Medicines & Precautions for Baralacha La Pass

Altitude Illnesses to Know

Medicines to Carry

1. Acetazolamide (Diamox) - PRIMARY PREVENTION DRUG

• How it works: Forces the kidneys to excrete bicarbonate, stimulating breathing and speeding up acclimatization
• Prevention dose: 125 mg twice daily - start 1-2 days before ascent, continue for 2 days after reaching highest altitude
• Treatment dose: 250 mg twice daily
• Side effects: Tingling in fingers and toes (very common), increased urination, blurred vision, mild nausea
• Contraindications: Sulfa drug allergy (acetazolamide is a sulfonamide), avoid in pregnancy, renal/hepatic impairment - always consult a doctor before taking
• (Harrison's, 22nd Ed., Table 475-1)

2. Dexamethasone - FOR TREATMENT (not routine prevention)

• For AMS/HACE prevention (if acetazolamide is contraindicated): 4 mg every 12 hours
• For AMS treatment: 4 mg every 6 hours
• For HACE treatment: 8 mg once, then 4 mg every 6 hours
• Important: Dexamethasone masks symptoms without treating the underlying cause - do not use it to continue ascending. Rebound illness can occur if stopped at altitude before acclimatization.
• (Harrison's, 22nd Ed.; CDC Yellow Book 2026)

3. Nifedipine (Extended-Release) - FOR HAPE

• Only for people with previous HAPE history, or as emergency treatment
• Dose: 30 mg SR every 12 hours
• (CDC Yellow Book 2026)

4. Ibuprofen - FOR HEADACHE / MILD AMS

• 600 mg every 8 hours helps prevent and treat AMS headache
• Available over the counter; reasonably effective, though slightly less so than acetazolamide
• Do NOT use it to mask symptoms and push higher

5. Paracetamol (Acetaminophen)

• 500-1000 mg for headache relief; safer for stomach than ibuprofen
• Does not prevent AMS - only symptom relief

6. Ondansetron / Domperidone

• For nausea and vomiting associated with AMS

7. Supplemental Oxygen

• Portable oxygen cans (available locally in Manali/Leh) are very useful for symptom relief
• Pulse oximeter to monitor SpO2 - keep above 90%; below 90% indicates significant hypoxia

Precautions

Before You Go

• Consult a doctor at least 1-2 weeks before the trip, especially if you have heart disease, lung disease, hypertension, diabetes, or a history of previous AMS
• Acclimatize in Manali (2,050 m) for 1-2 nights before attempting the pass
• If coming from Delhi, do not rush directly to Baralacha La in one day
• People >50 years may actually be somewhat less susceptible to AMS, but should still take precautions
• Avoid alcohol and sedatives (opioids, benzodiazepines) - they suppress breathing at night and worsen desaturation

During Ascent

• Ascend slowly: Above 3,000 m, do not increase sleeping altitude by more than 300 m per day
• "Climb high, sleep low" - You can go higher during the day while crossing the pass, but sleep at a lower altitude
• Walk at a slow, comfortable pace; avoid exertion on the day of crossing
• Drink at least 3-4 litres of water per day - dehydration worsens AMS
• Eat light meals; complex carbohydrates (rice, bread, potatoes) are easier to digest at altitude
• Avoid heavy, fatty, or meat-based food

Warning Signs - STOP & DESCEND

• Severe or worsening headache not relieved by ibuprofen/paracetamol
• Vomiting
• Unsteady gait (ataxia) - this suggests HACE
• Confusion or altered mental state - this is a medical emergency
• Breathlessness at rest or persistent dry cough - this suggests HAPE
• Cyanosis (bluish lips or fingertips)

Conditions to Be Extra Cautious About

• Pregnancy (avoid altitudes >3,600 m)
• Children - equally susceptible to AMS; acetazolamide dose 1.25 mg/kg every 12 hours up to 125 mg
• Sickle cell trait or disease
• Uncontrolled hypertension or heart failure

Quick Reference Card

Sources: Harrison's Principles of Internal Medicine, 22nd Ed. (2025), Table 475-1; CDC Yellow Book 2026 - High-Altitude Travel; PubMed Systematic Review PMID 40383249 (2025 network meta-analysis on AMS prophylaxis).