Acetazolamide: a treatment for chronic mountain sickness.
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.
Richalet
Jean-Paul
JP
Laboratoire EA 2363, UFR SMBH, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France. richalet@smbh.univ-paris13.fr
Rivera
Maria
M
Bouchet
Patrick
P
Chirinos
Eduardo
E
Onnen
Igor
I
Petitjean
Olivier
O
Bienvenu
Annick
A
Lasne
Francçoise
F
Moutereau
Stéphane
S
León-Velarde
Fabiola
F
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
D002257:Carbonic Anhydrase Inhibitors; D004921:Erythropoietin; D000086:Acetazolamide