Acute Mountain Sickness in Mountaineers and High-Altitude Athletes: Pharmacological Prevention and Practical Considerations

Abstract

Introduction: Acute mountain sickness (AMS) commonly follows rapid ascent to altitude and can compromise safety, physical capacity, and expedition or sport-related goals.

Aim: This narrative review summarizes evidence on pharmacological AMS prophylaxis, focusing on acetazolamide and dexamethasone, and discusses its relevance for mountaineers and high-altitude athletes.

Materials and methods: PubMed was searched for English-language publications from January 1990 to May 2026. Selected earlier landmark studies were included when important for historical or mechanistic context. Randomized trials, systematic reviews, meta-analyses, and recent clinical guidelines were prioritized, and the evidence was synthesized narratively.

Results: Acetazolamide remains the best-supported first-line option because it reduces AMS risk and facilitates acclimatization through effects on ventilation and acid-base balance. Dexamethasone may be useful in selected high-risk situations or when acetazolamide is unsuitable, but it does not promote acclimatization and may mask deterioration. Evidence for ibuprofen and other alternatives is less consistent. In athletes, benefit must be balanced against hydration, acid-base, and performance concerns.

Conclusions: Pharmacological prophylaxis is most appropriate when AMS risk is high, especially if rapid ascent is unavoidable or previous AMS suggests susceptibility. Medication should support, not replace, gradual ascent and adequate acclimatization.