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The Pros and Cons of Diamox

Thanks to Bob Holdsworth for this take on Diamox and the Mountain…

One of my concerns for the climb up Kilimanjaro was my ability to manage the altitude necessary to make the summit, and equally important, to enjoy the experience. Also, the threat of severe AMS lurked in the background to completely derail my attempt to summit or worse to miss my next birthday.

Past Experience

During previous hikes over 10,000 feet (3000m), I had struggled. Headaches, loss of appetite, and general fatigue were always present during trips to the Sierra Nevada. I recall experiencing shortness of breath just walking around camp at 12,000. When I was younger, better physical conditioning helped me push through the physical problems and get to the top (usually 13,000 to 14,000 feet). But Kilimanjaro is 19,341 feet (5895m)! Plus now that I am, let’s just say more mature (over 50), I was really concerned.

I know that in my earlier mountain trips, I did not drink enough water. Compounding this was usually no time to acclimatize because of the requirement to finish hikes over a weekend. Drinking adequate water (4 to 5 liters per day) will be easy to do this time and our extended trek across the western flank of Kilimanjaro will provide for acclimatization. However, my doubts still lingered.

Diamox: How & Why…

For this trip, I decided to take Diamox (Acetazolamide) to speed up the acclimatization process. Because of the reduced oxygen at altitude, breathing harder and faster allows your body to get more oxygen in the system as it produces more red blood cells. The increase in carbon dioxide exhaled at the same time makes the blood more alkaline. The kidneys get involved to excrete the excess alkaline to balance things out. Diamox helps the kidneys by speeding up the process. My local doctor prescribed 250 mg daily starting 2 days before the hike. I had read a number of articles that recommended anywhere from 125 mg to 500 mg per day, so this seemed reasonable.

Side Effects

The side effects described were numbness or tingling in the fingers and toes plus more frequent urination. There was also a big caution about not taking any sedatives once you started the medication. All of the side effects go away when you stop. This seemed manageable especially compared to not making it to the top.

I started taking the Diamox at the hotel in Moshi the night before we left for Kilimanjaro. I wanted to have a bathroom ready to see just how frequent, frequent is. Three Tuskers that night at dinner added more liquid than normal, but frequent turned out to be every other hour! Manageable in the hotel, but no more Tuskers until the end of the trip.

The first three days of the hike we climbed from 6890 feet (2100m) to 12,600 feet (3840m) over a relatively gradual incline and 22 km. I did not have any difficulty. The tingling side effect in my fingers and toes was no different than if you slept on your arm and felt mild numbness. It lasted for 20 to 30 minutes. I maintained my water intake which created two excursions per night out of the tent. This was not a problem because after midnight the skies cleared and I was able to view the splendor of every star in the sky and the Milky Way stretched across the heavens. A great side benefit even at the expense of a temporary chill from getting out of the sleeping bag.

The Result

The first test was Day 4 when we hiked from Shira Hut to Barranco Camp via the Lava Tower at 15,230 feet (4642m). We would ultimately sleep that night at 13,000 feet, but 15,000 feet was the highest I had ever hiked. It turned out to be no problem at all. Walking slowly (Swahili – poley poley), plenty of water, a good workout program prior to the trip, and the Diamox combined to make this day’s hike a great experience. I was not winded, no headache, and plenty of energy. The landscape was phenomenal and I was able to fully enjoy and appreciate it.

This was a major confidence booster for me. Over the next two days, we hiked up to Barufu Huts Camp at 15,358 feet (4681m). This was the last camp before our summit attempt that night at midnight. After 6 days and almost 40 kilometers of walking, the excitement and anticipation provided plenty of adrenaline. I was raring to go and felt great.

The Summit

When the last cheers of “Happy New Year” started to subside, we left Barafu Camp for the summit. Pitch black with your headlamp only illuminating the next three feet, we trudged steadily up the next 4,000 feet over the next 7 hours. We pass multiple groups huddled over fallen comrades and we lose one of our own to the altitude (Note – later in the day, she recovered and made it to the top). The ingredients of training, pace, hydration, and modern medicine combined to deliver me to the peak at 6:45AM. An unbelievable feeling of accomplishment and satisfaction wash over me as I get my picture taken at Uhuru Peak 5895m, Africa’s highest point, the world’s tallest freestanding mountain.

Could I have made it without Diamox? I don’t know. I wanted to give myself every advantage possible so I trained hard, took care of my body during the trip, followed directions (poley poley), and used available medicine whether it was Imodium or Diamox to aid my ascent. What I do know is that I made it and that is good enough for me.

By Peter Baxter | Permalink | 9 comments | January 20th, 2009
Tags: Latest News, Opinion, Random
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By Robbin Jordan | January 22nd, 2009

Great article — And how appropriate coming from the “Medicine Man” of the group. Not only were you adequately prepared, but you were very helpful in aiding the rest of us as well. Thank you!

By carlos Lapena | January 31st, 2009

I climbed with my fiance in Sept 07-Shira route.
Personally I carried diomax but never needed it. My fiance needed on the second day-Shira Huts 2-if not for the drug I think she would never of summitted. Should one use diomax preventatively?
I’m not sure it works but if you get altitude sickness it doesn’t work as well when you really need it I’m told. My recommendation is bring it and use it if needed./ Carlos Lapena BC Canada

By Bob Holdsworth | February 3rd, 2009

Thank Carlos – I had read other comments like this but also saw recommendations about the use of Diamox as a preventative for AMS. It was recommended, then if you experienced symptoms you could descend and increase the dosage. Because time was a factor on this trip, I did not want even a day to get ruined as I waited for the medicine to help. I agree it’s a personal choice but for me it was an easy choice to start at the beginning of the hike and take advantage of the benefits.

By suttoh | June 5th, 2009

hey all, im climbing kili via th westerrn breach in sept, my specialist has given me diamox, he hasnt said whether to take it preventatively or not but i think i will, just on the off chance i experience ams, im insulin taking diabetic so dont need any complications, thanks bob for your comments, kind regards,


By Sal | July 10th, 2009

I’m an expedition doctor – I feel altitude fairly badly at 3000m – I always take it before I go up – 250mg twice a day starting days before I go up. all the docs I know who do these things take it – that’s a pretty strong recommendation in my book – although you may not need it it does no harm.

By easybeach | August 7th, 2009

I climbed Kili in Sept ’08 when I was 58. There were 6 of us in the group and the only one who failed to summit was the one who didn’t take Diamox, and she was the youngest and strongest among us. The tingling side effects weren’t bad once you got used to them. In fact, I was glad to have them as they were proof that the drug was working. If you don’t take Diamox and can’t summit you’ll always be second guessing yourself. If you take it and still don’t make it to the top, then you gave it your best. That’s all you can ask.

By Nyevu | August 7th, 2009

Thanks Bob Holdsworth for your article. Just one correction…its not poley poley….but pole pole.
Looking forward to climbing Kili one day…..

By Frankie McAllister | September 29th, 2009

What do you take if you can’t take Diamox? I’m allergic to Sulphonomides so Diamox is contra-indicated for me. Is there anything else out there for emergencies even if not for prevention?

By sheila | November 16th, 2009

can anyone who has climbed Kili tell me if there are any narrow ledges on the climb. I’m keen to do it but not too keen on heights!


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