people will experience altitude sickness at 7,000 feet, and up to 50% will get sick at 10,000 feet. Health.com: The 10 most slimming vacations The study took place in California's White Mountains. Eighty-six men and women who lived close to sea level spent the night at 4,100 feet. In the morning, they drove to an elevation of 11,700 feet and proceeded to hike to 12,570 feet, where they again spent the night. The participants took the four doses of ibuprofen (or placebo) about every six hours. Each 600-milligram dose was equivalent to three standard over-the-counter ibuprofen tablets. The men and women had to be healthy enough to hike at a high elevation, but they weren't necessarily experienced hikers or mountain climbers. That suggests the ibuprofen regimen used in the study could be helpful for everyday tourists on ski or hiking vacations, not just elite climbers, says lead author Grant S. Lipman, M.D., a clinical assistant professor of emergency medicine at the Stanford University School of Medicine. "We weren't just looking at people who went to Nepal," says Lipman, an avid climber himself. "This [study] was done in our own backyard, so it's very translatable." Health.com: Essentials for healthy hiking Experts aren't certain what causes altitude sickness. One hypothesis is that lower oxygen levels at high elevations lead to leaks in the blood-brain barrier, which can cause the brain to swell. Ibuprofen, a non-steroidal anti-inflammatory drug, reduces swelling. Long-standing advice to prevent altitude sickness includes ascending gradually; drinking lots of fluids; avoiding alcohol for the first day or two at altitude; avoiding medications that can affect breathing, such as sleeping pills and sedatives; and eating lots of carbs, which some researchers believe can improve respiratory function, Lipman says. In rare cases, altitude sickness can cause potentially fatal brain swelling. Milder, more common symptoms usually go away in a few days - but that may be too long to wait for the trekker or skier with precious little vacation time, Lipman says. Copyright Health Magazine 2011
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It seems like four doses of 600mg each given every six hours seems like a LARGE amount of ibuprofen. I can only imagine that side effects would be terrible. That's 2400mg every six hours. * 4 for 24 hours, and you're at 9600mg of ibuprofen. That seems like an amazingly high amount compared to the (usual) maximum dosage per day of 1200-2400mg..
the article says four doses over a 24 hour period, not four doses each every 6 hours.
@Mask. You misunderstood because the writing was not clear. They took 600 mg every 6 hours (one 600mg pill), not 2400 mg every 6 hours. Their total daily dose was 2400 mg, which is well under the maximum daily dose used for arthritis.
"The participants took the four doses of ibuprofen (or placebo) about every six hours. Each 600-milligram dose was equivalent to three standard over-the-counter ibuprofen tablets. "
I took it to mean that they were giving four doses every four hours instead of four doses per day.
@Steve. That makes sense. Thanks. I was a little curious as to why they would have used such a large dose!
The maximum daily dose of ibuprofen by prescription is 3200 mg.
@Steve You're correct. I was meaning OTC that usual recommendations at 1200-2400mg per day.
@Mask: Yep, and even at those doses, quite a few people each year experience serious, even life-threatening GI bleeding. NSAIDs and and acetaminophen (for different reasons) are not to be taken lightly.
You read it wrong, but you are right about not popping them lightly. I get withdrawl symptoms if I take more than 800MG per day (usually significant headaches).
It is 4 doses of 600MG each equal to 2400MG in a 24 hour period. That is within the allowed amount. I live in the Colorado rockies and I can tell you this does work!
Keep that up and bye bye liver.
The dose is 600mg every 6 hours, or 2400mg in a 24 hour period. This is the commonly accepted max dosing for prescription ibuprofen, given either as 600mg every 6 hours, or in some cases, 800mg every 8 hours.
The medical dose after an acute injury is 3200mg day. If you are healthy (without kidney problems) this is likely to be safe for a short period of time
Mountain climbers have known about vitamin–I for at least 30 years!!!
Which vitamin?
Mountaineers have long called Ibuprofen–VITAMIN I
Can this help people who get these symptoms during and after an airplane flight? This happens to me and has prevented me from flying – have been very sick after a flight. Any comments from anyone else who has experienced this?
Most commercial flights have a cabin pressurized to 8000'. I have heard of situations that on red eye flights that might get bumped up to 10,000' so people will fall asleep, though I have no proof of this.
Why don't you give it a try? Take a couple of ibuprofen maybe half an hour before the flight and see if it makes a difference.
Call me a cynic, but it's too small a study to draw a conclusion, just 86 participants. Assuming 43 took placebo, 30 developed the condition, while 18 of 43 developed it taking ibuprophen. I'm sorry, but a difference of 12 people isn't that significant.
Presumably the study had STATISTICAL significance, or else it would not have been published. They can tell whether the study was statistically significant by doing calculations using the number of people in the study and the effect(s) observed. They can also estimate the size of study needed ahead of time before they recruit subjects. It is not a "gut feeling" type of thing.
Fortunately, statistical tests exist so that you don't have to just trust your gut about what feels significant. The P value based on the data you quoted is 0.016. That means that if ibuprofen has no effect, there would be a 1.2% chance that by random chance you would see the observed level of improvement among those taking ibuprofen. Although this isn't absolutely definitive, it is pretty good (generally, any P value below 0.05 is considered statistically significant).
What is important to realize is that science is always a work in progress. No single study is ever definitive, but this study provides solid evidence for follow-up work. (One of the biggest problems that scientists face is that the media will often present very preliminary studies as definitive answers, so when the follow-up experiments don't support the initial hypothesis, it makes it look like scientists can't make up their mind.)
While this is exciting for those who have minimal problems with ascending to over 12K (most people have some minor symptoms)....for those of us who have severe reactions (fainting) acetazolamide works 100% of the time. I ski in Colorado and have since I was a child. Coming from the east coast, I have had serious symptoms every time I've gone- even as a young child. I was told then to drink tons of water, and don't ski on day 1 of our trip. Even still- fainting for me on the mountain (seeing spots, falling over and needing medical staff on the mountain to bring me down) has happened more than once for me. I did some research awhile back and convinced my doctor to prescribe me acetazolamide- worked WONDERS. No mountain sickness AT ALL and the only side effect I had was that soda (coke/pepsi/carbonated products) taste funny. Advils might be something for the average person to try but for many of us who have severe reactions to being in the moutains- it's not enough.
Yes, but if you're allergic to sulfa, you can't take acetazolamide. So this is intriguing, although I'd like to see a broader study.
Also, as has been noted, NSAIDs can affect kidneys (so can acetazolamide), but generally not the liver. Tylenol/acetaminophen is the liver killer in overdose.
@Mask, clearly word problems are not your forte. You get an F. The correct answer is: 4(doses) x 600mg = 2400mg, over 24 hrs (indeed the max recommended dosage) which is basically 600mg (three pills) every 6hrs. Cheers to preventing liver damage!
Acetaminophen causes liver damage, ibuprofen can affect the kidneys.
Ibuprofen==kidney and GI problems
acetominopnen is liver problems
All within medical doses. Package doses are purposely much lower than toxic levels
http://www.Hear-The-Truth.com
What this study really tells us is that a Headache can make you feel nausea, dizziness and fatigue.
THE IBUPROFEN help me with my lower back pain, headache, even when I'm hangover, for years, proven is really good.
No more lame excuses out of her mouth, mile high club here I come!
If you take Ibu, take it with food
That is a LOT of Ibuprofen. Probably OK for ONE day, but enough that if done regularly will cause Acid Reflux and tinnitus (ringing in the ears).
This is a brilliant example of the fact that we often have no idea what other effects any given drug has on our body. This time it is for the good, but often it is not, as emplified by the epinephrine story: it saves the heart at the expense of the brain. I'd rather be dead from a heart attack than a vegetable.
This is an interesting article, but by no means is it without some flaws. 1) The dose of 600mg ibuprofen is more than the OTC dosing and would actually require an RX just like acetazolamide or dexamethasone. 2) Yes the incidence of AMS was reduced, but this was not compared to the gold standard of preventative drugs. 3) The trial had also set an a-priori LLQ reduction of 2 points, but did not reach this goal. This was an arbitrary a-priori reduction goal though. 4) Incidence of headache was not even reduced all that much within the study, 31% vs 29% (though severity of headache seemed to be reduced). GI symptoms were actually markedly reduced by ibuprofen...oddly enough.
Am I mistaken that the headache is not just a normal headace but actually swelling of the brain in acute mountain sickness ?
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