Clinical pharmacology in the prophylaxis and treatment of high-altitude illness

MA Jun; FAN Peng-cheng; ZHANG Qiang; MA Hui-ping; WANG Rong; JIA Zheng-ping

doi:10.3969/j.issn.1006-0111.2013.04.002

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Volume 31 Issue 4

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Article Navigation > Journal of Pharmaceutical Practice and Service > 2013 > 31(4): 246-250

MA Jun, FAN Peng-cheng, ZHANG Qiang, MA Hui-ping, WANG Rong, JIA Zheng-ping. Clinical pharmacology in the prophylaxis and treatment of high-altitude illness[J]. Journal of Pharmaceutical Practice and Service, 2013, 31(4): 246-250. doi: 10.3969/j.issn.1006-0111.2013.04.002

Citation:

MA Jun, FAN Peng-cheng, ZHANG Qiang, MA Hui-ping, WANG Rong, JIA Zheng-ping. Clinical pharmacology in the prophylaxis and treatment of high-altitude illness[J]. Journal of Pharmaceutical Practice and Service, 2013, 31(4): 246-250. doi: 10.3969/j.issn.1006-0111.2013.04.002

Clinical pharmacology in the prophylaxis and treatment of high-altitude illness

doi: 10.3969/j.issn.1006-0111.2013.04.002

Department of Pharmacy, General Hospital of Lanzhou Command, Lanzhou 730050, China

Received Date: 2012-08-22
Rev Recd Date: 2012-12-18

Abstract

The use choice of acetazolamide, dexamethasone, nifedipine, sildenafil, and salmeterol in the management of altitude illness such as acute mountain sickness, high-altitude cerebral edema, high-altitude pulmonary edema, and with underlying medical problems were reviewed. The indications and dosing recommendations for individuals without underlying disease were discussed, and drug selection or dosing regimens were considered which would be affected by the presence of renal insufficiency, hepatic insufficiency, other important medical conditions, and the potential for drug interactions. These issues should be taken adequate consideration; so clinicians could increase the chances that properly healed patients with underlying medical conditions who could enjoy a safe trip to high altitude.
- acetazolamide,
- dexamethasone,
- nifedipine,
- sildenafil,
- salmeterol,
- acute mountain sickness,
- high-altitude cerebral edema,
- high-altitude pulmonary edema

References

[1]	Maggiorini M, Brunner-La RHP, Peth S, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema:a randomized trial[J]. Ann Intern Med, 2006, 145:497.
[2]	Sartori C, Allemann Y, Duplain H, et al. Salmeterol for the prevention of high-altitude pulmonary edema[J]. N Engl J Med, 2002, 346:1631.
[3]	Teppema LJ, Balanos GM, Steinback CD, et al. Effects of acetazolamide on ventilatory, cerebrovascular, and pulmonary vascular responses to hypoxia[J]. Am J Respir Crit Care Med, 2007, 175:277.
[4]	Hackett PH, Roach RC. High-altitude illness[J]. N Engl J Med, 2001, 345:107.
[5]	Luks AM, Swenson ER. Medication and dosage considerations in the prophylaxis and treatment of high-altitude illness[J]. Chest, 2008, 133:744.
[6]	Pepys MB. Acetazolamide and renal stone formation[J]. Lancet, 1970, 1:837.
[7]	van Bortel L, Bohm R, Mooij J, et al. Total and free steady-state plasma levels and pharmacokinetics of nifedipine in patients with terminal renal failure[J]. Eur J Clin Pharmacol, 1989, 37:185.
[8]	Swan SK, Bennett WM. Drug dosing guidelines in patients with renal failure[J]. West J Med, 1992, 156:633.
[9]	Forgue ST, Phillips DL, Bedding AW, et al. Effects of gender, age, diabetes mellitus and renal and hepatic impairment on tadalafil pharmacokinetics[J]. Br J Clin Pharmacol, 2007, 63:24.
[10]	Muirhead GJ, Wilner K, Colburn W, et al. The effects of age and renal and hepatic impairment on the pharmacokinetics of sildenafil[J]. Br J Clin Pharmacol, 2002, 53(suppl 1):21S.
[11]	Grossman EB, Swan SK, Muirhead GJ, et al. The pharmacokinetics and hemodynamics of sildenafil citrate in male hemodialysis patients[J]. Kidney Int, 2004, 66:367.
[12]	Cazzola M, Testi R, Matera MG. Clinical pharmacokinetics of salmeterol[J]. Clin Pharmacokinet, 2002, 41:19.
[13]	Dawson AM, De Groote J, Rosenthal WA, et al. The effects of diamox ammonia metabolism in liver disease[J]. Clin Sci (Lond), 1957, 16:413.
[14]	Ene MD, Roberts CJ. Pharmacokinetics of nifedipine after oral administration in chronic liver disease[J]. J Clin Pharmacol, 1987, 27:1001.
[15]	Kleinbloesem CH, van Harten J, Wilson JP, et al. Nifedipine:kinetics and hemodynamic effects in patients with liver cirrhosis after intravenous and oral administration[J]. Clin Pharmacol Ther, 1986, 40:21.
[16]	Callejas RJL, Salmeron Escobar J, Gonzalez-Calvin J, et al. Successful treatment of severe portopulmonary hypertension in a patient with Child C cirrhosis by sildenafil[J]. Liver Transpl, 2006, 12:690.
[17]	Wang YW, Lin HC, Yang YY, et al. Sildenafil decreased pulmonary arterial pressure but may have exacerbated portal hypertension in a patient with cirrhosis and portopulmonary hypertension[J]. J Gastroenterol, 2006, 41:593.
[18]	Finley DS, Lugo B, Ridgway J, et al. Fatal variceal rupture after sildenafil use:report of a case[J]. Curr Surg, 2005, 62:55.
[19]	Manchee GR, Eddershaw PJ, Ranshaw LE, et al. The aliphatic oxidation of salmeterol to alpha-hydroxysalmeterol in human liver microsomes is catalyzed by CYP3A[J]. Drug Metab Dispos, 1996, 24:555.
[20]	Swenson ER. Carbonic anhydrase inhibitors and ventilation:a complex interplay of stimulation and suppression[J]. Eur Respir J, 1998, 12:1242.
[21]	Coudon WL, Block AJ. Acute respiratory failure precipitated by a carbonic anhydrase inhibitor[J]. Chest, 1976, 69:112.
[22]	Brubaker PL. Adventure travel and type 1 diabetes:the complicating effects of high altitude[J]. Diabetes Care, 2005, 28:2563.
[23]	Stuiver PC, Goud TJ. Corticosteroids and liver amoebiasis[J]. BMJ, 1978, 2:394.
[24]	Keiser PB, Nutman TB. Strongyloides stercoralis in the immunocompromised population[J]. Clin Microbiol Rev, 2004, 17:208.
[25]	Messer J, Reitman D, Sacks HS, et al. Association of adrenocorticosteroid therapy and peptic-ulcer disease[J]. N Engl J Med, 1983, 309:21.
[26]	Wu TY, Liu JL. Alcohol and aspirin in combination with dexamethasone causes gastrointestinal bleeding at high altitude[J]. Wilderness Environ Med, 2006, 17:69.
[27]	Arruda-Olson AM, Mahoney DW, Nehra A, et al. Cardiovascular effects of sildenafil during exercise in men with known or probable coronary artery disease:a randomized crossover trial[J]. JAMA, 2002, 287:719.
[28]	Fox KM, Thadani U, Ma PT, et al. Sildenafil citrate does not reduce exercise tolerance in men with erectile dysfunction and chronic stable angina[J]. Eur Heart J, 2003, 24:2206.
[29]	Petersen KU, Jaspersen D. Medication-induced oesophageal disorders[J]. Expert Opin Drug Saf, 2003, 2:495.
[30]	Sweeney KR, Chapron DJ, Brandt JL, et al. Toxic interaction between acetazolamide and salicylate:case reports and a pharmacokinetic explanation[J]. Clin Pharmacol Ther, 1986, 40:518.
[31]	Hill JB. Experimental salicylate poisoning:observations on the effects of altering blood pH on tissue and plasma salicylate concentrations[J]. Pediatrics, 1971, 47:658.
[32]	Spina E, Pisani F, Perucca E. Clinically significant pharmacokinetic drug interactions with carbamazepine:an update[J]. Clin Pharmacokinet, 1996, 31:198.
[33]	Tabbara KF, Al-Faisal Z, Al-Rashed W. Interaction between acetazolamine and cyclosporine[J]. Arch Ophthalmol, 1998, 116:832.
[34]	Olivesi A. Modified elimination of prednisolone in epileptic patients on carbamazepine monotherapy, and in women using low-dose oral contraceptives[J]. Biomed Pharmacother, 1986, 40:301.
[35]	Bailey DG, Dresser GK. Interactions between grapefruit juice and cardiovascular drugs[J]. Am J Cardiovasc Drugs, 2004, 4:281.
[36]	Kaplan RC, Heckbert SR, Koepsell TD, et al. Use of calcium-channel blockers and risk of hospitalized gastrointestinal tract bleeding[J]. Arch Intern Med, 2000, 160:1849.
[37]	Wu TY, Ding SQ, Liu JL, et al. High-altitude gastrointestinal bleeding:an observation in Qinghai-Tibetan railroad construction workers on Mountain Tanggula[J]. World J Gastroenterol, 2007, 13:774.
[38]	Smith M, Lin KM, Zheng YP. An open-trial of nifedipineherb interactions:nifedipine with St. John's wort, ginseng, or gingko biloba[J]. Clin Pharmacol Ther, 2001, 69:86.
[39]	Demaziere J, Fourcade JM, Busseuil CT, et al. The hazards of chloroquine self prescription in West Africa[J]. J Toxicol Clin Toxicol, 1995, 33:369.

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通讯作者: 陈斌, bchen63@163.com

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沈阳化工大学材料科学与工程学院沈阳 110142

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Clinical pharmacology in the prophylaxis and treatment of high-altitude illness

Department of Pharmacy, General Hospital of Lanzhou Command, Lanzhou 730050, China

Received Date: 2012-08-22

Rev Recd Date: 2012-12-18

Key words:

Abstract: The use choice of acetazolamide, dexamethasone, nifedipine, sildenafil, and salmeterol in the management of altitude illness such as acute mountain sickness, high-altitude cerebral edema, high-altitude pulmonary edema, and with underlying medical problems were reviewed. The indications and dosing recommendations for individuals without underlying disease were discussed, and drug selection or dosing regimens were considered which would be affected by the presence of renal insufficiency, hepatic insufficiency, other important medical conditions, and the potential for drug interactions. These issues should be taken adequate consideration; so clinicians could increase the chances that properly healed patients with underlying medical conditions who could enjoy a safe trip to high altitude.

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Reference (39)

[1]	Maggiorini M, Brunner-La RHP, Peth S, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema:a randomized trial[J]. Ann Intern Med, 2006, 145:497.
[2]	Sartori C, Allemann Y, Duplain H, et al. Salmeterol for the prevention of high-altitude pulmonary edema[J]. N Engl J Med, 2002, 346:1631.
[3]	Teppema LJ, Balanos GM, Steinback CD, et al. Effects of acetazolamide on ventilatory, cerebrovascular, and pulmonary vascular responses to hypoxia[J]. Am J Respir Crit Care Med, 2007, 175:277.
[4]	Hackett PH, Roach RC. High-altitude illness[J]. N Engl J Med, 2001, 345:107.
[5]	Luks AM, Swenson ER. Medication and dosage considerations in the prophylaxis and treatment of high-altitude illness[J]. Chest, 2008, 133:744.
[6]	Pepys MB. Acetazolamide and renal stone formation[J]. Lancet, 1970, 1:837.
[7]	van Bortel L, Bohm R, Mooij J, et al. Total and free steady-state plasma levels and pharmacokinetics of nifedipine in patients with terminal renal failure[J]. Eur J Clin Pharmacol, 1989, 37:185.
[8]	Swan SK, Bennett WM. Drug dosing guidelines in patients with renal failure[J]. West J Med, 1992, 156:633.
[9]	Forgue ST, Phillips DL, Bedding AW, et al. Effects of gender, age, diabetes mellitus and renal and hepatic impairment on tadalafil pharmacokinetics[J]. Br J Clin Pharmacol, 2007, 63:24.
[10]	Muirhead GJ, Wilner K, Colburn W, et al. The effects of age and renal and hepatic impairment on the pharmacokinetics of sildenafil[J]. Br J Clin Pharmacol, 2002, 53(suppl 1):21S.
[11]	Grossman EB, Swan SK, Muirhead GJ, et al. The pharmacokinetics and hemodynamics of sildenafil citrate in male hemodialysis patients[J]. Kidney Int, 2004, 66:367.
[12]	Cazzola M, Testi R, Matera MG. Clinical pharmacokinetics of salmeterol[J]. Clin Pharmacokinet, 2002, 41:19.
[13]	Dawson AM, De Groote J, Rosenthal WA, et al. The effects of diamox ammonia metabolism in liver disease[J]. Clin Sci (Lond), 1957, 16:413.
[14]	Ene MD, Roberts CJ. Pharmacokinetics of nifedipine after oral administration in chronic liver disease[J]. J Clin Pharmacol, 1987, 27:1001.
[15]	Kleinbloesem CH, van Harten J, Wilson JP, et al. Nifedipine:kinetics and hemodynamic effects in patients with liver cirrhosis after intravenous and oral administration[J]. Clin Pharmacol Ther, 1986, 40:21.
[16]	Callejas RJL, Salmeron Escobar J, Gonzalez-Calvin J, et al. Successful treatment of severe portopulmonary hypertension in a patient with Child C cirrhosis by sildenafil[J]. Liver Transpl, 2006, 12:690.
[17]	Wang YW, Lin HC, Yang YY, et al. Sildenafil decreased pulmonary arterial pressure but may have exacerbated portal hypertension in a patient with cirrhosis and portopulmonary hypertension[J]. J Gastroenterol, 2006, 41:593.
[18]	Finley DS, Lugo B, Ridgway J, et al. Fatal variceal rupture after sildenafil use:report of a case[J]. Curr Surg, 2005, 62:55.
[19]	Manchee GR, Eddershaw PJ, Ranshaw LE, et al. The aliphatic oxidation of salmeterol to alpha-hydroxysalmeterol in human liver microsomes is catalyzed by CYP3A[J]. Drug Metab Dispos, 1996, 24:555.
[20]	Swenson ER. Carbonic anhydrase inhibitors and ventilation:a complex interplay of stimulation and suppression[J]. Eur Respir J, 1998, 12:1242.
[21]	Coudon WL, Block AJ. Acute respiratory failure precipitated by a carbonic anhydrase inhibitor[J]. Chest, 1976, 69:112.
[22]	Brubaker PL. Adventure travel and type 1 diabetes:the complicating effects of high altitude[J]. Diabetes Care, 2005, 28:2563.
[23]	Stuiver PC, Goud TJ. Corticosteroids and liver amoebiasis[J]. BMJ, 1978, 2:394.
[24]	Keiser PB, Nutman TB. Strongyloides stercoralis in the immunocompromised population[J]. Clin Microbiol Rev, 2004, 17:208.
[25]	Messer J, Reitman D, Sacks HS, et al. Association of adrenocorticosteroid therapy and peptic-ulcer disease[J]. N Engl J Med, 1983, 309:21.
[26]	Wu TY, Liu JL. Alcohol and aspirin in combination with dexamethasone causes gastrointestinal bleeding at high altitude[J]. Wilderness Environ Med, 2006, 17:69.
[27]	Arruda-Olson AM, Mahoney DW, Nehra A, et al. Cardiovascular effects of sildenafil during exercise in men with known or probable coronary artery disease:a randomized crossover trial[J]. JAMA, 2002, 287:719.
[28]	Fox KM, Thadani U, Ma PT, et al. Sildenafil citrate does not reduce exercise tolerance in men with erectile dysfunction and chronic stable angina[J]. Eur Heart J, 2003, 24:2206.
[29]	Petersen KU, Jaspersen D. Medication-induced oesophageal disorders[J]. Expert Opin Drug Saf, 2003, 2:495.
[30]	Sweeney KR, Chapron DJ, Brandt JL, et al. Toxic interaction between acetazolamide and salicylate:case reports and a pharmacokinetic explanation[J]. Clin Pharmacol Ther, 1986, 40:518.
[31]	Hill JB. Experimental salicylate poisoning:observations on the effects of altering blood pH on tissue and plasma salicylate concentrations[J]. Pediatrics, 1971, 47:658.
[32]	Spina E, Pisani F, Perucca E. Clinically significant pharmacokinetic drug interactions with carbamazepine:an update[J]. Clin Pharmacokinet, 1996, 31:198.
[33]	Tabbara KF, Al-Faisal Z, Al-Rashed W. Interaction between acetazolamine and cyclosporine[J]. Arch Ophthalmol, 1998, 116:832.
[34]	Olivesi A. Modified elimination of prednisolone in epileptic patients on carbamazepine monotherapy, and in women using low-dose oral contraceptives[J]. Biomed Pharmacother, 1986, 40:301.
[35]	Bailey DG, Dresser GK. Interactions between grapefruit juice and cardiovascular drugs[J]. Am J Cardiovasc Drugs, 2004, 4:281.
[36]	Kaplan RC, Heckbert SR, Koepsell TD, et al. Use of calcium-channel blockers and risk of hospitalized gastrointestinal tract bleeding[J]. Arch Intern Med, 2000, 160:1849.
[37]	Wu TY, Ding SQ, Liu JL, et al. High-altitude gastrointestinal bleeding:an observation in Qinghai-Tibetan railroad construction workers on Mountain Tanggula[J]. World J Gastroenterol, 2007, 13:774.
[38]	Smith M, Lin KM, Zheng YP. An open-trial of nifedipineherb interactions:nifedipine with St. John's wort, ginseng, or gingko biloba[J]. Clin Pharmacol Ther, 2001, 69:86.
[39]	Demaziere J, Fourcade JM, Busseuil CT, et al. The hazards of chloroquine self prescription in West Africa[J]. J Toxicol Clin Toxicol, 1995, 33:369.

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Clinical pharmacology in the prophylaxis and treatment of high-altitude illness

doi: 10.3969/j.issn.1006-0111.2013.04.002

Abstract

References

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通讯作者: 陈斌, bchen63@163.com

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