When I say emergency medicines, I mean the things I always keep at home (in a secured hall closet – not the bathroom). I bring them with me on hiking, camping or road trips, and I bring smaller selections on flights. I keep them gathered together so I can quickly grab and run in an emergency. However, they do not live in my “first aid” kit, nor do they live in my car. First of all, medications don’t do well with widely varying environmental conditions. The more you shift humidity and heat, the quicker meds age and lose potency. I’d rather have them a little less available but more effective.
Second of all, these medications are equally useful in daily life. I chose not to keep both a daily and an emergency stash. I just don’t go through medications that quickly. However I am quick to replenish if I get below 50% of any medication. If I worked full-time in an office, I’d strongly consider keeping a second stash there – they’d still be climate controlled, and available if I became stranded away from home.
When talking about medicines, everyone expects a slew of disclaimers (this medication may cause itching, sweating, diarrhea, nausea, headache, blindness, and death – but ask your doctor if you can try it anyway!). So let’s start off with my disclaimers:
1) These are my personal choices, based on my medical and personal experience, as well as review of pharmacology. If you ask another doctor, you may get another recommendation. Despite rumors to the contrary, we are not God. There are many ways to treat the same problem. Feel free to disagree with me. Better yet – leave a comment and share your thoughts.
2) Take this point seriously. My recommendations are general, and may not apply to your personal situation. If you have medical problems or are taking prescription medications, you should know what over the counter (OTC) medications are a problem for you (and yes – my recommendations are over-the-counter!). When in doubt, always talk to your doctor (in advance, as part of emergency planning). If that is not an option, check other resources such as MedlinePlus or WebMD.
3) Before giving someone else an OTC medication, try to get a brief medical history, list of medications, and allergies. Keep OTC instructional materials available so you can check for interactions. Only give prescription medications to the person prescribed for – no sharing.
Now a few general thoughts on medications to help guide your purchases and keep costs down.
Meds in your emergency kit can sit around for months or years without use. If you pass the expiration date, is the medication still good? Is it dangerous?
The expiration date is how long the manufacturer guarantees full potency and safety, providing the medication has never been opened, and is stored under stable conditions. Pharmacists often add a “Use By” date to prescription medications, set arbitrarily at one year after purchase. The FDA runs ads telling you not to use expired medications because of both safety and potency concerns. They all endorse the “better safe than sorry approach”, even if it costs a lot more money (not to mention environmental consequences from the disposal of tons of unused medications). No one guarantees potency outside these limits because 1) drug companies aren’t required to test long-term stability and 2) consumer storage and handling of medications is unreliable. Meds in your hot trunk or moist bathroom break down faster than if kept cool, dark, and dry. Emergency meds shouldn’t live in your car unless you replace them often.
How much potency is really lost? The Department of Defense tested medication stability under their Shelf Life Extension Program (SLEP for acronym lovers). Could they use expired meds safely for military needs and could they save money? They found 88% of shelf lives could be extended by anywhere from 12-184 months. A 2012 scientific study of decades old medications also showed amazing preservation of potency. Although evidence supports potentially longer medication shelf lives than suggested by expiration dates, the FDA isn’t changing their approach any time soon. Occasional exceptions allow use of expired drugs in medication shortage or emergencies, but otherwise the official line is to throw out all medications after the arbitrary expiration or “use by” date (yet one more thing contributing to high health costs).
My thoughts about expired meds? Expired meds are generally safe – they don’t suddenly become toxic or dangerous while sitting in the bottle (tetracycline may be one exception). However, a dose may not last as long or work as well, depending on age, form (tablets and capsules last longer than liquids), and how you’ve stored them. Whether or not this matters depends on the purpose of the medication. When taken for a headache or cough, a little loss in potency is probably still good enough. On the other hand, even a slight drop in antiseizure medication potency might cause break through seizures. Under-treatment of infection with less potent antibiotics could create drug resistant germs.
Since most OTC medications are just for symptoms, even if a mild drop in potency occurs, it isn’t much of a problem. I routinely use OTC meds longer than the official expiration date and they work just fine (don’t tell the FDA on me). If you store them correctly, you can probably do the same. For prescription meds, it’s a more serious medical question. Will a potency change affect your underlying condition? You shouldn’t make this decision without medical advice.
I chuckle at consumer gullibility on every trip to the OTC aisle. 5-15 different variations often exist for the same OTC medication. Why do people spend more for the same thing? Generic and name brand effectiveness are equal for almost every medication. When purchasing OTC meds, make decisions based on drug name, cost, and possibly dosing frequency or dosage form. Always look for the real drug name and dose (check the tiny print under ingredients), not the brand name.
Caplets, tablets, capsules, etc – do you really need to spend more for a different pill shape? (Liquids for kids makes sense). How about stomach protection or enteric coating? Some prefer a coated pill for ease in swallowing (I prefer a spoonful of jam), but true enteric coating for the stomach can actually delay or decrease pill effectiveness. This might be a problem when using enteric coated aspirin for active heart symptoms.
How about 12 or 24 hour medications vs short-acting? Some 12 or 24 hour pills dissolve and absorb slowly, meaning they don’t help “now”. For ongoing medication use, long-lasting is good. It increases compliance (how often you remember to take your pills), and gives you smooth drug levels. But for intermittent or emergency symptom treatment, choose short-acting. They kick-in faster (and are often cheaper). You’ll have no trouble remembering to repeat the dose when the symptom returns in 4-6 hours. If it doesn’t return, you don’t need the med anymore!
Choose a target instead of a shotgun blast.
A popular OTC marketing strategy is combining two or more medications into one pill, then naming it something new (and non-generic). This dominates in the cold and flu aisle, but is creeping in elsewhere. The labeling sounds impressive – who wouldn’t want to treat runny nose, congestion, cough, aches, post-nasal drip, sore throat, athlete’s foot, and chronic heart disease with just one pill (the last two are just to see if you are paying attention). Shotgun combo meds hope that by mixing enough different medications, at least one thing in the group will make you feel better (and want to repurchase their pill). Remember you are paying for (and inviting side effects from) multiple medications hiding in one pill. I recommend buying generic medications from the appropriate classes, then choosing the correct one or two for your active symptoms. Avoid shotgun approaches to treatment.
At last – My Actual Emergency Medication Kit :
IBUPROFEN - my numero uno medication! I literally never leave home without it. It is an excellent pain reliever for injury, headache, menstrual pain, sickness related discomfort, and new and chronic musculoskeletal pain. It’s more effective than acetaminophen in both pain and fever control, and much safer than aspirin. It even helps post-operative pain. 200-400 mg every 6-8 hours works for most pain.
Acetaminophen – if you have room, throw in a small bottle of acetaminophen for those who can’t take ibuprofen. In addition, with severe fever, alternating ibuprofen and acetaminophen is more effective than either alone. Ongoing use of acetaminophen causes liver dysfunction. Keep the dose under 4000 mg a day (3000 mg is even better), and only for a few days maximum. Acetaminophen is found in many shotgun medications as well as in prescription painkillers – make sure to include these amounts in the total daily dose.
Aspirin – 325 mg, not enteric coated! Used solely for chest pain suggesting angina or heart attack, while seeking medical care. Unfortunately, cardiac deaths occur after every disaster. This is an important med that hopefully you won’t use.
Loperamide for diarrhea – between dietary alterations and the potential for food-borne or viral gastroenteritis (our old friend norovirus), diarrhea is common in disasters. It is also particularly burdensome when toilets are overrun or not readily available. When diarrhea interferes with function or hygiene, it is OK to treat it symptomatically, but if it lasts more than 2 days, if you notice blood, or if getting dehydrated, it’s time for a doctor.
Aluminum/magnesium antacids (not a shotgun). Calcium based antacids double as calcium supplements, but I don’t find them as effective. Good old-fashioned baking soda also works as an antacid, at ½ teaspoon in 4 oz of water every 2 hours as needed – if not effective in 3 doses, there’s no sense in continuing. Why basic antacids instead of the many alternatives? For my emergency kit, I want treatment for “now” symptoms, and standard antacids give the quickest relief. H2 or acid blockers (drug names tend to end in “ine” – ranitidine, famotidine, and cimetidine ) are not as quick-acting as antacids, and tend to cost more, but they still help in 1-2 hours. Ranitidine may be the fastest acting of the group, particularly in the effervescent dissolvable form. Omeprazole is a proton pump inhibitors (PPI), yet another drug class. It’s designed for chronic heartburn, and takes a day or two to work – not emergency kit appropriate!
Diphenhydramine – a moderately strong, rapid acting antihistamine. Diphenhydramine is a portmanteau drug – it belongs in your “bag” because it treats many things. Besides allergic reaction, it helps insomnia (the main ingredient in all OTC sleep aids), motion sickness, and nausea. Pretty good for a cheap little generic pill! What about the non-drowsy 24 hour antihistamines? Although mostly designed for seasonal allergies, cetirizine and fexofenadine are also effective for rashes and acute allergic reactions. Although long-acting, their onset of action is still pretty quick, so they might be an expensive add when you can’t afford sleepiness (but I’d still have diphenhydramine).
Antihistamines are found in many shotgun cold meds, yet there are no allergic or histamine reactions in a cold. They have a drying side effect which might help runny noses, but actual antihistamine benefit in colds is questionable. I’ll stick with Kleenex or a handkerchief!
Cold and Flu Medications – many are shotgun medications, with combinations of decongestants, antihistamines, pain relievers, cough suppressants expectorants, and the kitchen sink. For severe nasal congestion, I choose oxymetazoline, a nasal spray decongestant. Nasal sprays have less systemic absorption, so less whole body side effects. Never use them for more than 3 days – they cause rebound congestion. Guaifenesin (an “expectorant”) and dextromethorphan (a “cough suppressant”) are often recommended for cough, but evidence for actual effectiveness is marginal. Honey or other throat soothers may work as well. I keep a large supply of throat lozenges/cough drops for this purpose.
Hydrocortisone cream 1% – my primary treatment for any skin inflammation, including rashes, eczema, poison oak and ivy, insect bites, contact reactions – even mouth sores or hemorrhoidal discomfort and itching. Best of all, a tiny amount goes a long way.
Anti-itch cream – pramoxine hydrochloride, diphenhydramine, or calamine. Topical treatment for irritations with an allergic component, such as insect bites or reactions to plants or chemicals. For refractory rashes, use these in combination with hydrocortisone cream.
Antibiotic ointment – I primarily depend on good wound cleansing, but for burns and open skin in a dirty environment, topical antibiotic ointment might decrease infection, while providing a barrier and keeping the wound moist to promote healing. I say “might” because some feel these agents are overused and relatively ineffective, with a high rate of allergic reaction. Vaseline may serve the same purpose for a fraction of the cost. I keep both in my kit.
Burn gel or lotion – most first aid texts don’t include burn gels, but I use them on small painful stage one burns (like the frequently recurring curling iron burn). Many contain lidocaine, which causes serious complications with too much absorption across broken skin. Never place a dressing over a lidocaine treated burn – it increases absorption.
Terbinafine cream for athlete’s foot and jock itch. After a disaster, hygiene suffers, feet ill get damp, and you might share bathing areas. Although not life-threatening, foot and groin symptoms are annoying and distracting. I keep a topical antifungal in my kit.
Medicated powder – sweat and poor hygiene leads to heat rashes, skin chafing, and irritation. I use medicated powder on skin folds and feet. Basic baby powder might work as well, but I haven’t tried it – no babies around my house!
Eye wash and lubricant eye drops – small foreign objects and airborne irritants are common eye complaints. Clean water works as an eye rinse, but only if available. I recommend a bottle of eye wash, and lubricant eye drops for comfort.
So there you have it – my personal emergency medicine kit has 16 items. It’s small, reasonably affordable, and useful in daily life. But “what about prescription medications?” “Don’t doctors get better things in their kits?” The short answer is NO, but a more detailed explanation will have to wait for another post.
Sheila Sund, M.D.
P.S. For instructions on safe disposal of medications, visit FDA Disposal of Unused Medications: What You Should Know.