Indications: moderate to severe AMS with progressive neurologic symptoms and/or ataxia
Usual treatment dose:
(1) loading dose of 4 to 8 mg IM, IV, or po
(2) maintenance dose of 4 mg q6h
A dose of 4 mg q12 h (or 2 mg q6h) for prophylaxis but this would require clear reasons to give, such as allergy to acetazolamide.
Potential problems:
(1) hyperglycemia in a patient with diabetes or prediabetes
(2) exacerbation of infection, including amebiasis and strongyloidiasis
(3) increased risk for avascular necrosis
(4) increased risk for tendon rupture, including fluorquinolone therapy
(5) pregnancy class C (no human data, teratogenic in animals)
(6) recurrence of AMS if drug discontinued and the patient is still at altitude
(7) increased risk of peptic ulcer disease or upper G hemorrhage
No dosage adjustment is required for liver or kidney disease.
