Key result
A systematic review of human and animal studies demonstrated that various medications exhibit altered pharmacokinetics, efficacy, and side effect profiles under hyperbaric conditions.
Why the study?
Medication use may impact the capacity to adapt to hyperbaric conditions, prompting an assessment of the interaction between diving and medication to support decision making regarding fitness to dive.
Does medication use under hyperbaric conditions pose significant risks or provide protective effects in divers?
Systematic Review
Does medication use under hyperbaric conditions pose significant risks or provide protective effects in divers?
Most medication is not a contraindication to diving, as no significant dangerous pressure-related interactions were found in human studies.
Most medications remain safe for divers despite pharmacokinetic changes; extends hyperbaric pharmacology evidence but leaves human translation gaps open.
BACKGROUND: Physiological changes are induced by immersion, swimming and using diving equipment. Divers must be fit to dive. Using medication may impact the capacity to adapt to hyperbaric conditions. The aim of this systematic review is to assess the interaction of diving/hyperbaric conditions and medication and to provide basic heuristics to support decision making regarding fitness to dive in medicated divers. METHODS: This was a systematic review of human and animal studies of medications in the hyperbaric environment. Studies were subdivided into those describing a medication/hyperbaric environment interaction and those concerned with prevention of diving disorders. Studies without a relation to diving with compressed air, and those concerning oxygen toxicity, hyperbaric oxygen therapy or the treatment of decompression sickness were excluded. RESULTS: Forty-four studies matched the inclusion criteria. Animal studies revealed that diazepam and valproate gave limited protection against the onset of the high-pressure neurological syndrome. Lithium had a protective effect against nitrogen-narcosis and losartan reduced cardiac changes in repetitive diving. Human studies showed no beneficial or dangerous pressure-related interactions. In prevention of diving disorders, pseudoephedrine reduced otic barotrauma, vitamins C and E reduced endothelial dysfunction after bounce diving and hepatic oxidative stress in saturation diving. DISCUSSION AND CONCLUSIONS: Animal studies revealed that psycho-pharmaceuticals can limit the onset of neurologic symptoms and cardiovascular protective drugs might add a potential protective effect against decompression sickness. No evidence of significant risks due to changes in pharmacologic mechanisms were revealed and most medication is not a contraindication to diving. For improving decision making in prescribing medicine for recreational and occupational divers and to enhance safety by increasing our understanding of pharmacology in hyperbaric conditions, future research should focus on controlled human studies.
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Hoencamp et al. (2019) conducted a systematic review in Hyperbaric conditions and diving. Various medications vs. Placebo or normobaric conditions was evaluated on Drug efficacy, pharmacokinetics, and side effects under hyperbaric pressure. A systematic review of human and animal studies demonstrated that various medications exhibit altered pharmacokinetics, efficacy, and side effect profiles under hyperbaric conditions.
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