uptodate 建議不要連續使用超過七天
WMS 2014 指引建議不要連續使用超過 十天
(Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2014 Update)
Dexamethasone
Prospective trials have established a benefit for dexamethasone in AMS prevention.20, 21 The recommended adult doses are 2 mg every 6 hours or 4 mg every 12 hours. Very high doses (4 mg every 6 hours) may be considered in very high-risk situations such as military or search and rescue personnel being airlifted to altitudes greater than 3500 m with immediate performance of physical activity but should not be used outside these limited circumstances. The duration of use should not exceed 10 days to prevent glucocorticoid toxicity or adrenal suppression. Recommendation Grade: 1A. Dexamethasone should not be used for prophylaxis in the pediatric population because of the potential for side effects unique to this population and the availability of other safe alternatives—specifically graded ascent and acetazolamide.
Prospective trials have established a benefit for dexamethasone in AMS prevention.20, 21 The recommended adult doses are 2 mg every 6 hours or 4 mg every 12 hours. Very high doses (4 mg every 6 hours) may be considered in very high-risk situations such as military or search and rescue personnel being airlifted to altitudes greater than 3500 m with immediate performance of physical activity but should not be used outside these limited circumstances. The duration of use should not exceed 10 days to prevent glucocorticoid toxicity or adrenal suppression. Recommendation Grade: 1A. Dexamethasone should not be used for prophylaxis in the pediatric population because of the potential for side effects unique to this population and the availability of other safe alternatives—specifically graded ascent and acetazolamide.
Dexamethasone
Dexamethasone is very effective in the treatment of AMS.38, 39, 40 The medication does not facilitate acclimatization, and further ascent should be delayed until the patient is asymptomatic while off the medication. Recommendation Grade 1B. Extensive clinical experience supports the use of dexamethasone in patients with HACE. It is administered as an 8-mg dose (IM, IV, or PO) followed by 4 mg every 6 hours until symptoms resolve. The pediatric dose is 0.15 mg/kg/dose every 6 hours.19 Recommendation Grade: 1C.
Dexamethasone is very effective in the treatment of AMS.38, 39, 40 The medication does not facilitate acclimatization, and further ascent should be delayed until the patient is asymptomatic while off the medication. Recommendation Grade 1B. Extensive clinical experience supports the use of dexamethasone in patients with HACE. It is administered as an 8-mg dose (IM, IV, or PO) followed by 4 mg every 6 hours until symptoms resolve. The pediatric dose is 0.15 mg/kg/dose every 6 hours.19 Recommendation Grade: 1C.
當使用類固醇就不要繼續上升。至少應停留在原地。類固醇無法加速高度適應，停用後可能引起反彈現象。至少休息到停藥後，病患沒有再次出現高海拔疾病症狀。
Dexamethasone 對於治療AMS非常有效.
Dexamethasone is very effective in the treatment of AMS.24, 25, 26 The medication does not facilitate acclimatization and further ascent should be delayed until the patient is asymptomatic while off the medication. Recommendation grade 1B.
Extensive clinical experience supports the use of dexamethasone in patients with HACE. It is administered as an 8-mg dose (intramuscularly, intravenously, or orally) followed by 4 mg every 6 hours until symptoms resolve. The pediatric dose is 0.15 mg/kg per dose every 6 hours.11 Recommendation grade: 1C.
下面是關於高海拔肺水腫 HAPE 的部分.
2014 WMS 指引關於 Dexamethasone 使用於HAPE建議
Dexamethasone 預防 HAPE
In the same study that assessed the role of tadalafil in HAPE prevention, dexamethasone (16 mg/d in divided doses) was also shown to prevent HAPE in susceptible individuals. The mechanism for this effect is not clear, and there is very little, if any, clinical experience using dexamethasone for this purpose. Further data are necessary to validate this result. Recommendation Grade: 1C.
Dexamethasone 治療 HAPE
Considering its potential role in HAPE prevention, noted above, and studies demonstrating effects on maximum exercise capacity,57 pulmonary inflammation, and ion-transporter function in hypoxia,58 dexamethasone may have a role in HAPE treatment. Although reports document its clinical use in this regard,59 no study has established whether it is effective for this purpose. Recommendation Grade: 2C.
Considering its potential role in HAPE prevention, noted above, and studies demonstrating effects on maximum exercise capacity,57 pulmonary inflammation, and ion-transporter function in hypoxia,58 dexamethasone may have a role in HAPE treatment. Although reports document its clinical use in this regard,59 no study has established whether it is effective for this purpose. Recommendation Grade: 2C.
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