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Preventie van acute hoogteziekte met acetazolamide

M.E. van Vessem, B. Kayser, T. Stijnen, R.R. Berendsen

Abstract

Van Vessem ME, Kayser B, Stijnen T, Berendsen RR. Prevention of acute mountain sickness with acetazolamide. Huisarts Wet 2013;56(12): 610-5.
Objective To assess which dose of acetazolamide is effective in preventing acute mountain sickness (AMS) among individuals walking or climbing at high altitude, bearing in mind adverse drugs reactions.
Various databases (Pubmed, Embase, Cochrane) were searched for trials comparing acetazolamide with placebo for the prevention of AMS. Included studies had to report dichotomous data on the incidence of AMS, have a randomized controlled design, be methodologically sound (minimum Jadad score ≥3), and be written in English, German, or Dutch. As non-uniform effects between studies were expected, data were analysed using a random effects model.
Of the 803 studies retrieved, 18 met the inclusion criteria. There was no statistical heterogeneity among the studies. Acetazolamide (dose range 250–750 mg/day) effectively prevented AMS. Subgroup analysis yielded risks ratios of 0.51 (95% confidence interval 0.38–0.69), 0.51 (95% CI 0.40–0.64), and 0.48 (95% CI 0.30–0.76) for doses of 250 mg, 500 mg, and 750 mg acetazolamide, respectively. There was no dose–response effect. The number-needed-to-treat was 5.5, 5.5, and 5.2 for the 250-mg, 500-mg, and 750-mg doses, respectively. Paraesthesia, dysgeusia, and polyuria were significantly more common in individuals who received prophylactic acetazolamide than in individuals who received placebo.
A minimal dose of 125 mg acetazolamide twice daily is effective as AMS prophylaxis. Higher doses do not significantly improve prophylaxis and may lead to more side effects.

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