Ibuprofen Prevents Altitude Illness: A Randomized Controlled Trial for Prevention of Altitude Illness With Nonsteroidal Anti-inflammatories
Acute mountain sickness (AMS) occurs commonly in hikers who ascend to altitudes above 8250 feet. There have been few studies that have defined the efficacy of ibuprofen in regard to preventing AMS. The purpose of this prospective, double-blinded, randomized, placebo-controlled trial was to study whether ibuprofen helped prevented AMS occurrence, and also whether it decreased the severity of the symptoms.
In this study, the largest AMS prevention study done at elevations commonly found in North America, the authors evaluated hikers at White Mountain in California from July to August 2010. They analyzed participants who resided at an altitude below 4100 feet, and assessed the incidence and severity of AMS after they drove to 11 700 feet and then hiked 2.7 miles to a final altitude of 12 570 feet. Acute mountain sickness was defined as having a Lake Louise Score of 3 or greater, with headache and 1 other symptom. Secondary outcomes measures included headache severity by visual analog scale and peripheral oxygen saturation by fingertip pulse oximetry.
During this study, 86 participants were randomly assigned to receive either a placebo or ibuprofen. Four doses of ibuprofen, 600 mg, or placebo were given over a day and a half, starting 6 hours before ascent. The incidence of AMS was 69% in the placebo group compared with 43% in the ibuprofen group, with an odds ratio of 0.9, and number needed to treat of 4 to prevent 1 case of AMS. Subgroup analysis showed that no specific symptom of AMS, except for gastrointestinal symptoms, which were higher in the placebo group, was decreased in the intervention group, suggesting that ibuprofen prevented the group of symptoms that AMS represents, rather than just masking headache or a particular symptom.
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Prepared by Brian Vu, MD, UT Houston Emergency Medicine, Houston, TX, USA