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Viagra used to prevent pulmonary edema at high altitudes

In the beginning, it gave hope to older men trying to give their sexual performance a lift.

Now sildenafil, better known by its trade name, Viagra, is gaining popularity for a different use among skiers and mountain climbers. Their concern: avoiding high-altitude pulmonary edema, a potentially deadly condition in which excess fluid collects in the lungs.

Research has been accumulating about sildenafil’s value in nonsex-related uses. The drug has been shown to help some people with high blood pressure in arteries supplying the lungs, a condition known as pulmonary hypertension.

Studies on its use for pulmonary edema include one published in the Annals of Internal Medicine in August. German researchers found that the drug not only prevented this type of edema but also increased the ability to exercise at altitude.

“It’s still preliminary and needs to be better studied,” says Dr. Peter Hackett, a founding member of the Wilderness Medical Society, a Colorado-based association focused on health in remote environments. “People should not just be running out and buying this stuff because they are going” to high altitudes.

Hackett, director of emergency services at the Telluride Medical Center in Colorado, has studied the drug. He says people who have a history of pulmonary edema and are bound for high-altitude hiking or skiing might consider taking sildenafil as a preventive but only with their doctor’s OK. He has used sildenafil to treat pulmonary edema with good results, he says, though he would not routinely recommend the drug.

Sildenafil has not been shown to relieve the more common type of altitude sickness known as acute mountain sickness, or AMS, says Dr. Robert “Brownie” Schoene, past president of the Wilderness Medical Society and professor at UC San Diego School of Medicine. Symptoms include headache, nausea, loss of appetite and difficulty sleeping.

“AMS can occur at altitudes of 6,000 to 8,000 feet,” Schoene says. Descent often helps; if symptoms persist or are severe, medical help is recommended.

By contrast the symptoms of high-altitude pulmonary edema, or HAPE, include shortness of breath, fatigue and cough, sometimes with frothy, pink sputum. Schoene says the condition has been recorded at 8,000 feet but is much more common at 9,000 to 12,000 feet, and the onset is usually two to four days after arrival.

“In our emergency room, we probably see a dozen cases of HAPE a year,” says Dr. Chris Hummel, director of the emergency department at Mammoth Hospital in Mammoth Lakes.

Confirmed diagnoses of acute mountain sickness occur at about the same rate, Hummel says, “but we suspect the number is actually … higher. Many with acute mountain sickness don’t come to the ER.”

Treatment typically involves supplemental oxygen and the drug nifedipine (Adalat, Procardia), which lowers pulmonary artery pressure.

“It’s the same concept as sildenafil, but sildenafil is more potent than nifedipine,” Schoene says. In the lungs, sildenafil keeps the blood vessels dilated, he says. Pressure doesn’t build, and the vessels don’t leak fluid into the lungs’ tiny air sacs.

For mountain climbers, a typical dose of sildenafil is 50 milligrams every eight hours, Hackett says. To treat erectile dysfunction, the usual dose is 50 milligrams before sex, he says.

Unwanted sexual arousal usually is not a problem, Hackett says. “There has to be sexual stimulation, which is usually not available on a mountain-climbing expedition. You are just struggling to survive.”

Healthy Traveler appears every other week. Kathleen Doheny can be reached at kathleen doheny@earthlink.net.

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Viagra May Help Severe Altitude Sickness

From the WebMD Archives

Feb. 1, 2005 — A new use for Viagra may be in the works. The erectile dysfunction drug may help protect against lung problems resulting from high altitudes, say French researchers.

High altitude can sometimes cause illness, especially in people with existing heart and lung problems. The thinner air or lack of oxygen at higher altitudes can cause blood vessels to constrict. When this occurs within the lungs. the constriction of blood vessels can put more force on the heart. leading to life-threatening heart failure. The higher altitude can cause blood vessels in the lung to leak fluid and build up in the lung, interfering with oxygen exchange.

Viagra works by relaxing blood vessels, allowing more blood to flow freely through vessels. The researchers used this drug to block the effects of high altitude on blood vessels on the lung. They looked at whether the use of Viagra would help the lungs continue to get oxygen while ascending to higher altitudes.

In a recent experiment, Viagra was better than a placebo at protecting men’s lungs. The results appear in the February issue of the American Journal of Respiratory and Critical Care Medicine .

This was no ordinary lab test. Instead, 12 men perched on a French mountain about 2.7 miles (4,350 meters) above sea level, pushing their lungs to the limits in the name of science.

The participants were normal, healthy men around 29 years old. They weren’t mountaineers. None was used to high altitudes. The closest any of them had gotten to Mount Everest was probably seeing it in a photo.

But they were in for an adventure when they enrolled in the study.

High-Altitude Tests

Jean-Paul Richalet, MD, PhD, and colleagues wanted to see if Viagra (sildenafil) helped stop dangerous high-altitude health conditions.

High-altitude pulmonary edema (HAPE) occurs when high altitude and low air pressure causes fluid to leak from blood vessels and builds up in the lungs. HAPE has a mortality rate of 44% if untreated, say the researchers. It’s triggered by intense physical exertion at high altitudes that people aren’t accustomed to.


The study started at sea level, where the men had baseline measurements taken. Then they left their normal lives behind for the mountains.

First stop: Chamonix. The French mountain town is located about 0.6 miles (1,035 meters) above sea level in the Alps, near the Swiss border. The men spent a day there to start adjusting to altitude. The next day, they strapped into a helicopter and soared almost 10,000 feet (3,000 meters) higher to Observatoire Vallot, located just below the summit of Mont Blanc, the highest point in Western Europe.

For five days, they stayed in the mountain observatory. Afterwards, they came back down the mountain for follow-up tests.

While on the mountain, the men filled out surveys checking for signs of acute mountain sickness three times a day. Their breathing was also monitored at rest. In addition, they rode stationary bikes until they couldn’t pedal any more, exercising until exhaustion on their second and fifth days on the mountain.

Half of the men received Viagra. The rest were given a placebo. The Viagra group took 40 milligrams of the drug three times a day, starting on their first day on the mountain.

At first, both groups struggled to adjust. “Subjects suffered from acute mountain sickness until day four,” say the researchers.

High altitudes caused a host of problems. Their blood pressure rose 29% higher than at sea level. Dizziness and stomach problems were similar in both groups.

After one or two days, the Viagra group’s blood pressure started to normalize. By the sixth day, it was 6% lower than before the experiment. But for the placebo group, it remained high, leveling off about 21% higher than normal.

As expected, high altitude made breathing rougher for all of the men. But the Viagra group had less of a setback at rest and during exercise than the placebo group. Side effects were minor, such as muscle pain. say the researchers.

More studies should be done to see if Viagra can replace the current treatment (calcium -channel blockers or steroids ) to treat HAPE, say Richalet and colleagues.

WebMD Health News


SOURCES: Richalet, J. American Journal of Respiratory and Critical Care Medicine. February 2005; vol 171: pp 275-281. News release, American Thoracic Society. WebMD Medical Reference in collaboration with The Cleveland Clinic: “Heart Disease — A Healthy Heart: How It Works.”

В© 2005 WebMD, Inc. All rights reserved.


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