Emergency Medication Kit for International Travel

Over the counter medications in some foreign countries can be costly, and it’s not just because of the exchange rate.  In some locals of South America, Africa, and India, pharmaceutical treatments may not be common practice.  The locals often use herbal treatments, thus there is less demand for pharmaceuticals.  Pharmaceuticals can also be very expensive.  I remember once, buying an ointment in Peru that usually goes for $10 in the US, and it cost $40!  Living in the US, we take for granted the easy access and availability of over the counter medications.  Traveling abroad, you may find that it is not easy to locate a Pharmacy.  This being said, foreign countries also have different manufacture standards for medications, and what you buy in Peru may not be what you are used to using in your home country.  You can understand how it becomes practical to carry an Emergency Medication Kit for International travel.

When you’re ill, you will not want to have to travel far, in unfamiliar places, and not knowing the language.  You are much better off having an Emergency Medication Kit available.  It will save you money, time, and unnecessary pain.   And you will have a much more enjoyable vacation.

1.       Here is what I recommend:

• Obtain some Travel information prior to departure:

• If you are an AAA triple member, you can get books, brochures, and maps on your travel destination.   This information will give you some idea of what the weather will be during the month you plan to travel.
•  Know where Medical  Care  Resources are located

• Traveling with Medications that you take every day:

• Bring enough supply to last during your trip.  Keep your medications in your carry-on.   If medications are liquids or sharp objects i.e. insulin syringes, and have these items in your checked luggage.  Follow airline security guidelines for your country of origin.  Traveling from the USA view security guidelines at  http://www.tsa.gov/
• All medications should be in its original containers.
• For Controlled Medications and Insulin Syringes: it is advisable to get a letter from your prescribing physician that you need to take the controlled medications and to use insulin syringes for medical reasons.  Make sure the physician writes a letter on office stationary.  For more information, read about medication restrictions on the US Department of State website: http://travel.state.gov/travel/cis_pa_tw/cis/cis_4965.html      

• Bring your favorite Vitamins: Vitamin C, B-complex, Multivitamins, Herbal and/or Homeopathy remedies
• Bring Epinephrine auto injector (EpiPen) if allergic to bees or have a history of severe allergic reactions.  Again, follow airline security guidelines: http://www.tsa.gov/
• Bring Sunscreen lotions that are 15 SPF or greater, Hat, and Sunglasses, especially at high altitudes i.e. Trip to Machu Picchu where there is a risk of sunburn. Some medications and herbal products are likely to cause photosensitivity.  If you are not aware which medications can cause photosensitivity, please talk to your Physician and Pharmacist.
• First-Aid Kit is a must!!  Some of the medications Tylenol, Aspirin, Antacid, Hydrocortisone, Bacitracin ointment are in a First-Aid Kit.  Suggest adding Vitamin E in case you get sun-burned.   We bought our lightweight and compact first aid kit at REI.com.

2.       A  Brief List of Over-the-Counter Medications Useful when Traveling Abroad:

• Pain or Fever:

1. Tylenol is great for minor aches, fever and pain; especially if you are not able to tolerate Aspirin or Ibuprofen.  Tylenol does not have anti-inflammatory properties; thus, Tylenol will not reduce inflammation if sprains or injuries occur.
2. Aspirin or Ibuprofen for relief of minor aches, pain, reduce fever, and helps reduce inflammation of sprains or injuries.  Note:  Aspirin should not be given to children or teens with flu-like symptoms or chickenpox).  For relief of heart attack, use Aspirin Chewable 81 mg.

• Stomach upset i.e. Gastric Acid Reflux or Heartburn : A list of over-the–counter medications:

1. Proton Pump Inhibitors (PPI’s): lower amount of acid in the stomach.  Recommend to take these PPI once or twice a day 30 to 60 minutes before a meal because while eating you produce acid.
   1.  Omeprazole (Prilosec OTC ®)
   2.  Lansoprazole (Prevacid 24 HR®)
2. H2 Blockers (Histamine Receptor Antagonists):  These medications are effective at night to prevent acid secretion.  At night, acid secretion is mediated by histamine. It is recommended to take one of these H2 blockers at bedtime as needed (after a heavy late meal)
   1.  Nizatidine (Axid AR® and others)
   2.  Famotidine (Pepcid AC®, Pepcid Complete® and others)
   3.  Cimetidine (Tagament HB® and others)
   4.   Rantidine (Zantac 75®, and others)
3.  Antacids are often used for Heartburn. For Travel purposes, I recommend the tablet form instead of liquid.  Most of these Antacids come as chewable tablet form.
   1.  Mylanta
   2.  Maalox
   3.  Gaviscon
   4.  TUMS
   5.  Pepto-Bismol

• Diarrhea or Constipation:

1. Anti-diarrhea  Loperamide (Imodium®) or Diphenoxylate/Atropine (Lomotil®) (prescription from  your Physician) and  Probiotic Supplements
2. Mild Laxative for Constipation:  Docusate Sodium (Colace®), Senna, Senokot, Glycerin suppository

• Respiratory Symptoms and Sore Throat:
  1. Antihistamine                           
     1. Diphenhydramine (Benadryl®)
     2. Chlorpheniramine (Chlor-Trimeton®)
     3. Cetirizine (Zyretec®)
     4. Loratadine (Claritin®)
  2. Decongestant
     1. Pseudoephedrine (Sudafed®)
  3. Antihistamine in combination with Decongestant
     1. Claritin-D® (active ingredient:  5 mg of loratadine (antihistamine) and 120 mg of pseudoephedrine ( decongestant)
     2. Zyretic-D® (active ingredients:  5mg cetirizine (antihistamine) and 120 mg of pseudoephedrine (decongestant)
  4. Ophthalmic antihistamine and Decongestant
     1. Visine-A®
     2.  Naphcon A®
  5. Antihistamines for Sleep
     1. Diphenhydramine (Benadryl®)
     2. Tylenol PM®
     3. Doxylamine (Unisom®)
  6. Cough suppressant/expectorant
     1. Guaifenasin (generic)
     2. Robitussin or Robitussin DM
     3. Mucinex
  7. Throat lozenges
     1. Cepacol
     2. Cepastat
     3. Chloraseptic

• Dry Eyes:

1.  Artificial Tears
2.  Tears Naturalae®

3.       Prescription Medications from your Doctor:

1. Antibiotic for Traveler’s Diarrhea:   Ciprofloxacin (Cipro®) or Azithromycin (Zithromax Z-Pak®) per your Primary Physician.
2. Moderate to Severe Diarrhea:  Diphenoxylate/Atropine (Lomotil®)
3. Difficulty sleeping or Jet Lag:  There are Prescription Medications for sleep such as Zolpidem (Ambien®) for short-term ONLY. 
4. Traveling to High Altitudes: See your Primary Doctor to receive Guidance on what Prescription is best for per your Medical and Medication History:
   1. Acetazolamide (Diamox®) is the drug of choice if NOT Sulfa Allergic.  It is recommended to take:
      1.  Acetazolamide (Diamox®) 125 mg:  One tablet before ascent and then twice a day if needed to prevent altitude sickness for 4-5 days when you reach your travel destination. 
      2.  Possible Side Effects such as tingling in extremities, blurry vision, taste alteration, nausea and vomiting, and diarrhea.  If side effects occur, discontinue taking the medication.
   2. Alternate medications if Sulfa Allergic i.e. Dexamethasone.   But, keep in mind that Dexamethasone only covers symptoms.  It does not help people acclimate like Acetazolamide.  Again, it is advisable to see your Primary Doctor for a prescription of altitude sickness.

4.       Herbal Remedies for High Altitudes.

 All Herbal and Natural Medicine Supplements will have some kind of drug interaction with Prescription Medications.  If you are taking Prescription Medications and plan to take any herbal remedies or supplements, please speak to your Physician or Pharmacist to check if there are any drug interactions. 

1. Read more about altitude sickness and altitude sickness prevention.
2. Vitamin C, Vitamin E, and Co-enzyme Q10:   These supplements help remove free radicals, and are strong antioxidants.  Co-enzyme Q10 increases the body’s cellular ability to use oxygen.    Best to take them before and on the day of hiking. 
   1.   Note: There are seven different forms of Vitamin E (tocopherol).  One of them is Vitamin E2, a specific form of Vitamin E.   Vitamin E2 is recommended for high altitudes.   The”E2” helps oxygenate the heart tissue to prevent altitude sickness and angina.   A supplement named Cataplex® E2 contains Vitamin E2 and Selenium for high altitudes.  Cataplex® E2 is an oxygen-sparing part of the whole Vitamin E complex. 
3. Gingko biloba extract:  This herb increases the blood flow throughout the body, especially the brain.  Gingko Extract has been found to have Drug Interactions with some of the Prescription Medications.
   1. There are many different Gingko biloba extracts.  Not all will be effective for high altitude sickness.  There was one study that used one specific Gingko biloba extract (24% flavoinoid glycoside, 6% terpenoids) 80 mg twice a day that greatly reduced the occurrence of symptoms of acute altitude sickness including headache, fatigue, dyspnea, and nausea and vomiting.  It is recommended to take this herb 5 days before the trip.  Yet, much more studies needs to be done. 
      • Side effects of Gingko Extract are known to cause diarrhea, and symptoms such as irritability and restlessness when taken at very high doses.
4. Natural Medicine for Difficulty Sleeping:
   1.  Melatonin: for jet-lag and insomnia
   2. Passionflower: for insomnia and anxiety
   3. Valerian: for  insomnia, anxiety associated with restlessness

NOTE:  All Herbal and Natural Medicine Supplements will have some kind of drug interaction with Prescription Medications.  If you are taking Prescription Medications and plan to take any herbal remedies or supplements, please speak to your physician or pharmacist to check if there are any drug interactions.  Gingko Extract has been found to have Drug Interactions with some of the Prescription Medications.

Disclaimer: The information provided in this article is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging. You should not use the information in this article for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any supplementation program, or if you have or suspect you might have a health problem.

Enjoy your travels!!!

Tajinder Hammer, Pharm.D (Doctor of Pharmacy)

Mike and Tajinder Hammer have a passion for the teachings of the medicine people of Peru, and leads regular tours to Machu Picchu and the Sacred Valley area of Peru.  Join them for the best Machu Picchu Trips!