During the pretravel consult, travelers should discuss with the health care provider or a pharmacist how to obtain medications safely and legally at the destination or during travel, should replacement or new medications be needed.
Travelers who need an uninterrupted supply of a medication should determine the availability of a particular medication (or a safe equivalent) at the destination, should the need arise. The need to obtain medications while traveling can occur for any number of reasons:
- Medications may be lost during travel.
- The traveler may not have packed sufficient medication for the entire stay or the stay may have been unexpectedly extended.
- A medication may need to be changed or a new medication added (e.g., changing antimalarial drugs or treating an acute illness).
- A traveler may be unable to carry a current drug into a country because it is not licensed or if it is banned in the destination country; in many countries it is illegal to import personal prescription medications via mail.
The medication to be obtained must be safe and effective. In developed countries, regulatory agencies often require that drug manufacturers conduct safety and efficacy studies before licensure. In developing countries, this is less likely to be the case. When travelers need to acquire medications in developing countries, they face the prospect of unproven or unsafe medications, therapeutically non-equivalent drugs, or adulterated or expired medications.
It is always advisable to carry a sufficient supply of medications and not have to obtain medication in a developing country. However, if that is not possible, the following are important issues to consider:
- Availability of the exact medication or an equivalent product
- Laws and procedures when obtaining prescription medications
- Reliable sources of medications
- Counterfeit medications
Travelers should keep a list all medications and their generic names in case it is necessary to replace any of the medications during travel. Ask the pharmacist to create a Personal Medication Record, which lists the drug, regimen, and purpose of each drug. In addition, it is wise to obtain an extra written prescription for critical medications to show to a physician or pharmacy at the destination.
Upon return to the home country, the traveler should dispose of any medication obtained abroad and resume taking the correct domestic product.
Availability of Medications
The availability of drugs depends on many factors, such as import restrictions, pharmaceutical interest in distribution to a particular country, national drug preference and regulations, and requirements to use domestic pharmaceuticals.
Identifying A Replacement Medication
When a traveler needs replacement medication, it must first be determined if the same drug is available in the destination country. Some countries have national formularies that can be consulted, listing available, licensed drugs. However, most developing countries do not have such formularies, making it difficult to determine availability.
If unable to determine if the same drug is available, or if there is no equivalent foreign version of a medication, the traveler should work with a health care provider (in the home country or locally at the destination) or with a local pharmacist to select an effective alternative medication.
Travelers should follow these options for identifying a replacement medication:
- Contact the travel medicine specialist or a pharmacist at home who can access international drug databases that can provide information on exact or equivalent products and the name of the product in that country.
- Contact a local pharmacist and show him or her the prescription (or prescription label), assuming language is not a barrier.
- Contact the embassy for assistance or check the embassy website; many U.S. embassies list reliable local pharmacies.
- Contact a travel assistance or travel insurance company, if a membership has been purchased.
- Consult a reliable internet source such as drugs.com.
Obtaining the Medication
Laws and Regulations
Pharmaceutical regulations vary from country to country. Some countries have limited availability of certain drugs or prohibit their importation. In addition, travelers should not plan to have someone mail (including express couriers) medications to them.
- In the U.S., it is not legal for an individual to mail prescription drugs anywhere.
- In addition, other countries may have restrictions on unregistered drugs (i.e., medications not approved for use in that country) coming into their country by mail.
- Controlled substances and psychotropics are completely prohibited in some countries (e.g., the United Arab Emirates, Japan, Zambia), and possession of even a small amount of these substances for personal use may result in arrest, incarceration, and charges of drug trafficking.
- In some countries, controlled substances are not available at all for outpatient use (except cancer patients), even with a local doctor's prescription
- A limited number of countries (e.g., Japan, Zambia, United Arab Emirates) prohibit certain common prescription medications as well as commonly used over-the-counter medications; these cannot be imported nor are they available. This includes ingredients found in inhalers and cold, cough, allergy, and sinus medications (e.g., diphenhydramine; Benadryl). Banned ingredients may also include those deemed to be stimulants, such as pseudoephedrine, levomethamphetamine, the common cough suppressant dextromethorphan, and dextroamphetamine (e.g., Adderall).
Sources of Medication
Once it has been determined that the same or an equivalent product is available, the traveler must know how to obtain it.
- If prescription from the traveler's home country is not honored in the destination country, visit a local physician to obtain a valid domestic prescription; however, be aware that the domestically available medication may be in a different category of drug.
- In some developing countries, a prescription or visit with a physician is not necessary, and prescription medications, especially antibiotics, may be obtained directly from the pharmacy. If a medical evaluation is not required (e.g., the traveler is replacing lost medication), this might be the best solution.
- In many countries—even those that require a prescription—pharmacists may have the latitude to provide short-term or emergency refills (generally for a more common, benign, chronic medication) without a prescription. Travelers should show the pharmacist the empty bottle or a copy of the original prescription.
- In countries where prescription vs. non-prescription laws have been enacted, the needed medication may be considered prescription, and thus a prescription from a physician is required. The medication may be dispensed directly to the traveler or obtained from a pharmacy.
- It is helpful to the pharmacists or physician to see the prescription, even if it is not honored in that country, because it shows the name of the medication, dosage, and directions for use.
Reliability of Medication Sources
Sources Likely To Be Reliable
If possible, determine before travel the best option for obtaining a pure drug, such as a hospital pharmacy versus a stand-alone pharmacy. Pharmacies can be part of a hospital, stand alone, associated with another retailer (e.g., a grocery store), government run, or private. In most countries, a local pharmacy will generally have a wider selection of medications than will a clinic or hospital pharmacy.
- In Africa and Asia, due to counterfeiting and lack of quality control in private pharmacies, it is recommended to obtain medications from a hospital pharmacy.
- In other countries, local knowledge may be required to identify which type of pharmacy is most reliable. For example, in Central America, supermarket and hospital outpatient pharmacies are more reliable (but require a prescription).
- In developing countries, pharmacists may not be required to be present in the pharmacy; however, when seeking an equivalent medication, the traveler should insist on speaking directly with a pharmacist.
Some medical evacuation or travel insurance providers and the U.S. Embassy may assist travelers in identifying a reliable source for the medication, once a replacement medication has been identified.
Sources Likely to be Unreliable
Travelers should not purchase medications in open markets, from street vendors, or from a business that does not appear to be a legitimate pharmacy; these sources may go by names such as "chemist," "druggist," or "Apothecary (Apotheke)" but should not be considered reliable.
It is generally not recommended to purchase medications from physicians in developing countries, as they are least likely to store the medication correctly or have the correct medication in stock.
Identifying Potential Problems
Once the medication has been obtained, look for the following that might indicate lack of potency, wrong medication, or a dispensing error:
- Check the imprint on the tablet/capsule with tablet identification databases (check with the home pharmacist) to reduce dispensing errors.
- Call a pharmacist at home to help verify authenticity of medications purchased abroad (such as color, shape, and side imprints).
- Discolored, film coat peeling/cracking, tablets sticking together, or liquids that don't easily go back into suspension upon shaking may indicate degradation of the drug and potential for loss of potency or bacterial grow (in the case of liquids).
- Ask the pharmacy to print or give the traveler an English translation of the medication name, dose, and directions for use.
Travelers should be aware of the potential for counterfeit medications, particularly in developing countries. The World Health Organization estimates that 10-30% of medications in developing countries may be counterfeit. In Africa and India, up to 35% of the drug supply is counterfeit.
Common counterfeit medications in Africa and Asia are antimalarials, particularly artemisinin-containing products. Other medications, due to their high cost, may also be adulterated with less expensive ingredients, such as oncologic and HIV medications. Even common medications such as antibiotics, analgesics, and steroids have been reported to be counterfeited globally.
Counterfeit medications can have an innocuous additive that results in lack of potency, or a more dangerous additive that could cause severe adverse reactions. Some counterfeit medications may have less of the active ingredient than labeled, which can result in treatment failure. Mislabeling can also occur whereby a counterfeit medication is erroneously labeled with the wrong strength or salt of the medication, resulting in dosing errors.
Tips to minimize the risk of receiving a counterfeit medication:
- Be suspicious of cheap branded products; brand name products are more often counterfeited than generic products.
- Verify that medications are in their original, unopened container, the container looks "authentic" (e.g., no misspellings, poor quality print, etc.), and the medication has not expired.
- In the U.S., most prescription medications are dispensed in exact counts in medication vials from larger bulk containers and are not dispensed in unit-of-use containers. In other countries, especially in the developing world, unit-of-use containers (e.g., blister packs) are more common.
- Because counterfeit medications are found mostly in tablet and capsule formulations, the traveler can search the internet or contact a home pharmacist, who can look up the color, size, shape, and imprint on the medication to make sure it is valid.
- Be wary of drugs that taste or smell strange or crumble easily, often due to the addition of an incompatible filler or ingredient.