Traveling Internationally with Medications
G. Rosselot MS, MPH, APRN-BC, FAANP, FISTM, FFTM, RCPS (Glas), FATHNA

• Many travelers have heard that they can access medications for much lower costs internationally. As a rule, no traveler should depart without a full supply of any medication they may need during their trip. Medications purchased in another country may be counterfeit, contaminated, expired, lack the same active ingredient as a U.S. product, or simply not available. All medications prescribed to manage a chronic condition and any OTC drug usually used for first aid, upper respiratory infections, musculoskeletal pain, etc. should be brought from home. In addition, medications for possible trip associated risks (motions sickness, altitude illness, traveler's diarrhea, or constipation, etc.) should also be packed for the trip. Travelers should only consider purchasing medications from sources that are reliable and vetted and the packaging is original.
• Travel health nurses (THNs) should advise travelers to bring a one or two week extra supply of essential medications (Rx and OTC) in the event of trip delays. Bringing more than what would be considered personal use could lead to questions or problems at Customs. Medications should be kept in their original containers. Bring copies of any Rx prescriptions, including the generic names for medicines. Names on prescriptions should match the traveler's passport. Per CDC, leave prescription copies at home with a friend or relative in case the traveler loses a copy or needs an emergency refill.
• Medications should only be kept in carry-on luggage, never in checked luggage. Emergency drugs such as epinephrine auto-injectors, inhalers, and the like should be kept on the person, not stored in overhead bins during transit. Research will be necessary to ensure that medications requiring refrigeration can be safely maintained during travel and at the destination.
• When traveling to hot, humid destinations, it is especially important to store medications in cool, dark areas.
• Questions about crossing borders? THNs can help travelers research and review all questions and regulations pertaining to the importation of medications into a destination. Is a particular medication allowed? What are the maximum quantities that may be imported? Know that some medications- most notably narcotic agents, HIV drugs, and injectable hormones, but also OTCs such as cold medicines- may be considered controlled substances and not allowed into certain countries. Bringing these banned medicines into a destination could result in criminal prosecution. Unfortunately, there is no one central resource for knowing what countries ban what dugs. The International Narcotics Control Board maintains a website with regulations about medications containing controlled substances for some, but unfortunately not all countries at https://www.incb.org/incb/en/travellers/country-regulations.html. Another approach to answer these questions is to directly contact U.S. embassy personnel in the destination country to learn about any medication prohibitions. Contacting a foreign embassy may or may not be helpful.
• All the cannabis products that are approved in some US states often are not approved abroad and should not be taken out of the U.S.
• It might be advisable for oral contraception users to switch to a LARC method – either an IUD or implant before traveling for a lengthy period, as pills and other products can be easily misplaced, are vulnerable to temperature changes, and may not provide protection in the event of traveler's diarrhea or vomiting.
• If a traveler needs to take a medication into a country where the importation of that drug is banned, the clinician can help the student to either 1) identify an alternative medication that is allowed or 2) identify a medical provider in the destination country that perhaps can prescribe the drug or a national equivalent. If time allows, a provider may be able to switch an individual's medication prior to departure.
• It is not advisable to have family or friends mail medications to a traveler as these packages are routinely delayed at Customs and rarely arrive intact or in a timely fashion. Travelers should be admonished to never try to "sneak in" a banned medication nor ask family or friends to ship that banned item. Criminal prosecution of the traveler can result.
• Individuals traveling for several months or longer may be challenged to bring a sufficient medication supply to last the trip duration. Usually, a 90- day supply is an acceptable limit. A letter explaining the larger quantity of medication brought into the country may be helpful when going through customs. This letter should be written on letterhead by the prescribing provider and translated into the local language. This approach is also recommended for any injectable medications such as auto-injectors and insulin.
• If a traveler is using health insurance to secure more than a 30 day- supply of prescriptive medications, the prescribing provider should request a "vacation override" or equivalent from the insurance company at least several weeks before departure. Alert the traveler that often these overrides only permit medication purchases just a few days before the departure date.
• Anyone leaving in less than two weeks may be challenged to acquire needed medications. For more guidance refer to The Last Minute Traveler section of the CDC Yellow Book https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/last-minute-travelers.
• If a traveler must acquire a new medication or renew or replace a prescription during a trip, it is advisable to contact their travel assistance insurance or the administration of their local program (study abroad, mission group, etc.) for guidance.
• It is never advisable to send a traveler with vaccine doses to complete an immunization series. Cold chain storage must be preserved to ensure vaccine efficacy.

Resources for Additional Learning

CDC provides a good overview of this topic with additional specific recommendations and resources on their Traveling Abroad with Medicine website @ https://wwwnc.cdc.gov/travel/page/travel-abroad-with-medicine#

IAMAT in 2019 published one of the best resources on this topic: Travelling with Medications: A Guide. It provides many excellent recommendations, goes into considerable detail, and includes a handy checklist. It is available @ https://www.iamat.org/assets/files/IAMAT_Travelling_with_medications.pdf

Harvard Global Support Services Tips for Traveling with Medication https://www.globalsupport.harvard.edu/travel/advice/tips-traveling-medication

US State Department Travel Smartly with Prescription Medications https://travel.state.gov/content/travel/en/international-travel/before-you-go/your-health-abroad.html

FDA Traveling with Prescription Medications https://www.fda.gov/consumers/consumer-updates/5-tips-traveling-us-medications

US Customs & Border Patrol Restricted and Prohibited Item https://www.cbp.gov/travel/us-citizens/know-before-you-go/prohibited-and-restricted-items

ATHNA is the national professional association for the travel health nurse, not a "travel nurse." Travel health nursing is a recognized ANA specialty that prepares individuals, families and groups for international travel and cares for them upon return. Travel nurses are individuals who travel across the US to provide temporary, traditional nursing care at facilities where unmet staffing needs are high and supplemental staffing is needed during times of peak capacity.

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