Millions of adventure-seekers get a thrill from skiing, hiking, climbing or traveling to high-altitude destinations each year. But about 25% of Americans who ascend to such thin-air environments experience symptoms of altitude sickness such as headaches, fatigue, nausea and vomiting, caused by the lack of oxygen at high elevations. Altitude sickness not only puts a damper on your trip, but it could also lead to fatal consequences — in some cases, it can result in lethal swelling of the brain.
The good news is that a common over-the-counter medication — ibuprofen, which you might know better as Advil or Motrin — could help reduce the symptoms. Researchers report in the Annals of Emergency Medicine that among a group of 86 men and women who spent two days hiking in the White Mountains of California, those who were randomly assigned to receive ibuprofen were 26% less likely to develop acute mountain sickness than those who took a placebo.
The ibuprofen group took four doses of 600 mg each in a 24-hour period during which they ascended to 12,570 ft. About 43% of the hikers who took ibuprofen developed symptoms like headache, nausea and dizziness, compared with 69% of those in the control group, as measured by a questionnaire of symptoms that the participants filled out.
“The idea that an ounce of prevention is worth a pound of cure is more important in wilderness medicine where you may be two hours or more away from any definitive health care,” says study author Dr. Grant Lipman, assistant professor of emergency medicine at Stanford University School of Medicine. “Ibuprofen can prevent 26% of cases of altitude sickness and help people who are without symptoms to stay without symptoms.”
Ibuprofen was about as effective as current medications to treat altitude sickness, which include prescription-only acetazolamide (Diamox) and dexamethasone, but it doesn’t come with as many side effects, says Lipman. That’s what makes ibuprofen attractive as a potential preventive for mountain climbers and hikers. Ibuprofen’s quick-acting effect is also a plus, since it takes only about one to two hours to be absorbed completely by the body; in contrast, current altitude sickness treatments must be started a day before climbing to thinner air.
In the current study, the study participants assigned to take ibuprofen — all of whom lived close to sea level — spent one night at a staging area, located at 4,100 ft., near California’s White Mountains and took one 600 mg dose about six hours before climbing to a higher altitude. They then drove to 11,700 ft., where they took another 600 mg dose, and then hiked to their highest elevation at 12,570 ft. At the top, they took another dose of ibuprofen, spent the night and received their final dose of the drug the following morning.
The researchers found that while ibuprofen prevented acute mountain sickness in many hikers, for those who still got sick with the five main symptoms measured — headache, nausea and vomiting, weakness, dizziness and sleeplessness — the over-the-counter painkiller did not lessen symptoms overall. However, it did slightly reduce nausea and vomiting, compared with placebo. That’s enough of an effect to salvage quite a few recreational trips to higher elevations, says Lipman.
So, how does ibuprofen work? At higher elevations, the body has to readjust to the decrease in oxygen in the air and the change in air pressure. Many people respond by experiencing a mild swelling of the brain, which researchers believe is triggered by the release of inflammatory factors that lead to leaky blood vessels and allow fluid to build up in the brain. That can put pressure on nerves and cause headaches and dizziness. Ibuprofen, an anti-inflammatory drug, reduces swelling.
Previous studies have shown that ibuprofen can lower the risk of headaches associated with altitude sickness, but Lipman and his colleagues found that it does much more. “At altitude, there is something called the zone of tolerance, or the ‘altitude glass ceiling’ above your head where you can still tolerate the thinner air. Ibuprofen can increase the amount of space above you by increasing the altitude at which your body is now tolerant to your environment,” he says.
Its effects aren’t permanent, however, and Lipman recommends that anyone trying ibuprofen on their next climb should start by taking 600 mg (that’s three over-the-counter tablets of Advil) several hours before going up, and then giving themselves at least 24 hours off of the drug before taking it again prior to making another ascent. That gives their bodies time to acclimatize to the new elevation and, he says, “in a sense reset the barometer to see if your body is in balance to the new altitude.”
Eventually, Lipman says, most people experiencing mountain sickness will get accustomed to the higher altitude and their symptoms will recede. Ibuprofen can help some climbers to get over that initial adjustment period.
A mountain climber himself, Lipman says he takes ibuprofen in the morning before an ascent and can vouch for its effectiveness in preventing mountain sickness. “Without a doubt, I would recommend that people planning on going to altitude try ibuprofen. Plus, you can’t drink beer on Diamox,” he jokes, “so that’s reason enough to take ibuprofen.”