title: Acetazolamide: a treatment for chronic mountain sickness.
abstract: BACKGROUND
  Chronic mountain sickness or Monge's disease is characterized by an excessive polycythemia in high-altitude dwellers, with a prevalence of 5 to 18% above 3,200 m. To date, no pharmacologic treatment is available.
  
  
  OBJECTIVE
  We evaluated the efficacy of acetazolamide in the treatment of chronic mountain sickness and the importance of nocturnal hypoxemia in its pathophysiology.
  
  
  METHODS
  A double-blind placebo-controlled study was performed in three groups of patients from Cerro de Pasco, Peru (4,300 m), treated orally for 3 weeks with placebo (n = 10), 250 mg of acetazolamide (n = 10), or 500 mg of acetazolamide (n = 10), daily.
  
  
  RESULTS
  Acetazolamide decreased hematocrit by 7.1% (p < 0.001) and 6.7% (p < 0.001), serum erythropoietin by 67% (p < 0.01) and 50% (p < 0.001), and serum soluble transferrin receptors by 11.1% (p < 0.05) and 3.4% (p < 0.001), and increased serum ferritin by 540% (p < 0.001) and 134% (p < 0.001), for groups treated with 250 and 500 mg of acetazolamide, respectively. Acetazolamide (250 mg) increased nocturnal arterial O(2) saturation by 5% (p < 0.01) and decreased mean nocturnal heart rate by 11% (p < 0.05) and the number of apnea-hypopnea episodes during sleep by 74% (p < 0.05). The decrease in erythropoietin was attributed mainly to the acetazolamide-induced increase in ventilation and arterial O(2) saturation.
  
  
  CONCLUSIONS
  Acetazolamide, the first efficient pharmacologic treatment of chronic mountain sickness without adverse effects, reduces hypoventilation, which may be accentuated during sleep, and blunts erythropoiesis. Its low cost may allow wide development with a considerable positive impact on public health in high-altitude regions.
authors.affiliation: Laboratoire EA 2363, UFR SMBH, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France. richalet@smbh.univ-paris13.fr
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Richalet
authors.forename: Maria
authors.initials: M
authors.lastname: Rivera
authors.forename: Patrick
authors.initials: P
authors.lastname: Bouchet
authors.forename: Eduardo
authors.initials: E
authors.lastname: Chirinos
authors.forename: Igor
authors.initials: I
authors.lastname: Onnen
authors.forename: Olivier
authors.initials: O
authors.lastname: Petitjean
authors.forename: Annick
authors.initials: A
authors.lastname: Bienvenu
authors.forename: Francçoise
authors.initials: F
authors.lastname: Lasne
authors.forename: Stéphane
authors.initials: S
authors.lastname: Moutereau
authors.forename: Fabiola
authors.initials: F
authors.lastname: León-Velarde
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D000532:Altitude Sickness / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004562:Electrocardiography; D004921:Erythropoietin / Q000097:blood; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006400:Hematocrit; D006801:Humans; D008297:Male; D010092:Oximetry; D010101:Oxygen Consumption / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D004921:Erythropoietin; D000086:Acetazolamide