Concerning the use of Diamox medicine on a Kilimanjaro climb, there is a tendency now for people to use it as a default drug in order to increase summit success rates and prevent altitude sickness. This would be a very inappropriate conclusion to make because although the drug is useful for dealing with some altitude symptoms and it can certainly assist where symptoms like lack of sleep are causing a problem, it should not in any way diminish from the more important acclimatization rules in climbing, most relevant being the number of days spent on the mountain.
We are very certain, the statistics for failure and success on Kilimanjaro climbing can only be appropriately understood in light of the number of days spent on the mountain. For 7 days the rate is consistently around 85%-90%, for six days it goes down 65% and for the people who try it in 5 days the rate drops to well below 50%. So although this may bring the average down, the right question to ask is the rate specifically for seven days.Diamox has certain advantages attached to the ability to acclimatize, but it also has substantial disadvantages. Primarily it’s a strong diuretic so dehydration is a big concern, not least because you have to get up multiple times in the night for a pee. It forms a sensation of tingling all over the face and in the hands which some people find unpleasant. It also has the psychological consequence of making people think they are somehow invincible, which leads to bad decision habit on the mountain. Over the years we have seen some terrible examples of pill popping which has resulted in people getting in more risk and hurting themselves more than if they had never taken the drug.
However, in cases of mild altitude symptoms ‘AMS’ which is to be expected with at least three quarters of any team, Diamox given in small doses in the evening (half a 250mg tablet) will assist in better sleeping and it will help the body adjust to the increased nocuous atmosphere. Usage should be monitored with a pulse oximeter to check pulse rate and oxygen saturation. As a general guide, it is useful in letting you know how people’s bodies are reacting. Since going to altitude is a form of hypoxia, you would expect every human body to react in some way, even if it is just feeling much more tired than usual and yawning a lot. Unfortunately, AMS is a pretty random phenomenon and every metabolism reacts differently to it, so some people will have a hard time of it while others will think they have ‘got away with it’. Actually, they haven’t, because every human body has to produce additional erythropoietin in order to make more red blood cells to carry less oxygen around the muscles so we can live.
People should use Diamox cautiously and try to avoid the attitude that without them you will definitely get altitude sick. We much prefer to look at a diet for example reduced salt will reduce blood pressure and a better acclimatization plan. We advise spending longer time just doing nothing and letting your body adapt. On Mt. Kilimanjaro our itineraries allow two such days sleeping at the same altitude which gives everyone the chance to achieve summit day without hurting yourself.
Also do be aware that proper altitude illness like a Cerebral Oedema or Pulmonary Oedema, actually needs a variety of drugs plus an immediate descent. ‘Dex’ (dexamethasone) and Nifedipine are both used for Oedemas and a Pulmonary Oedema can occur on the descent as well as the ascent. Our experience is that people hear Anecdotally of Diamox as a kind of wonder drug but are unaware of all the other drugs and how to use them.