• 
• 

Three Part Question

[In healthy adults ascending to altitude >(2500m)], is [Ibuprofen better than Acetazolamide] at [preventing Acute Mountain Sickness]

Search Strategy

PubMed search ((ibuprofen) AND (acetazolamide)) AND (AMS OR Acute Mountain Sickness OR HAI OR High Altitude Illness)

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Patrick Burns , Grant S Lipman , Keiran Warner , Carrie Jurkiewicz , Caleb Phillips , Linda San Feb 2019 United States of America	Ninety-healthy adult volunteers who normally resided at low altitude	Randomised-controlled, non-inferiority study assessing whether ibuprofen was as effective as acetazolamide for the prevention of AMS (LLQ>3 plus headache).	Outcome: Ibuprofen was slightly inferior to acetazolamide for acute mountain sickness prevention and should not be recommended over acetazolamide for rapid ascent.	Key Result: The total incidence of acute mountain sickness was 56.5%, with the incidence for the ibuprofen group being 11% greater than that for acetazolamide, surpassing the predetermined 26% noninferiority margin (62.2% vs 51.1%; 95% confidence interval [CI], -11.1 to 33.5).
Jeffrey H Gertsch, Grant S Lipman, Peter S Holck, Andrew Merritt, Allison Mulcahy, Robert S Fisher Sept 2010	343 healthy non-Nepali males and females volunteers.	A prospective, double-blind, randomized, placebo-controlled trial in the Nepal Himalaya designed to compare the effectiveness of ibuprofen and acetazolamide for the prevention of HAH and AMS (LLQ >30 plus headache)	Outcome: Ibuprofen was similar to acetazolamide in preventing symptoms of AMS		Intent to treat vs measured outcomes. Large proportion lost to follow up.
			Key Result: AMS incidence was similar when treated with acetazolamide (18.8%) or ibuprofen (13.7%; P = .34), and both agents were significantly more effective than placebo (28.6%; P = .03)

References

1. Patrick Burns , Grant S Lipman , Keiran Warner , Carrie Jurkiewicz , Caleb Phillips , Linda San Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide The American Journal of Medicine Feb 2019; 147-251
2. Jeffrey H Gertsch, Grant S Lipman, Peter S Holck, Andrew Merritt, Allison Mulcahy, Robert S Fisher Prospective, double-blind, randomized, placebo-controlled comparison of acetazolamide versus ibuprofen for prophylaxis against high altitude headache: the Headache Evaluation at Altitude Trial (HEAT Wilderness & Environmental Medicine Sept 2010; 236-243