What's Inside My Travel Pharmacy?

I never leave home without these meds and supplies

My travel pharmacy, made from brain-tanned and smoked deer hide and a deer antler bead on the purse strings.

Traveling by definition means leaving the familiar, the safe and the comfortable. Whether traveling to a distant tropical island, a natural wilderness or a neighboring state, there is always some level of risk inherent in being away from home. This is why I never travel without my “travel pharmacy,” a collection of supplies and medications that comes with me wherever I go. I keep mine in a buckskin pouch I made myself from deer skin. For more about what exactly I keep in my travel pharmacy, and my strategy in packing it before a trip, continue reading below. Please comment with your own experience and medication preferences. And please subscribe!

The current contents of my travel pharmacy all laid out.

First a disclaimer: None of this is meant as medical advice, and anyone with chronic or complex medical conditions should speak with their doctor before heading out. Travel entails many physiologic stresses on the body, from new foods to a different healthcare mileu to lower air pressure on air planes (quite similar to the air at 7,000 feet above sea-level). I’m also not a pill-pusher: medications should only be taken when necessary, but many of the meds below can turn a miserable day on the road into something actually enjoyable. There is also a ton of great travel-related and country-specific info on the CDC’s travel website: http://wwwnc.cdc.gov/travel/. In fact, if you schedule an appointment with a travel doctor, often they will simply pull up this website in the exam room and read it with you. And, needless to say, anyone allergic to the medications mentioned below should avoid them (duh).

I firmly believe that the average person can (and should) take more of their medical care into their own hands, especially minor ailments. Many patients who come to my ER could have avoided the visit (and the bill) with a little knowledge about what over-the-counter medications are available and what they’re used for.

A travel pharmacy must fit the travel and the traveler

Choosing which medications and how much of them to bring depends on many factors, including the travel destination, common diseases to be expected there (local epidemiology), the time of year, and the traveler’s own medical predispositions and pre-existing conditions. I tend to get reflux now and then so I never travel without an over-the-counter (OTC) antacid. If you suffer from seasonal allergies, don’t forget to pack the anti-histamines (they come in both sedating and non-sedating forms – see below). Those travelers with chronic medical conditions should always bring enough of their daily medications for the whole trip, plus extra just in case.

In terms of the destination, when traveling to tropical countries in the developing world, I prepare for encountering malaria and traveler’s diarrhea, as well as hot sweaty rashes in my crotch (simple Vaseline works amazing for chaffing thighs, by the way). The access I’ll have to medications while traveling is also a crucial detail – if I’m heading to another large American city with a pharmacy on almost every corner, I know I can easily replenish my stock. In this case I put a limited quantity of each medication into my travel pharmacy (perhaps just 5-10 pills or so). If I’m heading deep into the wilderness where the only medications and supplies available will be hauled in on the backs of humans or animals, and the only evacuation will be by helicopter or walking out over many days, I bring many more types of medications and a larger quantity of each. The variety of injuries and diseases one encounters in the wilderness is obviously much greater.

Travel pharmacy strategy

The first principle is “don’t go overboard”. With proper strategy and smart medication choices, even a small unobtrusive pharmacy stuffed into the bottom of your backpack can contain an impressive arsenal of medications. To prevent going overboard, start with a small container that will necessarily limit what you can fit inside. My small buckskin pouch is the perfect size because it doesn’t let me over-pack. (And if I’m going to the wilderness, I bring a much larger bag). Plastic travel cases for soap make sturdy containers with decent capacity, and they’re sold at most convenience stores.

Loperamide, pseudoephderine and bisacodyl bubble packs. No need to carry huge amounts of any one medication, especially when traveling to a place where pharmacies are available and replenishing your travel pharmacy is easy.

I prefer bubble packs whenever possible, and I discard the bulky cardboard boxes that medications come in. This keeps the travel pharmacy compact and orderly. I even snip the bubble packs with a small scissors to minimize their size, and I snip off empty bubbles after I’ve used the pills from inside them.

Don’t bring entire pill bottles - even the smallest sizes have way more pills than will typically be needed. If I don’t have bubble packs, I put pills into small Ziploc bags (each medication in their own bag). You can also fold paper or newspaper into small pouches to carry each medication. Here is one technique for making them: https://www.instructables.com/How-to-make-a-closed-paper-pouch/.

It’s important to label medications with the drug names, dosages (the number of milligrams in each tablet), the number of tablets per dose, and the dosing schedule (how often the medication can be taken). I generally have these numbers memorized, since I deal with them all day long at work. But if you don’t have them memorized, or just to be safe, label each medication with this information. For Ziploc bags you can put tape on the bag and write on it (though it doesn’t always stick so well). For paper pouches, it is very easy to write the important numbers on the pouch. Some bubble packs have this information on them already, though it becomes more difficult to read after you’ve popped a few pills out their bubbles. If I’m unfamiliar with a medication, I sometimes take scissors and cut out the “Drug Facts” square from the cardboard box the medication came in and put that into the Ziploc bag or paper pouch along with the medication.

This photo shows one of my other strategies. Sometimes, for the sake of having fewer Ziploc bags in my travel pharmacy, I group various medications together into a small container with a screw top. This one is about 1.5” in diameter and 1” tall. I printed out a legend in a small font from my computer, and, in each row, I wrote the markings on the pill itself on the left, and the name and dosage of the medication on the right. So, for example, the dexamethasone pills have “54” on one side and “662” on the other; the melatonin has no markings at all; and the aspirin actually says “aspirin” on it (and I know that regular-strength aspirin it’s 325 mg per pill so I didn’t bother writing the dosage). Note that there is one typo: the azithro (azithromycin, an antibiotic) is actually 250 mg per pill and not 25, as I wrote. But I know that azithromycin doesn’t come in 25 mg tabs, and almost always comes in 250 mg tabs, so there is little danger that I would over- or under-dose.

Including creams in a travel pharmacy is a unique challenge. They often come in tubes that are way too large for travel purposes, unnecessarily adding weight and bulk. I’ve tried various strategies here: I’ve put only tubes that are almost empty into my travel pharmacy after rolling them up like nearly-empty toothpaste tubes; I’ve squirted small amounts of a cream into a Ziploc bag or into a tiny plastic container with a screw top, like the one in the photo above - this got messy; I’ve even squirted some cream into tin foil and folded it up neatly with the cream at the package’s very center, and then wrapped the whole thing in plastic wrap. None of these are perfect solutions. The best thing is to just buy the smallest tubes of cream possible, which are often available at pharmacies.

Choosing medications

Let’s start with OTC medications, which account for the large majority of all drugs in my travel pharmacy. Virtually all of them are available under brand names or as generics. Choose whichever one is cheaper, with an eye toward the ones that come in more convenient packaging for your travel pharmacy.

I also want to highlight that there is a staggering variety of OTC medications available in US pharmacies, which can be used to treat a wide variety of symptoms and illnesses. The majority of what I do for patients in the ER, especially children, could be done by themselves using OTC meds alone. Plus, I enjoy meandering down pharmacy aisles while pondering pharmacology as much as I do meandering down butcher shop aisles while pondering anatomy. And now the medications:

For pain I always bring ibuprofen (brand name: Motrin, Advil) or other NSAIDs like naproxen (brand name: Aleve). Ibuprofen is one of the most effective OTC medications there is and it works quite well for pain related to bumps, bruises, muscle strains, sore throat, headache, chest muscle soreness from coughing, and minor burns. It can take the edge off the large majority of pains experienced by the human body. Not to mention it reduces fever too. Ibuprofen can upset stomachs, so beware of this and switch to Tylenol for pain if you develop excessive heartburn, stomach upset, or black or red stool (and see a doctor for the latter issue).

Tylenol (generic name: acetaminophen) reduces fevers just about as well as ibuprofen, but its pain-killing abilities are much weaker. For bad pain, however, it comes in handy: I take 600 mg ibuprofen together with 1000 mg Tylenol (they are safe to take together and are more effective at reducing pain than either alone - this combination is just about the maximum pain-killing that can be achieved with OTC meds alone in the US. Though I hear codeine is available OTC in Canada). When I broke my toe after slipping on my stairs at home, I took exactly this combination of medications within 2 minutes of the injury. Still, straightening the crooked toe myself was darn painful.

Benadryl (generic name: diphenhydramine) is the Forrest Gump of medications: it goes everywhere and does everything. My travel pharmacy is never without Benadryl. It can treat allergies, whether it’s hay fever, food allergies, or allergic reactions and rashes. It helps with itch of almost any cause, allergic or otherwise. Benadryl can be used for motion sickness (either as treatment or prevention), as well as vertigo and mild nausea. Unfortunately, there are no great OTC medications for nausea or vomiting, so Benadryl sometimes has to suffice if I don’t have Zofran (generic name: ondansetron) with me. (I often wonder if Zofran should be OTC rather than prescription-only). Benadryl is also a great sleep aid – for this purpose I take two tabs instead of one. In fact, many sleep aid brands like Unisom often simply contain two Benadryl tabs. For colds that wake people up at night coughing, Benadryl helps dry up secretions in addition to providing some sedation and better sleep – this use of the medication is one of my favorites.

Benadryl’s versatility makes it an essential ingredient in every travel pharmacy. Such medications with multiple uses are the best for travel pharmacies, since they save space.

Keep in mind that Benadryl’s sedating effects make it less than ideal for treating any of these conditions during the daytime. In these cases, I recommend non-sedating antihistamines such as loratadine (brand name: Claritin), cetirizine (brand name: Zyrtec - “zyrtec” is basically just “cetirizine” backwards) and fexofenadine (brand name: Allegra). These are all available OTC. For bad allergies or allergic reactions, I often recommend patients taken one of these non-sedating antihistamines in the morning and Benadryl at bedtime. I’ve heard that Allegra is the strongest of the three, but I find that some people just respond better to one than the others, and it seems fairly idiosyncratic in my experience. I always have at least a few tabs of these medications in my travel pharmacy.

Pseudoephedrine is another incredibly effective OTC medication – it’s up there with ibuprofen in my personal pharmacologic pantheon. It helps with the runny nose of colds or allergies, as well as congestion and sinus headaches, and is often sold under the brand Sudafed. It is the “D” in combination meds like Claritin-D or Allegra-D. When a bad cold is dragging me down, pseudoephedrine dries up my nose but also gives me a bit of energy, which is a really nice side effect. These stimulant effects are why it is kept behind the pharmacist’s counter, and also why it can raise blood pressure or cause palpitations, so beware. Importantly, don’t confuse this medication with phenylephrine which also appears under the brand name Sudafed but is far far far inferior as a decongestant. I don’t really believe phenylephrine does anything at all when taken by mouth (though when doctors give it IV as a slow drip, it does raise dangerously low blood pressure). You often find phenylephrine in combination cold remedies like Dayquil and Contac; I rarely use these and just take the constituent meds (and I always choose pseudoephedrine over phenylephrine).

Famotidine (brand name: Pepcid) is an antacid and life-saver for me. I use it myself and often give it to my patients in the ER for stomach upset of virtually any kind. It helps with heartburn and gastritis, and almost any pain in the upper abdomen. When people have gastrointestinal infections (vomiting from the GI tract’s upper end and diarrhea from its lower end) famotidine can help with the upper end symptoms. I often combine it with medications for nausea and vomiting, and I believe there is some synergy there.

Other medications in my travel pharmacy:

• loperamide (brand name: Immodium) for diarrhea.

• bisacodyl (brand name: Dulcolax) for constipation. This is not my favorite laxative, but Miralax (generic name: polyethylene glycol) is too bulky to carry in my small travel pharmacy, so I include a bubble pack of bisacodyl instead.

• melatonin for jet lag and insomnia.

• aspirin (generic name: acetylsalicylic acid) which I carry just in case of a heart attack in me or in someone else (I don’t strongly recommend everyone carry this medication. It’s just me).

A medication I find doctors almost never recommending, but which I have greatly benefited from, is bismuth subsalicylate (brand name: Pepto bismol). I first fell in love with it during a bout of gastritis in India (which caused me nausea, loss of appetite, uncontrollable burping, and bloating and fullness after just a few bites of food). It really helped my symptoms, and I’ve since found that Pepto can be used for just about any intestinal symptom from GI tract’s top to its bottom. It can even prevent traveler’s diarrhea if taken regularly. This medication’s major downside is that the pills are large, and you have to take two tablets four times a day. This means several days of this medication becomes extremely bulky. I don’t often carry Pepto as a result, though I never go to the developing world without packing a bottle in my suitcase. Also beware: the bismuth in this medication turns your stool black, which can be confused with blood.

For OTC creams, I recommend three kinds:

• an antibiotic cream - they are all roughly the same, though I prefer one with a Vaseline base, rather than a white cream.

• an antifungal cream - Lotrimin (generic name: clotrimazole) or Lamisil (generic name: terbinafine) works great for athlete’s foot and most other skin fungi. Note: the strongest OTC antifungal creams are for vaginal yeast infections, but there is no good reason those same ones can’t be used anywhere else on the body’s surface.

• a steroid cream - hydrocortisone 1% is the strongest OTC steroid cream available.

As for prescription medications, I never leave home without Zofran (generic name: ondansetron) which, in my opinion, is the best medication for nausea and vomiting, or “anti-emetic,” there is. It comes in tiny tablets that dissolve under the tongue, and it’s nice not to have to swallow a tablet when you’re already nauseous. I also carry another anti-emetic called Reglan (generic name: metoclopramide) which, combined with ibuprofen and/or Tylenol, is excellent for bad headaches and migraines. Other prescription medications in my travel pharmacy include:

• an antibiotic or two, such as azithromycin for respiratory infections, and Keflex (generic name: cephalexin) for skin infections.

• Dexamethasone - an oral steroid which has a wide variety of uses, from asthma attacks, to bad allergies, to altitude sickness.

• Gas-X (generic name: simethicone) really helps with gas pains more than other medications, so I always have a few tabs on me.

And for supplies, the single most important thing in my travel pharmacy is a pair of ear plugs. I put these under the category of psychiatric prophylaxis. I also carry a few bandaids (I generally don’t like bandaids for most wounds, since, unlike gauze, they trap moisture. However they are useful for holding together the edges of a cut, which reduces bleeding and allows the wound edges to re-grow into one another). I like carrying a needle (such as an 18-gauge needle commonly used in hospitals) for everything from popping pimples to extracting splinters, though I often leave this out of my carry-on when traveling by plane, since the TSA would not approve. A small bottle of hand sanitizer has many uses besides cleaning your hands or sterilizing questionable silverware – I once used it to treat my own mild case of Athlete’s foot by applying it between my toes after every shower. Duct tape also has a million and one uses while traveling. In order to avoid taking a giant roll, I take a short length of duct tape off and wrap it around a small wooden dowel, as in this photo:

In conclusion, traveling means being creative and resourceful with your pharmacy. Choosing what to include in a traveler’s pharmacy depends on anticipating problems. Know your body and know your medications, and you’ll be ready for most ailments that travel throws at you. And when something more severe comes up, know where to get actual medical help.

Please comment and tell me about your own experience and your own favorite medications.