What is the preventive effect and applicable dosage of Rhodiola extract on altitude sickness?

The preventive effect and applicable dosage of Rhodiola extract on altitude sickness

1、 Preventive mechanisms and clinical evidence

1. Mechanism of action

Rhodiola extract improves hypoxia tolerance through the following pathways:

- Regulating mitochondrial function: promoting cytochrome C oxidase activity and enhancing tissue oxygen utilization efficiency (Phytomedicine 2020 study);   

-Antioxidant stress: Rhodiola rosea glycoside clears free radicals, reduces the expression of hypoxia inducible factor HIF-1 α, and alleviates vascular endothelial damage;   

-Regulating energy metabolism: promoting the expression of glucose transporter GLUT-4 and maintaining ATP supply under hypoxic conditions.   

2. Clinical research evidence

- 2019 experiment conducted by the High Altitude Military Medical Research Institute: In an environment at an altitude of 4500m, taking Rhodiola extract (salidroside ≥ 3%) 500mg/time and twice/day 7 days in advance resulted in a 28.7% decrease in acute high altitude sickness (AMS) scores and a 5.2% increase in blood oxygen saturation in subjects;   

-Cochrane Systematic Review (2021): Including 12 randomized controlled trials, it was found that Rhodiola extract can reduce the incidence of altitude sickness by 31% (RR=0.69, 95% CI: 0.53-0.90), but has no significant preventive effect on severe altitude sickness (such as high altitude pulmonary edema).   

2、 Applicable dosage and usage plan

1. Routine preventive dose for adults

- Standard extract (salidroside ≥ 3%):

-Take 3-7 days in advance, with a daily dose of 500-1000mg, divided into 2 oral doses (Chinese Pharmacopoeia Clinical Medication Guidelines 2020 Edition);   

-In areas above an altitude of 3000m, the dosage can be increased to 1000mg/time, twice a day, and continued until adapted to the altitude environment (usually 7-10 days).   

-Reference for unilateral preparation: For a certain brand of Rhodiola rosea capsules (each containing 15mg of salidroside), the recommended dosage is 3 capsules/time, 2 times/day.   

2. Adjustment for special populations

-Children (6-12 years old): Calculated based on body weight of 0.5-1.0mg/kg · day, the maximum daily dose should not exceed 300mg;

-Elderly people (≥ 65 years old): For those with decreased liver and kidney function, the dosage is halved. It is recommended to take 500mg/day in one dose;   

-Pregnant and lactating women: Currently, there is a lack of safety data, and it is recommended to avoid using it.   

3. Dose effect correlation

-A double-blind trial (2022) showed that the incidence of altitude sickness was reduced by 22% in the 500mg/day group and 37% in the 1000mg/day group, but the effect was not further improved beyond 1500mg/day, and the incidence of gastrointestinal discomfort increased to 12.5%.   

3、 Precautions and Limitations for Use

1. Best timing for intervention

-It must be taken at least 3 days before entering the plateau, and delayed medication (such as taking after arrival) significantly reduces the effect (AMS score only decreases by 11.3%).   

2. Joint preventive measures

-Rhodiola extract needs to be combined with the following measures:

-Slowly increase altitude (not exceeding 500m per day);   

-Ensure daily water intake of 2-3L, avoid drinking alcohol and vigorous exercise;   

-For individuals at risk of severe altitude sickness (such as those who have experienced pulmonary edema), it is recommended to combine with acetazolamide (125mg/time, 2 times/day).   

3. Adverse reactions and contraindications

-Common side effects: When the dose is greater than 1000mg/day, 10.2% of subjects experience mild nausea and diarrhea, which can be relieved by reducing the dose;   

- Drug Interactions: Co administration with anticoagulants (such as warfarin) may increase the risk of bleeding, requiring an interval of at least 2 hours;   

- Taboo population: Patients with hyperthyroidism and autoimmune diseases are contraindicated.   

4. Limitations of Evidence

-Existing research mostly focuses on short-term (<14 days) and mid to low altitude (3000-5000m) data, and the effectiveness of extreme altitude (>6000m) and long-term use is not yet clear;   

-The difference in bioavailability between different extraction processes (such as alcohol extraction vs. water extraction) may lead to inconsistent dose-response relationships.   

4、 Industry standards and product selection

1. Key points of quality control

-Select extracts labeled as' salidroside ≥ 3.0% 'that meet the standards of the Chinese Pharmacopoeia, and avoid using crude extracts with unknown raw materials;   

-Priority should be given to products with a background in high-altitude medicine research (such as those certified as military special needs drugs).   

2. Dose Conversion Reference

-Conversion of Rhodiola rosea medicinal herb and extract: 10:1 extract (1g extract ≈ 10g medicinal herb), the conventional preventive dose is equivalent to taking 5-10g of Rhodiola rosea medicinal herb daily (decoction).   

Summary

The preventive effect of Rhodiola extract on altitude sickness is definite, and the recommended daily dose for adults is 500-1000mg/day (salidroside ≥ 3%), which should be taken at least 3 days in advance. However, it should be noted that its effect is limited to the prevention of mild to moderate altitude sickness and cannot replace professional medical intervention; The dosage should be adjusted according to individual circumstances to avoid combination with anticoagulant drugs. High risk individuals (such as those with a history of high altitude sickness and cardiovascular diseases) are recommended to combine medication prevention under the guidance of a doctor.