medication to travel with

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Traveling with Medication

• Declare all drugs, medicinal, and similar products to the appropriate CBP official;
• Carry such substances in their original containers;
• Carry only the quantity of such substances that a person with that condition (e.g., chronic pain) would normally carry for his/her personal use; and
• Carry a prescription or written statement from your physician that the substances are being used under a doctor's supervision and that they are necessary for your physical well being while traveling.

U.S. residents entering the United States at international land borders who are carrying a validly obtained controlled substance (other than narcotics such as marijuana, cocaine, heroin, or LSD), are subject to certain additional requirements. If a U.S. resident wants to bring in a controlled substance (other than narcotics such as marijuana, cocaine, heroin, or LSD) but does not have a prescription for the substance issued by a U.S.-licensed practitioner (e.g., physician, dentist, etc.) who is registered with, and authorized by, the Drug Enforcement Administration to prescribe the medication, the individual may not import more than 50 dosage units of the medication into the United States. If the U.S. resident has a prescription for the controlled substance issued by a DEA registrant, more than 50 dosage units may be imported by that person, provided all other legal requirements are met. Note: Only medications that can be legally prescribed in the United States may be imported for personal use. Be aware that possession of certain substances may also violate state laws. If you have any questions regarding the importation of a controlled substance into the United States, please contact the Drug Enforcement Administration, Office of Diversion Control, International Drug Unit, at (202) 305-8800.

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Everything you need to know about traveling with medication

While getting to travel is an incredible opportunity, it doesn't always come without some annoyances.

In addition to ongoing COVID-19 testing requirements and restrictions, you also have to deal with packing — in particular, how to pack medication you might need on the trip. After all, the last thing you want during a getaway is to run out of prescription medication (especially if you're stuck someplace due to a positive coronavirus result) or come down with a nasty head cold without access to over-the-counter medications.

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That's why it's essential to know certain key details when hitting the road with medications in tow . To find out the best way to be prepared for your vacation, TPG spoke with Dr. Julian Klapowitz of Travel Medicine Consultations, who shared everything you need to know about traveling with medication.

Should I pack my medication in my carry-on bag?

The short answer is yes; that way, you don't risk losing essential medicine in your checked luggage. In fact, the U.S. Centers for Disease Control and Prevention specifically recommends carrying your prescription medication.

"If I give someone three months of malaria pills, I still tell people to put everything in their carry-on," said Klapowitz. "That way, it doesn't accidentally get lost. Plus, the luggage storage area of the airplane can be freezing. So, anything liquid — like insulin — may end up frozen."

How much medication am I allowed to bring?

Generally speaking, 30 days' worth of medication is acceptable pretty much everywhere. If it's more than that, a doctor needs to provide a note, and you should also have the original prescription, according to Klapowitz. Just allow for extra time at security if you have larger amounts of pills or liquid medicine that doesn't fall into traditional TSA guidelines.

When traveling internationally, the quantity issue really boils down to the types of medications allowed in your destination.

What if I'm traveling for an extended period?

The same answer from above pretty much applies here.

"If you're traveling for more than 30 days, try to have the medication you will need for the entirety of the trip," said Klapowitz. "But, again, those larger quantities will require a doctor's note and original prescriptions to prove the need to travel with that amount."

How do I get medication abroad?

If you don't have enough medicine to get you through an entire vacation or are stuck needing something abroad, there are ways to get medication. Interestingly, the U.S. is more strict regarding many medications than many other countries where you can purchase antibiotics, blood pressure medications and a variety of other pills over the counter.

But, in some destinations, counterfeit medications are a major problem.

"You should be fine to walk into a pharmacy or doctor's office in places like Western Europe and know it's safe," said Klapowitz. "If you're somewhere that's not as reliable, contact the nearest U.S. embassy or consulate. They should be able to get you in touch with reputable doctors and pharmacies."

Are there destinations that have medication restrictions?

Yes, some destinations do have medication restrictions. For example, Japan doesn't allow certain allergy and sinus medications, and types of inhalers are illegal. Plus, travelers to the United Arab Emirates have ended up in prison because the country has strict narcotics laws.

"Before traveling internationally, check with the foreign embassy of your destination to make sure your medicines are allowed in that country," said Klapowitz. "If it is banned, talk with your doctor about possible alternatives. Or, if you plan to travel with it, be sure all medication is in the original bottle.

"You should also have a doctor's letter explaining the condition and need for the specific restricted medication and an original prescription," Klapowitz added. "Of course, it's not guaranteed you'll be allowed to keep it, but it certainly increases your chances."

Which medications are often restricted?

The most common banned substance is narcotics. "If somebody is thinking about taking codeine, Percocet, Vicodin or methadone, I usually advise to see if it's possible to travel abroad without them," said Klapowtiz.

"The same is true for some regulated psychotropic medications like Adderall and Ambien. But always do your research on the specific destination."

How can I travel with a restricted medication?

Unfortunately, sometimes the answer is that you just can't travel with restricted medication.

But, countries will have a variety of rules — i.e., allow 30-days' worth — so it's important to contact the embassy to see what's allowed. "

Again, if you plan to travel with a restricted medication, be sure you have the documentation to back it up, and everything is clearly labeled," said Klapowitz.

What if my medication is liquid?

If traveling domestically, liquids are allowed so long as they adhere to the TSA's 3.4-ounce rule and fit in a quart-sized bag.

The TSA will allow you to travel with more than that amount, but you must declare the liquid medications to TSA officers at security for inspection.

"The same is basically true for international destinations, so long as it's not a banned substance," said Klapowtiz. "Just be sure to have the original prescription and doctor's note, and leave time for extra security checks."

Can I bring syringes?

Usually, bringing sharp, pointy objects onto a plane isn't allowed. But, some medicines require the use of syringes or needles.

"If you have diabetes, for example, have the same documentation as you would for a restricted medication," said Klapowitz. "Unused syringes and needles are allowed when accompanied by the medication, prescription and doctor's note."

Are there medications I should always bring with me when I travel?

"I always recommend bringing Tylenol, Motrin or Advil for pain and fever, and Imodium for mild diarrhea," said Klapowitz.

"You should also consider taking an antacid if the local diet doesn't agree with you. Then, for anybody who gets motions sickness , pack Dramamine."

In addition to those standard medications, Klapowitz suggested bringing any OTC medications you commonly use.

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Traveling with Medications: What You Need to Know

Lindsay Tigar

Lindsay Tigar is a travel and lifestyle writer with a constant thirst for adventure and exploring new lands. You can find Lindsay globetrotting when the mood strikes, making sure to find time to explore both the wine and fitness scene in countries across the globe. Her work has appeared across dozens of outlets; learn more at LindsayTigar.com .

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If you’re heading out on a long trip—or moving abroad—and you rely on prescriptions, it’s vital to your health to know the rules about traveling with medication. “Millions of Americans are dependent on medicines and with the globalization of travel, access to prescription medicine is even more crucial,” explains Dr. Robert Quigley, senior vice president and regional medical director at International SOS .

From how to get more than a 30-day supply of pills to what you’ll need from your stateside doctor to get a prescription abroad, here’s advice from international healthcare experts about traveling with medication.

Bring a Note from Your Doctor

Dr. Christopher C. Hollingsworth, MD, a general and endovascular surgeon who has practiced in Europe and the United States, says it’s unlikely you’ll get stopped at customs or border control because you’re carrying more than a month’s supply of medicine. However, having an official prescription on hand when traveling with prescription medication is never a bad idea.

“In general, countries honor the rights of travelers to transport their prescribed medications with them,” Dr. Hollingsworth explains. As long as you have supporting documentation about your medical condition (ID cards or a letter from a physician), you are unlikely to have a problem.

Dr. Brendan Anzalone, a doctor of osteopathic medicine and the president and chief medical officer at AeroMD Air Ambulance , suggests going digital with these forms, as they can get lost or creased throughout your travels. This will ensure you won’t have to go digging if you’re questioned.

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Keep Medicines in Their Original Bottles

Again, while it’s unlikely you will face any sort of issue when you’re flying with medication, Dr. Anzalone still recommends keeping your pills in the original bottle—complete with the sticker on the front with your name and doctor’s name—as an extra safety precaution. “Carrying your medication in [its] original prescription bottle with a label on it from the pharmacy is helpful if there are any questions in the security line,” he explains.

If you don’t have room in your luggage for the full-size bottles and must downsize, you can pack a small day-of-the-week pill organizer rather than several bulky bottles. Ensure you have documentation from your physician to avoid any potential issues. Paul Tanenbaum, R.Ph., a retired pharmacist, offers this tip if your original prescription bottle is too large: “Make friends with your pharmacist and see if he or she could make you a smaller travel-size bottle for you to fill up.”

Learn the Laws Around Traveling Internationally with Medications

The recommendations for domestic trips also apply to traveling abroad with medication. When flying internationally with prescription medications, the U.S. Department of State  recommends storing medications in their original labeled containers and bringing a copy of a doctor’s letter to show customs officers and other officials if necessary. The prescription should note the brand and generic name of the drug.

If you’re taking an unusual drug or one that contains narcotics such as sedatives, carry a note from your doctor explaining what the medication is and why you need it.

Note that some over-the-counter drugs legal in the U.S. may be illegal elsewhere. For example, painkillers containing codeine are prohibited in the United Arab Emirates. Always double-check before you fly.

Exercise Caution with Herbal Medicines

Flying with herbal medicines or supplements to international destinations can be tricky since each country has its own laws about what’s allowed in. To find out what may be restricted in the countries you’ll be visiting or transiting through, refer to the  embassy website  or contact local consulates.

Make sure herbal remedies and Ayurvedic medicines are in clearly labeled, well-sealed containers, preferably in original bottles. Although the TSA doesn’t require it, it may be helpful to bring a doctor’s note explaining your remedies’ intended use. Keep up to date with any changes in TSA rules by downloading its free MyTSA app ( iOS | Android ).

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Always Pack Medicine in Your Carry-On

Now that you have the prescriptions you need and the note from your doc to prove your case, it’s time to pack. Depending on how much medicine you need each day, you may be tempted to shove your pill pack into your checked bag, but Dr. Anzalone warns against it: “It is best to keep medications in your carry-on baggage. If your checked baggage gets lost, you will still have your prescription medications with you. Remember some aircraft cargo holds are not temperature controlled, which may affect temperature-sensitive medications.”

If you’re worried about bringing medication that must be refrigerated (like insulin, for example) on a plane, Dr. Hollingsworth offers the TSA regulations on cool packs that are allowed through the gates. “Domestically, gel-cooling packs are allowed if frozen at time of presentation to security,” he notes.

Liquid medications (prescription or over-the-counter, like saline solution or eye drops) aren’t subject to the TSA’s three-ounce limits. However, you are required to declare anything over that amount to security officers and present it for inspection.

You may also travel with accompanying items, such as IV bags, pumps, and syringes, as long as they’re declared before you begin the screening process. All of these items will be X-rayed unless you request a manual inspection.

Bring Extra Medication

Dr. Hollingsworth’s rule of thumb is to bring twice the amount of medicine you need and to separate the bottles between your carry-on and your personal item. Why? Two words: flight troubles. “Changes or delays can have a butterfly effect that can have repercussions for the rest of your trip. Plan for the unexpected and pack extra medication you might need for an unplanned longer stay,” he says.

Exercise Caution When Flying with Narcotics

If you’re traveling with any type of prescribed narcotic used to relieve pain, such as Vicodin, Oxycontin, Percocet, or codeine, you might want to bring your prescription documentation, as well as a doctor’s note. Though this is not required by the TSA, it may prove helpful when getting through security. Since these types of drugs are widely abused, security screeners may be suspicious if they are unaccompanied by the proper paperwork. Having the original prescription will prove the pills’ necessity, and avoid any further delays or additional questioning.

The trouble of traveling with only a doctor’s note is that unless it was written in the previous month, it may lose validity. Prescriptions are clearly dated and include the signature of your doctor. Simply make a photocopy of each prescription before you have it filled. The photocopied version will be null and void, but this does not alter it as a valid document.

To take extra precaution, you may also want to travel with phone numbers for your pharmacy and prescribing doctor. This may seem like an unnecessary hassle, but it could prevent delays and problems at the airport.

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Be Strategic About Your Meds

If your carry-on is just too heavy to meet those puddle-jumper restrictions, Dr. Hollingsworth challenges you to be strategic. While you might want to take your mini-sized bottle of Advil, those sorts of medications are available everywhere.

“Give priority to any medications that are vital to your functioning or survival. Asthma inhalers, diabetic medications, anti-seizure medications, and blood pressure medications come to mind. Make sure to bring medications that have rebound or withdrawal symptoms if you run out,” he says. “A trip is not a good time to see how you function without your arthritis or anti-anxiety medications.”

Consider Travel Insurance

Many factors influence whether you should purchase travel insurance . How long will you be traveling? Where are you going? Will you be lounging by a beach for a week or undertaking adventure activities in a rainforest? Do you have ongoing medical conditions that might need care?

If you’ll need health insurance for your trip, Dr. Quigley recommends exploring your options before heading overseas to determine what policy and plan are best for you. You can also work with assistance companies—like International SOS—to help you if you’re struggling with a health situation overseas.

Make a Date with Your Doctors

If you’re leaving the U.S. for an extended time, in addition to getting foreign currency and shedding tears at your farewell party, you should schedule pre-departure appointments with your doctors. During these visits, get a full physical and begin a discussion about your wellness needs while traveling. Work with your physician to plan for the medications you’ll need. Medical professionals can help you secure more than a 30-day supply of any medicines along with the necessary paperwork. They can also offer advice about what you need to bring to keep your health top-notch.

Find the Loopholes for Refilling Prescriptions Overseas

Dr. Quigley explains that prescriptions cannot be filled abroad, nor can your primary care doctor call in a prescription for you. But there is a way around it: Know the generic forms and other names of the same medicine. Depending on the country, you may be able to get the medicine without a prescription.

As an example, Dr. Hollingsworth was able to walk into a pharmacy in Paris and receive antibiotics for a pal with a serious ear infection—no note required. Even so, packing a few “just in case” prescriptions before you leave will help ease your worries. Your primary care doctor or a travel clinic can help you navigate the options.

Tanenbaum recommends caution: “If you must obtain your meds from somewhere other than your U.S. pharmacy, beware that there is a major problem of counterfeit drugs out there.” He also notes that brand and generic drug names may differ from one country to another: “The same name may be for a totally different medication; if you have to get some while overseas, it may not be what you usually take so that it does not treat your medical condition, and may actually be dangerous for you to take.” Make sure you’re visiting a reputable pharmacist (ask for a recommendation from your hotel or the local tourist board) and that you double-check whether the drug you’re requesting actually treats your condition.

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Most Importantly, Plan Ahead

Plan ahead, especially if you are switching time zones and have to take medicine at a certain time of day. “Have a medical itinerary run parallel to your day-to-day travel itinerary. Plan out the nearest towns [to] where you’re going to be and identify the best providers for you based on your specific medical needs. Don’t let it be a fire drill when you get there,” recommends Dr. Hollingsworth. “If you know in 30 days [that] you need to have a prescription refilled, and you know where you will be within that time frame, then research which medical professional will be best for you. Do your homework.” It just may save your trip—or even your life.

Tips to Stay Healthy While Traveling

Want more expert tips and vacation inspiration? Subscribe to SmarterTravel on YouTube!

 Editor’s note: This story was originally published in 2017. It has been updated to reflect the most current information. Molly Feltner, Jessica Labrencis, Patricia Magaña, and Michele Sponagle contributed to this story. A previous version of this story had an incorrect spelling of Paul Tanenbaum’s name. It has been corrected. Some of the links featured in this story are affiliate links, and SmarterTravel may collect a commission (at no cost to you) if you shop through them. As an Amazon Associate, we earn from qualifying purchases.

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How to Make Sure You Travel with Medication Legally

Traveling with medication — even prescription drugs — isn’t as simple as packing it. Here’s how to stay on the right side of the law, anywhere you go.

By Tanya Mohn

Travelers often pack medications when they go abroad, but some popular prescription and over-the-counter ones Americans use for things like pain relief, better sleep, allergies and even the common cold are illegal in some countries.

The United Arab Emirates and Japan, for example, are among the most restrictive nations, but many ban or restrict importing narcotics, sedatives, amphetamines and other common over-the-counter medications.

Most travelers won’t run into problems for carrying small amounts for personal use, said Katherine L. Harmon, who oversees health analysis for iJET International , a travel risk management company. But noncompliance can result in confiscation,(which could, in turn, have severe medical consequences), deportation, jail time, and even the death penalty. “Does it happen a lot? No. Could it? Yes,” Ms. Harmon said. “Consumers need to understand this and how it might adversely impact them before they book that awesome trip to an exotic location.”

She shared a few tips to keep you on the right side of the law, whatever you take and wherever you roam.

Laws vary by country and there is no central, up-to date repository, so Ms. Harmon suggests consulting your physician, travel medical insurance company, or local pharmacist four to six weeks before traveling. “When you inquire about your shots, ask about medications. Odds are they may not know off the top of their head, but they have the resources to find out.”

She also suggests checking with the embassy of your destination country. The State Department website lists foreign embassies in the United States, and their contact information. It also lists insurance providers that offer overseas health coverage. Comparison websites Insure My Trip and SquareMouth can help assess those insurance plans, if they’re necessary.

Label and Pack Your Medication Properly

Carry all of your medication — even vitamins and supplements — in their original, clearly marked containers or packaging in a clear plastic bag in carry on luggage. Make sure the name on the prescription, the medicine container and your passport (or one for the recepient of the medication) all match. If you lost the product information insert, ask the pharmacist to print a new one for you.

Also, check the Transportation Security Administration’s website for up-to-date rules and regulations on packing and carrying your medication when you depart. The standard rules for liquid carry-ons don’t apply to medications in liquid or gel form, but you need to inform the T.S.A. when you pass through security so they don’t confiscate it .

Obtain and Carry Necessary Documentation

Keep copies of your original prescriptions, if you can . Better yet, obtain a letter on official letterhead from your physician that lists the medicines you need and why they were prescribed. Ideally, you would get this translated to the language of your destination country, so it’s easy to read.

For some medication and specialized equipment used to administer them, some countries require documents to be submitted to government officials well in advance of your arrival. Ms. Harmon, for example, was questioned at the Singapore airport once for entering with an EpiPen, but she had prior authorization allowing its transport.

Know the Names and Amounts of Active Ingredients

The documentation you carry should also indicate the generic and chemical names of the active ingredients, which determines permissibility, not brand names.

For example, the active ingredient in Benadryl, diphenhydramine, is banned in Zambia in over-the counter products. In Japan, it is allowed only if the amount in a tablet or injection is limited. However, a typical 25 milligram tablet of Tylenol PM in the United States exceeds the 10 milligram maximum amount in a tablet you can bring into Japan. Some countries restrict the overall total amount of an active ingredient an individual traveler can legally import, which may impact longer stays.

Reduce or Substitute Medication

In countries where a medication is allowed, but its amount is capped, reducing your dosage or switching to another available medication is the best way to stay compliant. Allow enough time beforehand to ensure the smaller dose or new medicine works effectively, and consider making the switch before your trip to give yourself time to adjust.

Some medications can be used for several diagnoses. Hormones used for birth control may also be used to treat excessive menstrual bleeding, Ms. Harmon said. “Doctors need to get creative sometimes. Substitutions can allow authorities to accept the drug as a medical need rather than going against the country’s religious or moral code.”

Reassess Your Travel Plans

Parents with a child doing well on Adderall for attention deficit hyperactivity disorder who prefer not to make adjustments on the fly, or a student with bipolar disorder may want to consider vacation or study abroad locations where the medications they rely on for mental health are not banned or restricted.

“Viewpoints on treatment and diagnoses can vary widely,” Ms. Harmon said. “Western Europe and North America understand that brain chemistry is often at the root of these problems. But some countries, like Russia, do not consider mental health challenges as medical problems and often treat them criminally.”

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How to Travel With Prescription Medications

Last Updated: March 5, 2023 Approved

This article was medically reviewed by Shari Forschen, NP, MA . Shari Forschen is a Registered Nurse at Sanford Health in North Dakota. Shari has worked in healthcare since 1996 and her expertise lies in acute care bedside nursing on a medical oncology floor. She received her degree from Medcenter one College of Nursing in 2003 and her Family Nurse Practitioner Masters from the University of North Dakota in 2014. Shari is a member of the American Nurses Association. wikiHow marks an article as reader-approved once it receives enough positive feedback. In this case, 99% of readers who voted found the article helpful, earning it our reader-approved status. This article has been viewed 217,410 times.

When traveling, you want to make sure you remember any prescription medications you're taking. In most cases, you can travel with prescription medication without much hassle. However, when traveling abroad there may be some restrictions on certain types of medication. Even when traveling domestically, you want to make sure you take some precautions when packing and storing your medication. With a small amount of time and planning, however, traveling with prescription medication is a fairly easy process.

Planning Your Trip

• You can check regulations on your medications by checking country specific information on the State Department's website. You can also call the embassy or consulate of the country you plan to visit.
• It may be helpful to also browse the Center for Disease Control and Prevention website. The United Nations website also has information on prescription drug regulations by country. With a little detective work, you should be able to see what restrictions, if any, are placed on your medication.

• Doctors, especially in the US, tend to be very busy. It may take your doctor a few days, or even a few weeks, to write a letter about your medication. Start gathering these documents well in advance if you're planning on traveling abroad.

Packing Your Medications

• You should also make sure to keep your medication in all its original containers. If you're flagged for a security check, you do not want to look like you're carrying any suspicious pills.

• While it's unlikely any of the above items would be banned, it may be a good idea to double check airline regulations. In the event there are restrictions, you can usually get restrictions waived due to medical reasons.
• Even medications that do not need to be stored in cool temperatures may be affected by heat. It's unlikely the heat of an airplane would get hot enough to affect medication. However, it's a good idea to check with your doctor before traveling if there are any warnings about heat on your medication's label. It's better safe than sorry. [6] X Research source

• If you don't have a copy of your prescription, you should be able to get one from your doctor's office. This may take a few days, so plan ahead.

Avoiding Pitfalls

Expert Q&A

• If you are going to be out and about most days, consider getting a "pill organizer" and put your days worth of pills in it each night. Thanks Helpful 1 Not Helpful 0

You Might Also Like

• ↑ https://www.thatsinsurance.com/taking-medication-abroad-2018/
• ↑ http://www.cheapflights.com/news/traveling-with-medication/
• ↑ http://www.miusa.org/resource/tipsheet/medications
• ↑ http://travel.gc.ca/travelling/health-safety/medication
• ↑ http://www.nhs.uk/chq/Pages/1074.aspx?CategoryID=70
• ↑ https://www.iamat.org/blog/what-you-need-to-know-about-travelling-with-medications/

About this article

While traveling with prescription medication is typically an easy process, make sure to check restrictions so you don’t run into any problems. Certain prescriptions may be illegal in the country you're visiting, so check the State Department's website or call their consulate to check regulations. You may also need a letter from your doctor or a copy of your prescription while traveling, so make sure to have these documents before you travel. As you prepare for your trip, pack slightly more medication than you’ll need in case of delays and put it in your carry-on bag in case your checked bag gets lost. For more tips from our Medical co-author, including how to check airline policies on liquid medication, keep reading! Did this summary help you? Yes No

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I am traveling with medication, are there any requirements I should be aware of?

All passenger items must undergo security screening. It is recommended that medication be clearly labeled to facilitate the screening process.

You may bring medically necessary liquids, medications and creams in excess of 3.4 ounces or 100 milliliters in your carry-on bag. Remove them from your carry-on bag to be screened separately from the rest of your belongings.

Emergency Support

In case of emergency abroad, first call the local equivalent of 911 listed in the global 911 directory .

You may also contact International SOS by phone at +1-617-998-0000 or through the Assistance App .

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Access your International Emergency Management Team (IEMT) portal for information.

Tips for Traveling with Medication

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Many common U.S. medications and supplements are illegal abroad or require government authorization before your arrival.

Drug Facts: Traveling with Medication

Adderall. Benadryl. Birth control. Protein powder. These are just a few of the common U.S. medications and supplements that are illegal in some countries or require government authorization prior to your arrival.

Travelers are often caught off guard by the wide variance of laws regulating the importation of and access to medications across borders, whether mailed or hand carried. Depending on your destination, you could be subject to increased scrutiny from customs officials ( not a big deal, you think ) or confiscation and imprisonment ( that escalated quickly ). In Turkey, Egypt, and Malaysia, for example, a drug offense conviction can result in the death penalty.

Know Before You Go

Be aware of your destination’s banned and restricted medications. The US embassy website of your destination country is a good place to start—a quick query in the search bar should do the trick. You can also check your airline's website to see if things like flying with Adderall, for example, are prohibited.

If any of your medications are on the embassy's or airline's list of banned or restricted substances, you'll need to talk with your health care provider about suitable alternatives. Make sure the alternative medications are legally permitted and readily available in your destination.

Common Restrictions

• Narcotics and psychotropic medications (e.g. Adderall and Ambien)
• Over-the-counter medications and nutritional supplements (e.g. protein powder)
• Hormone medications (e.g. birth control pills, morning after pills, and hormone therapy medication for gender transition)
• Certain ingredients or quantities of ingredients (e.g. pseudoephedrine found in Sudafed, and diphenhydramine HCI found in Benadryl and Tylenol PM)

Ignorance isn’t an Excuse

Take this example of an American Toyota executive arrested in Tokyo after Japanese customs officials found a controlled pain medication in a package she mailed to herself. Japanese authorities can detain suspects without charge for up to 23 days, and the executive spent almost three weeks in jail before being released without charge. At a press conference, Toyota explained that their executive did not intentionally violate local laws; however, ignorance, in this case, had serious repercussions .

Chronic Conditions

For travelers with chronic physical or mental health conditions, anticipate how your new environment can affect your health. For example, if you have asthma and are traveling to areas with high levels of air pollution, you’ll want to discuss mitigation strategies with your health care provider. If you require injections, you’ll need to review airline and country-specific regulations for traveling with needles or syringes. Many airlines, like Emirates, have a list of prohibited goods on their website, as well as guidelines for traveling with a chronic health condition.

Mental Health

Practice self-care; difficulty in adjustment can be mitigated by trying to maintain your daily routine while abroad. If there are aspects of your routine that keep you happy at home—for example, working out—try to find facilities in your destination by which you can continue them.

Preexisting mental health conditions can be intensified by living in a different culture, and local resources may be less than or different from those to which you’re accustomed to at home. Discuss these concerns with your health care provider and know the counseling resources available to you abroad—including International SOS —should you need help.

Sexual and Reproductive Health

Cultural norms and laws that impact individuals’ access to sexual and reproductive health vary by country (and by state in the US). Consider bringing personal care and health-related items that may be unavailable or difficult to obtain in your destination, including menstruation products and contraceptives; as with your prescription and over-the-counter medications, make sure any contraceptives you bring with you are legal in your destination country.

Before You Leave

• Research your destination and transit locations. The International SOS destination guides, available in the Assistance App and member portal , include medical information such as vaccines, documentation, medication, clinics, and hospitals. Log in with your HarvardKey.
• If you're traveling to a region with a high risk of malaria, review the CDC's malaria advice and assess whether you'd like to carry preventative medication with you. Speak to your doctor about obtaining malaria medication, and treat it during travel just like you would any other prescription.
• Obtain necessary permits or government authorization.
• Ask your doctor for a letter on their letterhead explaining your medical treatment and necessity, translated into the host country’s language, if necessary.
• If you have to take your medication at a specific time, talk with your doctor about adjusting your schedule accordingly based on your travel time and time zone changes.
• Pack enough medication to last the length of your trip—plus extra in case of delays, but no more than personal-use quantities.

During Travel

• Keep all medications in your carry-on luggage and in their original, labeled containers; do not combine multiple medications into one container.
• The name on the prescription should match the name on travel documents and identification.
• Be prepared for additional screening.
• Carry a written prescription and a letter from your doctor explaining the medication and medical condition.
• Do not have banned or controlled substances mailed to you.
• In case of an emergency, contact International SOS if you are sick, injured, or need medical advice.

Returning to the U.S.

• If you're prescribed medication abroad, review U.S. Customs & Border Patrol's list of restricted and prohibited items to certify that medication obtained abroad may be brought back into the country.
• Declare all medication and associated items at customs.
• Carry medication obtained abroad in its original container.

Further Reading

Coronavirus: Advice for Travelers

Food and Drink Safety While Abroad

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5 Tips for Traveling to the U.S. With Medications

You’re returning from a trip overseas and want to bring back over-the-counter drugs from Europe that aren’t available here. Can you? Your mother-in-law is visiting from Mexico to help with the new baby and runs out of her blood pressure medication. Can she refill her prescription at a U.S. pharmacy? Your foreign exchange student forgot his allergy medication. Can his parents mail it to him from Japan?

Those are just some of the questions people ask the Food and Drug Administration’s Division of Drug Information, says LCDR Lindsay E. Wagner, an FDA pharmacist—although not every question the Division is asked falls under FDA’s regulatory authority.

“As a pharmacist at the FDA, I advise people to remember that we at FDA cannot ensure that medications approved in other countries are safe or effective, or have been manufactured properly,” says Wagner, PharmD.

So what are the rules for flying with or shipping medications? Here are some answers to common queries:

Q: What should travelers and visitors know about bringing medications into the U.S.?

A: When you come to the United States with medications, you fall under the authority of FDA, U.S. Customs and Border Protection (CBP) and the Transportation Security Administration (TSA) agents operating the nation’s airports. There are varying restrictions, and different agencies may have other requirements or jurisdiction over a product. So check with each agency before you plan to travel with medications into the country.

In general, you should have with you a valid prescription or doctor’s note—written in English—to bring medication to the U.S. The medication should be in its original container with the doctor’s instructions printed on the bottle. If you don’t have the original container, bring a copy of your prescription or a letter from your doctor explaining your condition and why you need this medication. Travel with no more than you need for your personal use during your stay. A rule of thumb: Bring no more than a 90-day supply of medication.

If you’re staying longer than 90 days, you may have additional medication sent to you by mail or courier. Include documentation showing that the medication is being sent for your own use while visiting the United States. This documentation may include: a copy of your visa and passport, a letter from your doctor, and a copy of your prescription (in English).

Q: What if there’s a generic available overseas but not here?

A: FDA does not permit personal importation of unapproved versions of FDA-approved drugs from foreign countries. FDA cannot assure that foreign-made versions of FDA-approved drugs have been properly manufactured, are safe and effective, and are the same formulation as the FDA-approved versions.

Q: Can a foreign traveler get a prescription filled when visiting the U.S.?

A: If you’re traveling to the United States from another country and need a prescription filled, you should visit a health care provider. Very few pharmacies can fill a foreign prescription, and this is determined on a state-by-state basis.

Q: Can you ship or mail a prescription medication to the U.S.?

A: In most cases, it’s illegal for people to import drugs into the United States for personal use. That’s because drugs available in other countries haven’t been evaluated or approved by FDA for use or sale in the U.S., so we can’t ensure that they’re safe and effective. FDA generally considers such drugs unapproved.

FDA understands that there are cases in which someone may need treatment with a foreign drug that’s not available in the U.S. and there are no other U.S. medicines available to treat the condition. FDA’s Personal Importation Policy provides instructions for FDA personnel relating to the personal importation of drugs that may be illegal in the United States. FDA considers the following when reviewing such an application:

• The drug is for a serious condition for which there is no effective treatment available in the U.S.
• There is no marketing or promotion of the drug to U.S. residents.
• The drug doesn’t represent an unreasonable health risk.
• You verify in writing that you’re importing the drug for your own personal use.
• You have a letter, written in English, from your doctor saying the drug is a continuation of treatment that began outside the United States or you provide the name and address of a U.S. licensed physician who will supervise your use of the foreign drug. The letter should accompany the package and be addressed to a Customs and Border Protection officer or broker.
• You’re not importing more than a three-month supply of the drug.

If the medicine is sent through the mail, Customs might detain it until an FDA inspector can examine it. This could take as long as a month. To speed things along, make sure the outside package is marked and states that it contains a letter to the CBP officer or broker. The best option is to send the package by a courier service and flag it so the U.S. Customs broker will alert FDA inspectors about the special circumstances for sending the package.

Q: What else should you know about traveling with medications?

A: If you have questions for FDA about traveling with medications, contact the Division of Drug Information at 855-543-DRUG (3784) or email us at [email protected] .

The Drug Enforcement Agency (DEA) has other restrictions on bringing controlled substances into the country. Review those rules § 1301.26 Exemptions from import or export requirements for personal medical use .

Contact TSA if you have questions about carrying prescription medications in your luggage or carry-on when flying. For more information follow TSA’s blog Travel Tips Tuesday .

Review the many webpages dedicated to travel questions provided by the U.S. Customs and Border Protection.

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How to Travel With Medications

Stay Healthy and Save Money

If you plan to travel to a foreign country, it is important that you provide for your medication needs before leaving. An illness in the middle of your trip can ruin your vacation and cost you money to get needed medications.

Depending on the circumstances, buying medications in foreign countries can be expensive. Moreover, in some countries, you may be at risk of getting a counterfeit drug.

By thinking ahead and packing smart, you can stay healthy and enjoy your time. This article will help you understand what you need to know about traveling with over-the-counter and prescription medications.

Organize a Health Kit

The Centers for Disease Control and Prevention (CDC) recommends that travelers assemble a health kit containing current prescription medications and over-the-counter (OTC) drugs that can be used to treat minor problems. What you include in your travel health kit depends upon your destination and length of travel.

You also should anticipate some disruption in travel plans and take extra medication so you do not run out. For example, you do not want to be stuck in an airport for an extra day without your diabetes medication or pain medication used to treat arthritis.

Which OTC Medications Should I Pack?

Since it is not practical to pack your entire medicine cabinet, your travel destination and your itinerary may help you decide which over-the-counter medications to buy for your kit.

For example, you are less likely to have diarrhea from drinking water in Canada than in Mexico. And, if you are planning a walking trip in London, you are less likely to need an anti-motion sickness medication.

The following are some basic medications to consider:

• Anti-diarrhea medication: Foodborne illness is very common and may cause diarrhea in up to 30% of travelers. This is especially common in parts of Central and South America, Africa, and Asia. Pack Imodium (loperamide) or Pepto-Bismol (bismuth subsalicylate).
• Antihistamine: To treat an allergic reaction, pack an antihistamine that will not make you drowsy, such as Claritin (loratadine).
• Anti-motion sickness medication: For a bumpy plane or boat ride, pack some Dramamine (dimenhydrinate).
• Medicine for pain or fever: Pack your preferred painkiller, such as acetaminophen or ibuprofen.
• Mild laxative or stool softener: Changes in your eating routine and access to different foods can cause constipation . Pack a laxative containing bisacodyl such as Dulcolax or a stool softener such as Colace (docusate).
• Antifungal ointment or cream: Fungal infections of the skin, such as ringworm and athlete’s foot are common, especially in warm climates. Pack a tube of Tinactin (tolnaftate) or Lotrimin (clotrimazole).
• Antibacterial ointments or creams: To help prevent a skin infection from a minor cut or scrape, pack a tube of Neosporin Ointment (polymyxin B, bacitracin, and neomycin).

How Do I Manage My Prescription Medications on a Trip?

Before you leave for your trip, see your healthcare provider to get an ample supply of all your prescription medications. Also, talk to your practitioner about your change in schedule and ask when to take medications if you are moving through different time zones.

If you are traveling to a country with malaria , talk with your healthcare provider about getting a prescription for a medication to prevent malaria, such as Lariam (Mefloquine), Malarone (atovaquone, proguanil), or doxycycline (the CDC has a guide to each of the available medications, some of which are recommended for certain areas).

If your destination is a country that puts you at high risk of diarrhea or other bacterial infections, ask your practitioner about the possibility of getting a prescription for an antibiotic, such as Cipro (ciprofloxacin).

Talk to your pharmacist about drug-food interactions. Since your diet may change during your trip, your pharmacist can advise you about foods that could affect your medications.

Pack your travel health kit, including your prescription medications, in your carry-on luggage. Make copies of your prescriptions and pack them with your medications. You should also leave a copy of your prescriptions at home with a friend or family member.

Make a list of your medications, including the generic names and brand names, and what conditions the medications treat. That will make it easier to find a replacement if you run out of or lose your medications .

Will I Have Problems Crossing Borders With My Medications?

If you use a controlled substance, such as a sedative, tranquilizer or narcotic pain medication, make sure you obtain a letter from your healthcare provider, on the practitioner’s stationery, stating why you need the drug.

Without such a letter, these medications may not be allowed into another country or allowed back into the U.S. when you return.

Likewise, you should have a letter from your healthcare provider if you take any medication by injection and you have to carry needles and syringes.

Make sure that all medications are labeled properly. The safest way to carry your medications is in the original bottles, which will also speed the process if your carry-on bags are inspected (this applies to vitamins and supplements as well).

However, if you do not have enough space for the bottles in your carry-on, you can transfer them to small plastic bags. When you have your prescription filled, the pharmacy will give you a print-out that usually has a tear-off section on the top that has the same information as the label on your medication container. You can enclose this tear-off sheet in the plastic bag.

But note that the Transportation Security Administration—TSA— clarifies that although they do not require travelers to have medications in their original pharmacy-provided containers, "states have individual laws regarding the labeling of prescription medication with which passengers need to comply."

You'll also want to make sure that the name on your prescriptions , pill bottles (or tear-off sheet if you're packing your medications in a bag or pill sorter), and ID or passport all match.

If you have a liquid medication, TSA doesn't require it to be less than 3.4 ounces (the rule that applies to most other liquids), but you do need to tell the TSA agent that you have medically necessary liquids in your bag when you start the screening process at the airport.

Even with all of that planning, it's important to also have a clear understanding of the laws and regulations in your destination country. In some cases, you might find that a particular destination's rules simply aren't compatible with a medication that you take , and you may want to consider a different destination instead.

You can discuss the specifics with your healthcare provider, your pharmacist, and the U.S. embassy in the country you're considering visiting . The embassy will be able to tell you whether a medication you take is banned in the country or only allowed in limited quantities.

Where Can I Get More Information Before I Leave on My Trip?

Centers for Disease Control and Prevention: The CDC maintains an excellent Travelers’ Health website that includes a wide range of information about travel issues related to health. One section of the site has an interactive map that provides access to health information for each country. And their traveling abroad with medicine page is a must-read if you're planning a trip outside the U.S. and will need to bring medication with you.

Transportation Security Administration (TSA): The TSA provides online information for travelers with disabilities and medical conditions, and it explains the current requirements for how to go through airport security with medications.

U.S. Department of State: The State Department maintains a travel website that provides a profile about the current status of every country in the world. These profiles include information about health-related issues and often highlight issues with prescription medications.

Transportation Security Administration : TSA has a helpful page about disabilities and medical conditions . It includes a tool that allows you to select from among a range of common disabilities and medical conditions to see exactly what you need to know about the screening process and any steps you might want to take in advance to make it as smooth as possible.

Traveling with medications is common, but does require some advance planning. It's generally advisable to pack medications in your carry-on luggage, and to have copies of your prescriptions with you. Liquid medications can be brought onboard aircraft even in quantities greater than the limits that apply to other liquids, but you'll need to notify the TSA screening agent of your liquid medication. For controlled substances, you'll need a letter from your medical practitioner, explaining why you need the medication. And there are some countries where certain medications simply aren't allowed, even though they're prescribed in other countries.

A Word From Verywell

Staying healthy on your trip can save you a lot of money. Out-of-pocket medical expenses in a foreign country can be enormous. Make sure to purchase travel insurance before you leave and pack your medications !

Centers for Disease Control and Prevention. Travelers' Health .

Centers for Disease Control and Prevention. Choosing a Drug to Prevent Malaria .

Transportation Security Administration. Can You Pack Your Meds in a Pill Case and More Questions Answered .

Centers for Disease Control and Prevention. Traveling Abroad with Medicine .

Mohn, Tanya. New York Times. How to Make Sure You Travel with Medication Legally .

Transportation Security Administration. Disabilities and Medical Conditions ; and TSA Cares: Traveling with Medication ; and Can you pack your meds in a pill case and more questions answered .

By Michael Bihari, MD Michael Bihari, MD, is a board-certified pediatrician, health educator, and medical writer, and president emeritus of the Community Health Center of Cape Cod.

Your Ultimate Guide To Traveling & Prescription Medications

• July 24, 2023
• Lauren Stuttaford

Traveling with prescription drugs internationally requires some extra planning and consideration. So, whether you’re exploring a foreign country or going on a business trip, it’s essential to know how to travel with prescription medication to ensure a smooth journey and uninterrupted health management.

In this guide, we’ll cover everything you need to know about traveling with prescription medicine, from international regulations to obtaining prescriptions abroad and more.

Can you travel internationally with prescription drugs?

Can you travel with prescription medicine? Yes, you can generally travel with prescription meds. However, it’s important to be aware of the specific regulations and restrictions of your destination country. Different countries have different rules about what medications are allowed, and what documentation you need to have with you.

For example, some countries require travelers to carry a doctor’s note, a translated prescription, or even a specific import permit for certain medications. It’s important to do your research and understand the specific rules of your destination country before traveling with prescription drugs internationally.

How to check local regulations for traveling with prescription medications?

Traveling with prescription medication can be a daunting task, especially if you’re not sure what the local regulations are in your destination country. To avoid any potential problems, it’s important to do your research and understand the specific rules of the country you’re visiting.

If you need information about traveling with prescription drugs internationally, here are a few tips on how to check local regulations for traveling with prescription drugs internationally:

• Contact the embassy or consulate of your destination country. This is the best way to get up-to-date information on the country’s medication importation policies. They will be able to tell you what medications are allowed, what documentation you need to have with you, and any other important information you need to know.
• Consult with a travel health specialist. A travel health specialist can help you understand the local regulations for your destination country and make sure you have everything you need to travel safely.
• Check the website of the Centers for Disease Control and Prevention (CDC). The CDC website has a wealth of information on traveling with prescription medications, including a list of countries with specific regulations.
• Do a Google search. A simple Google search can often turn up helpful information on the local regulations for traveling with prescription medications.

Once you’ve done your research, you’ll be well on your way to traveling with prescription medications safely and legally.

How to travel with prescription drugs internationally: flying with prescribed medication

Traveling with prescription drugs internationally can be a daunting task, but it doesn’t have to be. By following a few simple guidelines, you can ensure that you have everything you need during your journey and avoid any potential problems with the TSA.

Tips for flying with prescription medications:

• The best way to travel with prescription medication is to keep your medications in their original packaging, labeled with your name, prescription details, and dosage instructions.
• Pack your medications in your carry-on bag. This will help prevent loss or delays.
• Bring extra medications. Pack more than enough medication to cover your trip in case of unexpected delays or extensions.
• Store medications properly. Ensure medications are stored at the appropriate temperature, especially if some require refrigeration.
• Check the rules for liquids and gels, as some countries have restrictions on the amount of these items you can bring into the country.
• Contact the embassy or consulate of your destination country for up-to-date information on the country’s medication importation policies.

Familiarize yourself with TSA regulations for traveling with prescription medications:

When it comes to traveling with prescriptions TSA allows you to bring prescription medications in your carry-on bag or your checked luggage. However, there are some specific requirements that you must follow:

• Medications must be in their original containers, labeled with your name and prescription details.
• Liquid medications must be in containers that are 3.4 ounces or less and placed in a single, clear, quart-sized zip-top bag.
• If you have more than 3.4 ounces of a liquid medication, you can bring it with you if you have a doctor’s note or prescription.
• Controlled substances must be declared to the TSA at the security checkpoint.

Check out our comprehensive guide on Flying with Prescribed Drugs: How-to Pack, Tips & More! [Ultimate Travel Guide] . This guide covers essential tips on organizing your medications, packing them securely, and carrying the necessary documentation.

What should you do when you need to fill a prescription abroad?

When it comes to international travel with prescription meds, the thought of running out of medication while abroad can be stressful. If you find yourself in this situation, there are a few things you can do.

Can you fill prescriptions abroad?

In most cases, you can fill prescriptions abroad. However, there are some important factors to consider, like medication importation policies of your destination country and the availability of your medication in that country.

How to fill prescriptions abroad:

Here are some tips on how to fill prescriptions abroad:

• Do your research. Before you travel, it’s a good idea to do some research on the medication importation policies of your destination country. This will help you understand what medications are allowed and what documentation you need to have with you.
• Contact your doctor. If you’re not sure whether you can fill your prescription abroad, contact your doctor. They may be able to prescribe the medication you need or recommend a local healthcare provider who can help you.
• Bring a copy of your prescription. It’s always a good idea to bring a copy of your prescription with you when you travel. This will make it easier to fill your prescription if you need to.
• Be prepared to pay out of pocket. Even if your insurance company covers the cost of filling a prescription abroad, you may still have to pay a copayment or deductible. It’s important to be prepared to pay out of pocket for your medication if necessary.

Running out of medication while abroad can be stressful. Check out our guide on

Filling Prescriptions Abroad: When Travelling Internationally for step-by-step instructions on obtaining prescription medications in a foreign country.

How to get prescriptions abroad:

If you need a new prescription while traveling, it’s essential to know the options available to you. Here are some tips to help you prepare before your trip when traveling with prescriptions internationally, and even how you can get prescriptions when traveling.

The importance of being prepared:

Preparing before your trip, like arranging prescriptions for medications, is crucial because regulations vary from country to country. When it comes to traveling with prescription drugs internationally, you’ll want to make sure you have the required documentation and understand local laws. This guarantees a smooth journey and ensures you can maintain your medication management. If you don’t prepare you could face unexpected hurdles and potential health risks, so research and plan for a safe and enjoyable travel experience.

Taking prescription drugs abroad – preparing before your trip:

• Talk to your doctor. Before you travel, talk to your doctor about your medication needs. They can help you understand the medication importation policies of your destination country and recommend a course of action if you need to get a new prescription while you’re abroad.
• Get a copy of your prescription. Make sure you have a copy of your prescription with you when you travel. This will make it easier to fill your prescription if you need to.
• Research the medication importation policies of your destination country. Different countries have different rules about what medications are allowed and what documentation you need to have with you. Do some research before you go to make sure you know what to expect.

How to get prescriptions when traveling:

When it comes to international travel prescriptions, there are a few different ways to get prescriptions when you’re traveling abroad:

• Contact your doctor or a local healthcare provider. Your doctor or a local healthcare provider may be able to prescribe the medication you need.
• Visit a local pharmacy. Many pharmacies in foreign countries can fill prescriptions from doctors in other countries. However, it’s important to check with the pharmacy before you go to make sure they can fill your prescription.
• Use a travel health clinic or medical tourism company. Travel health clinics and medical tourism companies can help you get prescriptions while you’re abroad. They often have a network of doctors and pharmacies that they work with, so they can help you find the best option for your needs.

Head to our blog post: Prescriptions While Traveling: Your Guide to Getting Medication Abroad , for the ultimate guide on getting prescriptions while abroad. It explains various ways to obtain necessary prescriptions in different countries and more useful tips for international travel and prescription medication.

What to do if you lose your medication while abroad

• Take a deep breath and stay calm. It’s okay to be upset, but it’s important to stay calm so you can think clearly.
• Retrace your steps. Go back to the last place you remember having your medication and thoroughly search the area.
• If you’re traveling, report the loss to the local police. You can also ask them for a written report for documentation.
• Contact your doctor and pharmacy. Let them know that you’ve lost your medication and see if they can help you get a replacement.
• If it’s a critical medication, contact your doctor immediately. They can advise you on the next steps, which may include getting an emergency prescription or switching to a different medication.
• Consider using a pill organizer or keeping your medications in a secure location. This can help prevent future losses.

What to consider when traveling with prescription drugs

• Check the local regulations: Research the specific country’s laws and regulations regarding prescription medications to ensure compliance.
• Carry a doctor’s note: Obtain a letter from your healthcare provider stating your medical condition, prescribed drugs, and their purpose for customs clearance.
• Make sure you have sufficient supply: Carry an adequate amount of medication for the entire trip, including extra for unexpected delays.
• Don’t throw away original packaging: Keep medications in their original labeled containers to avoid confusion and prove legitimacy.
• Translation services if needed: If traveling to a country with a different language, have a translated copy of your prescription and medical documents.
• Always declare at customs: Disclose your prescription drugs to customs officials, if required, to prevent any issues at the border.
• Secure storage: Keep medications in a safe and cool place to maintain their efficacy throughout the journey.

Dealing with travelers’ diarrhea & getting prescription meds abroad

While traveling, a common health concern many people experience is travelers’ diarrhea. Changes in diet, water quality, and exposure to new bacteria can lead to this uncomfortable condition. Make sure you’re prepared and know what to do by reading our blog post on Traveler’s Diarrhea: Getting Prescribed Medicine Abroad .

Remember, seeking medical help can make a significant difference in quickly overcoming this temporary health issue and getting back to enjoying your travel adventures.

How Air Doctor can help you

Air Doctor is a valuable resource for travelers. The easy-to-use app instantly and seamlessly connects travelers to a global network of over 20,000 multi-lingual doctors and specialists so they can access trusted, quality medical care anywhere, anytime.

If you ever find yourself in need of medical assistance during your journey, you can use Air Doctor (with or without insurance) to find a doctor that meets your preferences (like language, gender, specialty, and more), and choose from clinic, at-home (hotel), and video consultations.

The Air Doctor solution accommodates multiple languages – with 24/7 multi-lingual support, doctors proficient in multiple languages, and an app which supports various major languages – in addition to video consultations in up to 21 languages.

Plus, we’re able to provide valid, local prescriptions through our cross-border telemedicine services.

The service makes it easier to manage any health-related concerns while traveling.

Download the app before your next trip.

Safe travels!

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Jenny Cohen Derfler

Air dr ceo & co-founder.

Jenny is the CEO and one of the Co-Founders at Air Doctor. She spent more than 20 years at Intel, most recently as general manager of its manufacturing facility in Israel and before that in various engineering and manufacturing roles in Silicon Valley. Air Doctor is her second startup having previously founded electric vehicle company ElectRoad.

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7 travel pill cases to keep your meds organized

Whether you are going on a trip or need a way to keep your medications straight, a travel pill case can help. “They keep you organized so you can more easily remember to take your medications as prescribed each day,” says Dr. Karla Robinson , a board-certified family physician and medical editor at GoodRx.  “They can also help you keep track of medication you’ve already taken for the day to prevent taking extra doses by mistake.” 

Travel pill cases or organizers can especially be helpful on a trip because they are easier to pack than multiple pill bottles, says Robinson. Don’t take prescription medication? They can also be used for supplements and vitamins. 

SKIP AHEAD How we picked the best travel pill cases | The best travel pill cases of 2024 | How to shop for a travel pill case

Selected Our top picks.

select 34 top-rated Amazon travel accessories for your next trip

The best travel pill cases of 2024.

We consulted with medical professionals about what to look for when shopping for a travel pill case. Then, using their guidance, we rounded up highly rated options from top retailers. 

Auvon Weekly Pill Organizer

This case stores up to seven days’ worth of medication and each compartment has a different colored lid and is labeled with the day of the week. Each compartment can hold up to 12 large vitamins and the lids stay firmly shut until you push the button to open them, according to the brand. Because this case has one large compartment for each day, it’s best for people who take all their pills at the same time of day. This option has a 4.8-star average from over 47,800 reviews on Amazon.

Zannaki Metal Travel Pill Organizer 

Zannaki Metal Travel Pill Organizer

This aluminum pill organizer is made up of seven compartments that screw together to form a larger vessel that’s shaped like, well, a big pill. Each compartment is labeled with the day of the week and can hold up to eight fish oil pills or 16 large vitamins, according to the brand. When closed, the compartments are airtight and keep out moisture, according to Zannaki. This pill organizer has a 4.5-star average from over 1,350 reviews on Amazon and comes in six colors — including matte pink , ice blue and midnight black .

Zoksi Weekly Pill Organizer

If you need to take medication or supplements in the morning and then again at night, this pill organizer may be a good option for you. Inside a larger box that locks shut with a plastic clasp sits seven smaller containers that each have two compartments. Each container comes in a different rainbow hue and is labeled with a day of the week on the side. When pulled out and laid flat, each container is split down the middle and can be opened on either side.You can take the larger container if you will be away for a week or can just select a few of the smaller containers if you are taking a shorter trip. This pill organizer has a 4.8-star average from over 8,600 reviews on Amazon. 

Koviuu Weekly Pill Organizer

My husband recently bought this to keep his daily vitamins and supplements in and I love how chic it looks sitting on our bathroom counter. Made from BPA-free plastic, there are seven individual canisters (each labeled with a day of the week) that slot into a larger container to keep them all together and secure. Each canister is shaped like a skinny tube and can be opened from either end. Inside, there is a divider. So, you can put your morning medication in the top and your evening medications in the bottom. The larger container everything fits in has a rotating handle. When closed, it keeps the canisters locked in place and when opened, it props up the container at an angle so you can easily see your canisters. 

Ezy Dose Push Button Pill Case 

Ezy Dose Push Button Pill Case

Made for people who take medications twice a day, this pill case has two removable trays. Each one has seven compartments labeled with the day of the week and one tray has moons on each compartment to denote the medication you take at night, while the other has suns for the medication you take in the morning. Each compartment has a push button that opens it and can fit up to 60 Aspirin, according to the brand. This pill case has a 4.6-star average from over 89,000 reviews on Amazon.

Mossime 2-Pack Weekly Large Pill Organizer

If you need to be able to travel with two weeks’ worth of medications or want to buy a one-week organizer for both you and your significant other, this two-pack is for you. For under $10, you get two separate pill cases that have seven separate compartments, each marked with a day of the week. Each container is a different color, making it easy to differentiate them. The compartments can each hold up to eight large supplements and the lids snap closed, according to the brand. This two-pack has a 4.6-star average from 2,900 reviews on Amazon.

Med-E-Lert Premium Locking Automatic Pill Dispenser

Benjamin recommends a locking pill case for anyone with children and says choosing one with an alarm can be helpful for those who tend to forget to take their medication. This pill case delivers on both fronts. This pill organizer has 28 compartments, which equates to four weeks worth of once-a-day doses or two weeks worth of twice-a-day doses. You can program up to six alarms and set it so that when the alarm goes off, only the medication you are supposed to take at that time is accessible. In between uses, you can lock the case with a key. This case has a 4.3-star average from over 3,200 reviews on Amazon.  

select Your eyes can start to show signs of aging as early as your mid-twenties

How we picked the best travel pill cases.

The right travel pill case for you will have to do with your needs. However, the experts we spoke with said there are some universal things everyone should look for. Those characteristics include: 

Delineated compartments: Most travel pill cases have different areas to hold at least a week’s worth of medication, and our experts recommend paying close attention to how those compartments are situated. Look for clearly delineated compartments for each day if you take medication once a day or enough compartments for multiple times of day (morning, noon, evening, bedtime) if you take things at different times over 24 hours, says Alice Benjamin, a nurse practitioner and founder of the lifestyle website Ask Nurse Alice . 

Closing mechanism: If you plan on traveling with your pill case, it may get jostled around your suitcase. “Ensure your pill case has a secure closure mechanism to prevent accidental spills or openings, which could lead to medication mix-ups,” says Benjamin. “And if you have small children or pets at home, a pill case with a child-resistant or secure locking mechanism is important for safety.”

Clear labeling: “For people with visual impairments, larger markings, clear labeling or high-contrast design can be very helpful,” says Benjamin. “Some pill cases even have braille or raised text for tactile identification.” Even if you don’t have visual impairments, clear labeling can make it quick and easy to grab the medication you need and go.

Questions to ask yourself when shopping for a travel pill case

Shopping for a travel pill case is highly personal, as everyone has different needs when it comes to medications and supplements. To ensure you select a travel pill case best suited for you, experts recommend asking yourself these questions. 

What are your storage needs?

If you take only a few pills a day, you may be fine with a smaller case. If you take more medication or need to take things at different times of the day, a larger option with more compartments will serve you better. “That said, if you are traveling, I always recommend packing more than you will technically need,” says Robinson. “That way you are covered if something happens.” With this in mind, selecting something that will fit a bit more than you think you’ll need is wise.

How will you be using your pill case? 

Will you only be using your pill case when you travel? Or do you want something to put on your counter at home so your pills are organized and easy to remember? This may influence your choice. If you are just throwing it in a suitcase, you may not need to worry about aesthetics as much. But if it will be sitting out on your counter, consider something that you won’t mind looking at every day. 

Are your medications light-sensitive? 

The potency of some medications can be impacted if they are exposed to moisture and light, says Benjamin. Since bathrooms can get humid thanks to hot showers, you want a pill case that closes tightly so your medications aren’t exposed to that humid air. If you are taking a medication that shouldn’t be exposed to light, you’ll want to look for an opaque or darkly tinted pill case. In terms of maintaining the integrity of your medications, washing your pill case with soap and water regularly is also important — it ensures you aren’t transferring bacteria or residue to new medication you add in there, says Robinson.

Meet our experts

At NBC Select, we work with experts who have specialized knowledge and authority based on relevant training and/or experience. We also take steps to ensure all expert advice and recommendations are made independently and without undisclosed financial conflicts of interest.

• Dr. Karla Robinson i s a board-certified family physician and medical editor at GoodRx. 
• Alice Benjamin is a nurse practitioner and founder of the lifestyle website Ask Nurse Alice .

Why trust NBC Select?

Bethany Heitman is a contributor at NBC Select and a journalist who regularly covers topics like beauty, home and lifestyle. For this story, she spoke to two medical professionals about what to consider when shopping for a travel pill case.

Catch up on Select’s in-depth coverage of personal finance , tech and tools , wellness and more, and follow us on Facebook , Instagram , Twitter and TikTok to stay up to date.

Bethany Heitman is a contributing editor at NBC Select.

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Travelling with medication

The information on this page will help you if you’re travelling abroad with prescription, over-the-counter medication or medical equipment.

Medications may come under intense scrutiny when going through border controls in other countries or at the land border between Canada and the United States.

On this page

Before you leave, while you’re away, if you need help.

Some over-the-counter and prescription medications, dietary supplements, and herbal and homeopathic products legally available in Canada may be illegal in other countries or require prior approval from local authorities.

• Consult the health section of our destination-specific travel advice and advisories
• Contact the foreign government office accredited to Canada of the country you plan to visit to confirm the status of your medications in that country
• Keep all medications in their original, labelled containers.
• a copy of the original prescription and ensure that both the generic and trade names of the medications are included in case of loss or theft
• a doctor’s note explaining why you are taking the medications (highly recommended)
• Learn about what you can and cannot pack in your carry-on luggage
• fly with medications and medical items
• travel into and out of Canada with prescription medications that contain controlled substances
• Don’t buy medications outside Canada unless you have been advised by a health care professional.
• Know that some medications might come with certain stigmas, associate individuals with a vulnerable group or raise questions at your destination. For example, contraception, pre-exposure prophylaxis (PrEP) and anti-depressants might not be widely accepted, depending on your destination’s culture and laws.
• Remember that even if you’re authorized to use cannabis for medical purposes, it is illegal to transport it and all products containing cannabis, including products containing cannabidiol (CBD), across the Canadian border.
• It’s your responsibility to know and abide by local laws.
• Your Canadian citizenship offers no immunity from prosecution, and consular officials can’t get you out of jail.
• nearest Canadian office abroad
• Emergency Watch and Response Centre in Ottawa

Related links

• Sickness or injury
• Receiving medical care outside Canada
• Vaccinations
• Travelling with disabilities
• Travelling with a medical device
• What you can bring on a plane  (Canadian Air Transport Security Authority)
• Animal and plant ingredients in traditional medicine  (Environment and Climate Change Canada)
• Tips for healthy travel

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Take medicine in or out of the UK

You must carry medicine containing a controlled drug with you in your hand luggage when entering or leaving the UK. It may be taken away from you at the border if you cannot prove it was prescribed for you.

Taking medicine out of the UK

If you’re taking medicine out of the UK, ask your doctor or pharmacist whether your medicine contains a controlled drug. If it does, check the rules for the country you’re going to with the embassy before you travel.  You’ll need to prove it’s yours with either a prescription or letter from your doctor.

Bringing medicine to the UK

If you’re a UK resident who has been prescribed medicine while you were abroad, you need to contact the Drug and Firearms Licensing Unit ( DFLU ).

If you’re not a UK resident, you will need to carry a letter of proof that the medicine was prescribed for you.

The letter must include:

• the dates you are travelling to or from the UK
• a list of your medicine, including how much you have, doses and the strength
• the signature of the person who prescribed your drugs

You can only bring up to 3 months supply of your medicine with you.

Your doctor or pharmacist can tell you if your medicine contains a controlled drug. You can also check the drugs listed on the packaging of your medicine and search for them on the controlled drugs list . The list does not give names of medicines, only drugs that are used in medicines.

If it contains a drug listed as schedule 1

You must contact the DFLU before you travel to the UK.

You cannot bring schedule 1 drugs into the UK without a licence. Licences for schedule 1 drugs are limited to research or other special purposes. You cannot use a Schengen Certificate to bring schedule 1 drugs into the UK.

If you need more than 3 months supply of your medicine

You’ll need to contact a UK doctor or pharmacist to prescribe the medicine for you once you’re in the UK. This includes medicines not licensed in the UK. You may need to pay.

If you bring more than 3 months supply with you, or get more medicine posted to you, it will be taken away.

Exceptional circumstances

If there are exceptional circumstances which mean you need to bring more than 3 months supply of your medicine into the UK, you may be able to apply for a personal licence .

Contact the Drug and Firearms Licensing Unit ( DFLU )

Drug and Firearms Licensing Unit [email protected] Telephone: 0300 105 0248 Monday to Friday Find out about call charges

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Some things are too essential to leave behind. Know what to expect when traveling with medicine and most importantly, keep your medication with you.

Traveling with medication

Bringing medication through security.

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Medication and medical equipment.

Travelling with medication and medical devices overseas can be difficult. You may have trouble finding some things you need overseas. You may also have trouble taking what you need with you on your flight or cruise.

Some medication could be illegal in your destination. Locally bought medication can be poor quality or counterfeit, or some just hard to find, especially if they're not widely accepted in the local culture.

Plan ahead. Get the information you need before you go. When you're informed, you can take steps to reduce the risk of having problems with medication or medical equipment while you're away. 

Before you travel, make sure you:

• see your doctor or travel clinic for medical advice
• get travel insurance
• learn about Australian laws
• learn about the local laws around medication
• find out any cultural considerations about your medication or condition
• pack enough medication to stay in good health on your trip
• check whether your airline or cruise ship have restrictions on your medical equipment or mobility aids
• make emergency plans in case things go wrong .

This page is for Australians planning to travel overseas with medication or medical equipment. If you're already overseas and need medical supplies, see our general advice on  medical assistance overseas .

1. See your doctor

Consider your physical and mental health before you travel. Especially if you have a pre-existing medical condition. You could put your health at risk if you run out of medication while you're away.

See your doctor or travel clinic to:

• have a basic health check-up
• ask if your travel plans may affect your health
• plan any vaccinations you need
• make sure you have enough medication to cover your needs overseas, and a bit more to cover any unforeseen events.

Do this at least 8 weeks before you leave.

Authorities overseas may ask for evidence to prove the medication is yours. Ask your doctor for a letter stating:

• what the medicine is
• how much you'll take
• that it's for personal use. 

If you have a chronic health condition, talk to your doctor about how you will manage it while you're away. For more information, see our general advice on  vaccinations and preventative health.  

2. Get travel insurance

You need  insurance to travel overseas. Check if your insurer will cover:

• pre-existing conditions
• replacing a medical device if it's lost, damaged or stolen
• seeing a local doctor
• medical evacuation.

If you want cover for prescription medication you may need a specialised insurance policy. Most insurers won't cover the cost of prescription medication. This includes:

• if your bag is lost or stolen and your medication was inside
• if you are hospitalised and need a prescription medication.

Some countries have a  reciprocal health care agreement  with Australia. This covers essential medical care. It might not cover the cost of medication you need  while you're away . You will still need  travel insurance  to visit these countries.

3. Understand Australian law

You can only take prescription medicine out of Australia if it's for personal use and limits apply. This includes medicines supplied under the Pharmaceutical Benefits Scheme (PBS).  Find out if there are laws or restrictions on how much PBS-subsidised medication you can take overseas .

4. Understand the law in your destination

Not all medicine you take in Australia is available in other countries. Some common medicines may even be considered illegal or a controlled substance. Commonly restricted drugs include:

• amphetamines, such as ADHD medications
• medical marijuana/cannabis
• opioid-based painkillers, such as codeine
• medication containing pseudoephedrine, such as cold and flu tablets
• sleeping pills
• anti-anxiety and antidepressant medications.

If you're taking medication with you, confirm it's legal in your destination or if any rules or restrictions apply. Depending on your medication, you may need to apply for a permit to bring it to your destination.

What you can do:

• Contact the consulate or embassy of your destination. Ask their advice.
• Talk to your doctor if your medication is illegal in your destination. Ask if there's an alternative they can prescribe.
• Always carry medication in its original packaging.

Penalties for carrying or using controlled drugs can be severe. Read our travel advice for your destination .

5. Learn about local culture and attitudes

Attitudes and beliefs about some illnesses and medication can be negative in other countries. This includes attitudes and beliefs about seizures and  mental health  episodes.

It also includes attitudes toward reproductive health. Even if contraception is legal there, some doctors and pharmacists may refuse to supply it.

• Find out if your medication is controversial in your destination. You may wish to be discreet about it. 
• Find out if your  mental illness  is generally accepted in your destination. If it isn't, you may have trouble refilling scripts for it.
• Research your destination. Explore online resources for people with your condition or medication. Read the health section in our travel advisory.

It's important you respect your destinations' culture and attitudes, even if you don't agree with them. If you don't, you could find yourself in trouble. The Australian Government is limited in how and when it can help you. See the  Consular Service Charter . 

6. Pack enough for your trip

You may not be able to refill your script easily in your destination. If possible, pack enough medication to last your whole trip. If you're going for a long time, make sure the quantity you're taking is  within the law.

Medication and equipment that are cheap in Australia can cost a lot more overseas, especially if your items are subsidised by the Australian Government. This includes items subsidised under the  Pharmaceutical Benefits Scheme  (PBS) and  National Disability Insurance Scheme  (NDIS). 

• If it looks like you're taking a lot, local authorities could suspect you plan to sell it. You could be  arrested or jailed  for  carrying or using drugs . Check the  law .
• You may need to prove it's for you. Keep a copy of your script or a letter from your doctor with your medication, and if possible keep the medication in its original pharmacy packaging.
• Don't risk losing it all. If you keep all your medication together and your bag is  lost or stolen , you could be stuck without any. Keep a quantity of your medication is a separate bag, just in case. 

If you do run out while you're overseas, you need to know how to get more. Read our advice about getting  medical assistance  overseas. See the 'Health' section of your destination's  travel advisory  for local health care information.

7. Check restrictions on medical equipment

Your  airline or  cruise ship  may have restrictions on what you can carry on board. This often applies to carrying mobility aids and medical equipment. 

Restrictions often apply to assistance animals, battery-operated devices and sharps. This includes syringes.

Most airlines will require you to check in your wheelchair.

Talk to your airline or cruise about what restrictions may apply. Make sure you can:

• take the equipment you need
• access toilets and other facilities
• get the right support from the crew.

See our advice for travellers with a  disability .

8. Make emergency plans

Talk to the people you're travelling with about your and their medical needs. You may need to support each other if one of you gets sick overseas.

Have an action plan. If you carry emergency medication or use any medical or mobility aids, show your travelling companions what to do.

Know local emergency contact numbers. You can find these in our  travel advice for your destination .

Consular services and health

You're responsible for managing your health and access to medication and medical equipment while overseas.

If you need  medical assistance overseas , check local contacts in our  travel advice for your destination .

The Australian Government is limited as to how and when we can help. Read the  Consular Services Charter  for more information. 

What we can do

• We can provide consular help in a medical emergency.
• We can provide details of local doctors and hospitals.
• We can , in some destinations, provide a list of pharmacies.
• We can contact friends or family on your behalf, if you consent.
• We can transfer you to telephone counselling services.

What we can't do

• We can't give you medical advice.
• We can't guarantee your health and safety.
• We can't pay for your medication and medical expenses overseas.
• We can't recommend local doctors or hospitals to write you a script.
• We can't recommend a local pharmacy to refill your script.
• We can't get you out of jail if local authorities suspect you're carrying or using drugs .
• Read our general advice on  vaccinations and preventative health .
• See our advice for  mature travellers  or those travelling with  children .
• Know what happens if you're suspected of  carrying or using drugs  and  arrested or jailed overseas .
• See our advice for people travelling with a  disability  or a  mental health  condition.
• Read about about Australia's  reciprocal health care agreements .
• Before you go, get  international travel insura nce .
• See information about  travelling overseas with PBS medicines  (Services Australia).
• Read about  taking medicines and medical devices overseas  (Therapeutic Goods Administration).
• Read the  travel insurance buying guide  (CHOICE).

Related content

Many countries don't have the same access, services or support for people with disabilities as Australia. Learn more about travelling with a disability.

When you go overseas, you may be exposed to a range of infectious diseases. Before you go, learn about the health risks in your destination and see your doctor.

Medical tourism is when you go overseas for medical treatment. Before you go, gather the information you need. Make informed choices about your medical procedure.

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• Section 5 - Leishmaniasis, Visceral
• Section 5 - Onchocerciasis / River Blindness

CDC Yellow Book 2024

Author(s): Kathrine Tan, Francisca Abanyie

Infectious Agent

Transmission, epidemiology, clinical presentation.

INFECTIOUS AGENT:  Plasmodium spp.

Multiple countries in Africa, the Americas, and Asia

TRAVELER CATEGORIES AT GREATEST RISK FOR EXPOSURE & INFECTION

PREVENTION METHODS

Avoid insect bites

Use malaria chemoprophylaxis

DIAGNOSTIC SUPPORT

• 770-488-7788 (M–F 9 a.m.–5 p.m. Eastern)
• 770-488-7100 (after hours)

Parasitological diagnosis: DPDx

Malaria in humans is caused by protozoan parasites of the genus Plasmodium , including Plasmodium falciparum , P. malariae , P. ovale , and P. vivax . In addition, zoonotic forms have been documented as causes of human infections and some deaths, especially P. knowlesi , a parasite of Old World (Eastern Hemisphere) monkeys, in Southeast Asia.

Plasmodium species are transmitted by the bite of an infective female Anopheles mosquito. Occasionally, transmission occurs by blood transfusion, needle sharing, nosocomially, organ transplantation, or vertically from mother to fetus. Malaria transmission occurs in large areas of Africa, Latin America, and parts of the Caribbean, Eastern Europe, the South Pacific, and in Asia including South Asia, Southeast Asia, and the Middle East ( Map 5-12 , Map 5-13 , and Map 5-14 ).

Map 5-12 Malaria-endemic destinations in the Americas & the Caribbean

View Larger Figure

Malaria-endemic destinations are labeled using black font; destinations not endemic for malaria are labeled using gray font. Countries with areas endemic for malaria are shaded completely even if transmission occurs only in a small part of the country. For more specific within-country malaria transmission information, see Section 2, Yellow Fever Vaccine & Malaria Prevention Information, by Country .

Map 5-13 Malaria-endemic destinations in Africa & the Middle East

Map 5-14 Malaria-endemic destinations in Asia & Oceania

Malaria is a major international public health problem. According to the World Health Organization (WHO) World Malaria Report 2019, >90 countries reported ≈228 million infections and ≈405,000 deaths in 2018. Travelers going to malaria-endemic countries are at risk of contracting the disease, and almost all the ≈2,000 cases of malaria that occur each year in the United States are imported.

The risk of acquiring malaria differs substantially from traveler to traveler and from region to region, even within a single country. This variability is a function of the intensity of transmission within the various regions and the itinerary, duration, season, and type of travel. Risk also varies by travelers’ adherence to mosquito precautions and prophylaxis recommendations. In 2016, 2,078 cases of malaria (including 7 deaths) were diagnosed in the United States and its territories and were reported to the Centers for Disease Control and Prevention (CDC). Of cases for which country of acquisition was known, 85% were acquired in Africa, 9% in Asia, 5% in the Caribbean and the Americas, and 1% in Oceania or the Eastern Mediterranean. Of US residents with malaria who reported a reason for travel, 69% were visiting friends and relatives.

Information about malaria transmission in specific countries is derived from various sources, including WHO (see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country ). The information presented here was accurate at the time of publication; the risk for malaria can change rapidly and from year to year, however, because of changes in local weather conditions, mosquito vector density, and prevalence of infection. See updated information CDC website.

Malaria is characterized by fever and influenza- like symptoms, including chills, headache, myalgias, and malaise; symptoms can occur intermittently. In severe disease, acute kidney injury, acute respiratory distress syndrome, mental confusion, seizures, coma, and death can occur. Malaria symptoms can develop as early as 7 days after being bitten by an infectious mosquito in a malaria-endemic area and as late as several months or more after exposure. Suspected or confirmed malaria, especially P. falciparum , is a medical emergency requiring urgent intervention, because clinical deterioration can occur rapidly and unpredictably. See Box 5-10 for frequently asked clinical questions.

Box 5-10 Frequently asked clinical questions

How do i address concerns about side effects from prophylaxis.

• Prophylaxis can be started earlier if the traveler has concerns about tolerating a particular medication. For example, mefloquine can be started 3–4 weeks in advance to allow potential adverse events to occur before travel. If unacceptable side effects develop, the clinician has time to change the medication before the traveler’s departure.
• The drugs used for antimalarial prophylaxis are generally well tolerated. Side effects can occur, however. Minor side effects usually do not require stopping the drug. Clinicians should determine if symptoms are related to the medicine and make a medication change if needed.

WHAT SHOULD A TRAVELER DO IF THEY MISS A DOSE OF PROPHYLAXIS?

• Compared with drugs with short half-lives, which are taken daily, drugs with longer half-lives, which are taken weekly, offer the advantage of a wider margin of error if the traveler is late with a dose.
• For a weekly drug, prophylactic blood levels can remain adequate if the dose is only 1–2 days late. If this is the case, the traveler can take a dose as soon as possible, then resume weekly doses on the originally scheduled day. If the traveler is >2 days late, blood levels might not be adequate. The traveler should take a dose as soon as possible. The weekly doses should resume at this new day of the week (the next dose is 1 week later, then weekly thereafter).
• For a daily drug, if the traveler is 1–2 days late, protective blood levels are less likely to be maintained. The traveler should take a dose as soon as possible and resume the daily schedule at the new time of day.

WHAT HAPPENS IF TOO HIGH A DOSE OF PROPHYLAXIS IS TAKEN?

• Overdose of antimalarial drugs, particularly chloroquine, can be fatal. Medications should be stored in childproof containers out of reach of infants and children.

ISN’T MALARIA A TREATABLE DISEASE? WHY NOT CARRY A TREATMENT DOSE OF ANTIMALARIALS INSTEAD OF TAKING MALARIA PROPHYLAXIS?

• Malaria could be fatal even when treated, which is why prevention is always preferable to treating infections after they occur.

WHAT SHOULD BE DONE IF FEVER DEVELOPS WHILE TRAVELING IN A MALARIA-ENDEMIC AREA?

• Malaria and other potentially life-threatening infections acquired during travel could be fatal if treatment is delayed. Travelers should promptly seek medical help and continue to take malaria prophylaxis while in the malaria-endemic area.

WHAT SHOULD BE DONE IF A TRAVELER WHO TOOK MALARIA PROPHYLAXIS DEVELOPS FEVER AFTER RETURNING FROM THEIR TRIP?

• Malaria prophylaxis, while highly effective, is not 100% effective. Travelers should be advised to seek medical care immediately if fever develops, report their travel history, get tested for malaria, and get treated promptly if infection is confirmed.
• Malaria smear or a rapid diagnostic test must be performed, and results obtained immediately (within a few hours). These tests should not be sent out to reference laboratories that take days to weeks to return results. Empiric treatment with antimalarial drugs is not recommended because the malaria smear provides critical information for appropriate treatment. If a patient has an illness suggestive of severe malaria and a compatible travel history in an area where malaria transmission occurs, and malaria testing is not immediately available, start treatment as soon as possible, even before the diagnosis is established. See CDC recommendations for malaria treatment .

Travelers with symptoms of malaria should seek medical evaluation as soon as possible, even if still traveling. Consider malaria in any patient with a febrile illness who has recently returned from a malaria-endemic country. Diagnostic assistance is available from state public health laboratories or CDC. The CDC malaria laboratory can assist in speciating malaria by blood smear microscopy, or confirm species by PCR testing. The CDC laboratory also can assess malaria parasites for mutations that confer resistance to medications. Serologic testing , used in certain situations (e.g., case investigations), can also be done by CDC laboratories.

In the United States, malaria is a notifiable disease. Health care providers must report cases of malaria diagnosed via microscopy or PCR in the United States and its territories to local or state health departments. See more information on reporting malaria .

Blood Smear Microscopy

Blood smear microscopy remains the most important method for malaria diagnosis. Microscopy can provide immediate information about the presence of parasites, allow quantification of the density of the infection, and allow determination of the species of the malaria parasite—all of which are necessary for providing the most appropriate treatment. Tests should be performed immediately when ordered by a health care provider, and microscopy results should be available as soon as possible, ≤24 hours of the patient’s presentation. Assistance with speciation of malaria on smears is available from state health departments or CDC.

In resource-limited settings, and particularly in sub-Saharan Africa, overdiagnosis and the rate of false-positive microscopy for malaria can be high; warn travelers that a local diagnosis of malaria could be incorrect. In such cases, acutely ill travelers should seek the best available medical services and continue their prophylaxis regimen until they have a definitive diagnosis.

Rapid Diagnostic Testing

Rapid diagnostic tests (RDTs) for malaria detect antigens derived from malaria parasites. Malaria RDTs are immunochromatographic tests that most often use a dipstick or cassette format and provide results in 2–15 minutes. RDTs offer a useful alternative to microscopy in situations where reliable microscopic diagnosis is not immediately available. Although RDTs can detect malaria antigens within minutes, they have several limitations. RDTs cannot distinguish between all Plasmodium species that affect humans, they might be less sensitive than expert microscopy or PCR for diagnosis, they cannot quantify parasitemia, and an RDT-positive test result might persist for days or weeks after an infection has been treated and cleared. Thus, RDTs are not useful for assessing response to therapy. Furthermore, in some areas, mutations are increasingly being observed in malaria parasites, resulting in an absence of the malaria antigen usually detected by many RDTs, including the only RDT used in the United States. The absence of this parasite antigen in peripheral blood can lead to false-negative RDT test results.

Both positive and negative RDT results must always be confirmed by microscopy. Microscopy confirmation of the RDT result should occur as soon as possible, because the information on the presence, density, and parasite species is critical for optimal management of malaria. The US Food and Drug Administration (FDA) has approved an RDT (the BinaxNOW Malaria test) for hospital and commercial laboratory use; the test is not approved for use by clinicians or patients. Laboratories that do not provide in-house, on-the-spot microscopy services should maintain a stock of malaria RDTs so that they will be able to perform immediate malaria diagnostic testing when needed.

PCR Testing

PCR tests also are available to detect malaria parasites. These tests are more sensitive than routine microscopy, but results are not usually available as quickly as microscopy results, thus limiting the utility of PCR for acute diagnosis and initial clinical management. Use of PCR testing is encouraged to confirm the species of malaria parasite and detect mixed infections.

Malaria can be treated effectively if treatment begins early in the disease; delaying therapy, however, can have serious or even fatal consequences. Specific treatment options depend on the species of malaria, the severity of infection, the likelihood of drug resistance (based on where the infection was acquired), the patient’s age, and whether the patient is pregnant or breastfeeding.

See detailed CDC recommendations for malaria treatment . For assistance with the diagnosis or treatment of malaria, call the CDC Malaria Hotline (770-488-7788 or toll-free at 855-856-4713) from 9 a.m. to 5 p.m. Eastern Time. After hours, on weekends, or on holidays, call the CDC Emergency Operations Center at 770-488-7100 and ask the operator to contact the subject matter expert on call for the Malaria Branch. In addition, consult a clinician specializing in travel or tropical medicine or infectious diseases.

Travelers who decline to take prophylaxis, who choose a suboptimal drug regimen (e.g., chloroquine in an area with chloroquine-resistant P. falciparum ), or who require a less-than-optimal drug regimen for medical reasons are at increased risk for acquiring malaria and then needing prompt treatment while abroad. Medications not used in the United States to treat malaria (e.g., halofantrine, sulfadoxine-pyrimethamine) are widely available abroad. CDC does not recommend halofantrine for treatment because of documented adverse cardiac events, including deaths. These adverse events have occurred in people with and without preexisting cardiac problems, and both in the presence and absence of other antimalarial drugs. Sulfadoxine-pyrimethamine is not recommended because of widespread drug-resistant Plasmodium .

Reliable Supply of Malaria Treatment

Some travelers who take effective prophylaxis but who will be in remote areas might decide, in consultation with their travel health provider, to also carry a reliable supply of a full course of an approved malaria treatment regimen. In the event a traveler carrying a reliable supply is diagnosed with malaria, they will have immediate access to an approved treatment.

CDC recommends that the reliable supply be acquired in the United States, so clinicians can consider the traveler’s other medical conditions or medications when selecting an antimalarial drug and to avoid the possibility of travelers obtaining counterfeit drugs in the local pharmacy or market, or depleting local resources. In rare instances when access to medical care is not available and the traveler develops a febrile illness consistent with malaria, the reliable supply medication can be self-administered presumptively. Advise travelers that self-treatment of a possible malarial infection is only a temporary measure, and that prompt medical evaluation is imperative.

Two malaria treatment regimens available in the United States can be prescribed as a reliable supply for self-treatment: atovaquone-proguanil and artemether-lumefantrine. To treat malaria, CDC recommends against using the same (or related) drug that has been taken for prophylaxis. For example, atovaquone-proguanil can be used as a reliable supply medication by travelers who are not taking atovaquone-proguanil for prophylaxis. See Table 5-26 for dosing recommendations.

Table 5-26 Reliable supply regimens for malaria treatment 1

PEDIATRIC DOSE

ATOVAQUONE-PROGUANIL 2 Adult tablets:

• Atovaquone 250 mg
• Proguanil 100 mg

Pediatric tablets:

• Atovaquone 62.5 mg
• Proguanil 25 mg

4 adult tablets taken orally (as a single daily dose) for 3 consecutive days

Weight-based daily dose taken orally (as a single daily dose) for 3 consecutive days

5–8 kg: 2 pediatric tablets 9–10 kg: 3 pediatric tablets 11–20 kg: 1 adult tablet 21–30 kg: 2 adult tablets 31–40 kg: 3 adult tablets >41 kg: 4 adult tablets

Contraindicated in people with severe renal impairment (creatinine clearance <30 mL/min).

Not recommended for people taking atovaquone-proguanil prophylaxis.

Not recommended for children weighing <5 kg, or people who are pregnant or breastfeeding infants weighing <5 kg.

ARTEMETHER-LUMEFANTRINE 2 One tablet

• Artemether 20 mg
• Lumefantrine 120 mg

ADULT & PEDIATRIC DOSE

Weight-based treatment schedule for both adult and pediatric patients. Patients should take an initial dose, followed by a second dose 8 hours later, then 1 dose twice a day for the next 2 days (total of 6 oral doses over 3 days).

5 kg to <15 kg: 1 tablet per dose 15 kg to <25 kg: 2 tablets per dose 25 kg to <35 kg: 3 tablets per dose ≥35 kg: 4 tablets per dose

Not recommended for people taking mefloquine prophylaxis.

Not recommended for children weighing <5 kg, or people breastfeeding infants weighing <5 kg.

1 A reliable supply is a complete course of an approved malaria treatment regimen obtained in the United States before travel. A reliable supply is not counterfeit or substandard; will not interact adversely with the patient’s other medicines, including malaria chemoprophylaxis; will not deplete local resources in the destination country.

2 If used for presumptive self-treatment, patients should seek medical care as soon as possible.

Malaria prevention consists of a combination of mosquito avoidance measures and chemoprophylaxis. Prevention measures must address all malaria species in the travel area and apply to both short-term and long-term travelers. Although highly efficacious, interventions are not 100% effective, so all febrile persons returning from malaria-endemic areas should be tested for malaria even if they took chemoprophylaxis.

Preventing malaria involves striking a balance between effectiveness and safety: ensuring that all people at risk for infection use the recommended prevention measures, and preventing rare occurrences of adverse effects. Conduct an individual risk assessment for every traveler by collecting a detailed travel itinerary, including countries, specific areas to be visited in those countries (e.g., cities, rural areas, both), types of accommodation, season, and style of travel. Modify the risk assessment depending on traveler characteristics (e.g., pregnancy, underlying health conditions) and malaria characteristics at the destination (e.g., intensity of transmission, local parasite resistance to drugs). Depending on the level of risk, it might be appropriate to recommend no specific interventions, mosquito avoidance measures only, or mosquito avoidance measures plus chemoprophylaxis.

Several factors increase a traveler’s risk for malaria. Travel, even for short periods of time, to areas with intense malaria transmission can result in infection. Malaria transmission is not distributed homogeneously throughout a country, so review the exact itinerary to determine if travel will occur in highly endemic areas. In countries where malaria is seasonal, travel during peak transmission season also increases risk. Travelers going to rural areas or staying in accommodations without screens or air conditioning also will be at greater risk. The greatest risk for malaria is associated with first- and second-generation immigrants living in nonendemic countries who return to their countries of origin to visit friends and relatives (VFRs). VFR travelers might perceive themselves to be at no risk because they grew up in a malaria-endemic country and consider themselves immune to the disease. Tolerance acquired through continuous exposure to malaria is quickly lost, however; consider VFRs to have the same risk as other nonimmune travelers (see Sec. 9, Ch. 9, Visiting Friends & Relatives: VFR Travel ). Also remind travelers that they could become infected even if they had malaria before, and they still need to take preventive measures.

Mosquito Avoidance Measures

Because of the nocturnal feeding habits of Anopheles mosquitoes, malaria transmission occurs primarily between dusk and dawn. Travelers can reduce contact with mosquitoes by remaining in enclosed air-conditioned rooms or well-screened areas, sleeping under mosquito nets (preferably insecticide-treated), using an effective insecticide spray or mosquito coils in living and sleeping areas during evening and nighttime hours, and wearing clothes that cover most of the body.

All travelers should use an effective mosquito repellent, such as those that contain DEET (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods ). Repellents should be applied to exposed parts of the skin. If travelers are also wearing sunscreen, they should apply sunscreen first and insect repellent second. In addition to using a topical insect repellent, a permethrin-containing product can be applied to mosquito nets and clothing for additional protection against mosquitoes. Mosquito repellant–impregnated clothing also is available.

Chemoprophylaxis

Choosing a drug to prevent malaria.

All recommended primary prophylaxis regimens involve taking a medicine before, during, and after travel to an area with malaria. Beginning the drug before travel allows the antimalarial agent to be in the blood before the traveler is exposed to malaria parasites. In choosing a prophylaxis regimen before travel, the traveler and the travel health provider should consider several factors, including the presence of antimalarial drug resistance in the area of travel, length of travel, the patient’s other medical conditions, allergy history, other medications prescribed or already being taken (to assess possible drug interactions), potential side effects, and the cost of the antimalarial. Long-term travelers, defined as people who travel for ≥6 months, have additional considerations (see Box 5-11 ). Table 5-27 lists some of the benefits and limitations of medicines used for malaria prophylaxis; see additional information about choosing a malaria prophylaxis regimen .

Recommendations for drugs to prevent malaria by country of travel can be found in Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country . Recommended drugs for each country are listed in alphabetical order and have comparable efficacy in that country. When >1 drug is recommended,  Table 5-27  can help with the decision-making process. No antimalarial drug is 100% protective; therefore, travelers must combine prophylaxis with mosquito avoidance and personal protective measures (e.g., insect repellent, long sleeves, long pants, sleeping in a mosquito-free setting, using an insecticide-treated mosquito net).

Table 5-27 Malaria chemoprophylaxis: prescribing considerations

REASONS TO CONSIDER USING THIS DRUG

REASONS TO CONSIDER AVOIDING THIS DRUG

ATOVAQUONE-PROGUANIL

Good for last-minute travelers because the drug is started 1–2 days before travel.

Some people prefer to take a daily medicine.

Good choice for shorter trips because the traveler takes the medicine for only 7 days after leaving malaria-endemic area, rather than for 4 weeks.

Well tolerated and side effects uncommon.

Pediatric tablets are available and might be more convenient.

Cannot be used by people who are pregnant or who are breastfeeding a child that weighs <5 kg.

Cannot be taken by people with severe renal impairment.

Tends to be more expensive than some of the other options, especially for long trips.

Some people (including children) would rather not take medicine every day.

CHLOROQUINE

Some people would rather take medicine weekly.

Good choice for long trips because it is taken only weekly.

Some people are already taking hydroxychloroquine chronically for rheumatologic conditions; in those instances, they might not have to take an additional medicine.

Can be used in all trimesters of pregnancy.

Cannot be used in areas with chloroquine or mefloquine resistance.

Can exacerbate psoriasis.

Some people would rather not take a weekly medication.

For short trips, some people would rather not take medication for another 4 weeks after leaving malaria-endemic areas.

Not a good choice for last-minute travelers, because drug needs to be started 1–2 weeks before travel.

DOXYCYCLINE

Tends to be the least expensive antimalarial drug.

People already taking doxycycline chronically to prevent acne do not have to take an additional medicine.

Doxycycline also can prevent other infections (e.g., rickettsial infections, leptospirosis); thus, might be preferred by people planning to camp, hike, and swim in fresh water where risk is high

Cannot be used by people who are pregnant or who are breastfeeding a child, or by children aged <8 years.

Some people would rather not take medicine every day.

People prone to getting vaginal yeast infections when taking antibiotics might prefer taking a different medicine.

People might want to avoid the increased risk of sun sensitivity.

Some people are concerned about the potential of getting an upset stomach from doxycycline.

Can be used in all trimesters of pregnancy and during breastfeeding.

Cannot be used in areas with mefloquine-resistant Plasmodium spp.

Cannot be used in patients with certain psychiatric conditions; some travelers without psychiatric conditions would prefer not taking a medication with known neuropsychiatric side effects.

Cannot be used in patients with a seizure disorder.

Not recommended for people with cardiac conduction abnormalities.

Not a good choice for last-minute travelers because drug needs to be started ≥2 weeks before travel.

One of the most effective drugs for prevention of P. vivax; thus, a good choice for travel to places with >90% P. vivax .

Good choice for shorter trips because the traveler takes the medicine for 7 days after leaving a malaria-endemic area, rather than for 4 weeks.

Cannot be used in patients with G6PD deficiency.

Cannot be used in patients who have not been tested for G6PD deficiency.

Costs and delays associated with getting a quantitative G6PD test might prohibit testing; however, the test only has to be done once. After a normal G6PD level is verified and documented, the test does not have to be repeated the next time primaquine or tafenoquine is considered.

Cannot be used by people who are pregnant.

Cannot be used by people who are breastfeeding unless the infant has also been tested for G6PD deficiency.

Some people are concerned about the potential of getting an upset stomach from primaquine.

TAFENOQUINE

One of the most effective drugs for prevention of P. vivax malaria but also prevents P. falciparum .

Good choice for shorter trips because the traveler takes the medicine once, 1 week after leaving malaria-endemic area, rather than for 4 weeks.

Good for last-minute travelers because the drug is started 3 days before travel.

Cannot be used in people with G6PD deficiency.

Costs and delays associated with getting a quantitative G6PD test might prohibit testing; however, the test only has to be done once. After a normal G6PD level is verified and documented, the test does not have to be repeated the next time tafenoquine or primaquine is considered.

Cannot be used by children.

Not recommended for patients with psychotic disorders.

Abbreviations: G6PD, glucose-6-phosphate-dehydrogenase

Box 5-11 Malaria prevention & prophylaxis considerations for the long-term traveler (travel >6 months)

Considerations.

• Malaria prevention measures are the same for both short- and long-term travelers.
• Longer stays mean longer duration of exposure and increased risk of acquiring malaria.
• Travelers’ attention to mosquito avoidance can wane over time.
• Travelers might not adhere to a lengthy course of malaria prophylaxis due to forgetfulness, fear of side effects, and the possible declining sense of risk and need over time.
• Travelers might move between highly endemic or low endemic areas within a country or region.
• Travelers might have a decreased sense of risk and concern about malaria after engaging in local conversations and lore, particularly regarding malaria immunity over time.
• Travelers who become ill with malaria in countries with limited access and quality of health care might not receive appropriate or effective treatment.

ADDITIONAL ADVICE FOR LONG-TERM TRAVELERS

• Travelers should not count on being able to obtain safe, reliable malaria prophylaxis medication abroad; strongly advise that before leaving the United States they purchase enough medication to last them for the entire duration of their travel to malaria-endemic areas.
• Emphasize continued adherence to and safety of malaria prophylaxis drugs.
• Develop a plan for seeking immediate care when ill with fever, including where to get promptly tested and treated for malaria.
• Advise travelers to purchase travel insurance, including contingencies for medical evacuation.
• Consider having a reliable supply of a treatment dose of antimalarial drugs available in case malaria is diagnosed while traveling.

Medications Used for Prophylaxis

Atovaquone-proguanil.

Atovaquone-proguanil (Malarone) is a fixed combination of the drugs atovaquone and proguanil. Prophylaxis should begin 1–2 days before travel to malaria-endemic areas; the medication should then be taken daily, at the same time each day, while in the malaria-endemic areas, and daily for 7 days after leaving the endemic areas (see Table 5-28 for recommended dosages). Atovaquone-proguanil is well tolerated, and side effects are rare. The most common adverse effects reported in people using atovaquone-proguanil for prophylaxis or treatment are abdominal pain, nausea, vomiting, and headache.

Atovaquone-proguanil is not recommended for prophylaxis in children weighing <5 kg (11 lb), pregnant people, people breastfeeding infants <5 kg, or patients with severe renal impairment (creatinine clearance <30 mL/min). Proguanil can increase the effect of warfarin, so travelers might need international normalized ratio monitoring or adjustment of warfarin dosage. No data are available, however, regarding the clinical impact of taking atovaquone-proguanil and warfarin at the same time.

Table 5-28 Malaria chemoprophylaxis: dosing information

INDICATIONS

DOSING / CONTRAINDICATIONS / PRECAUTIONS

Prophylaxis in all malaria-endemic areas

Adult tablets:

1 adult tablet taken orally, 1×/day

Weight-based daily dosing schedule (taken orally, 1×/day) 5 kg to <8 kg: 1/2 pediatric tablet 8 kg to <10 kg: 3/4 pediatric tablet 10 kg to <20 kg: 1 pediatric tablet 20 kg to <30 kg: 2 pediatric tablets 30 kg to <40 kg: 3 pediatric tablets ≥40 kg: 1 adult tablet

Begin taking 1–2 days before travel to malaria-endemic areas.

Take 1×/day, at the same time each day, while in malaria-endemic areas. Continue taking 1×/day for an additional 7 days after leaving endemic areas.

Take with food or a milky drink.

A pharmacist might need to prepare and dispense partial tablet doses in individual capsules, as described in the text.

Prophylaxis only in areas with chloroquine-sensitive malaria

300 mg base (500 mg salt) taken orally, once a week

5 mg/kg base (8.3 mg/kg salt), up to a maximum dose of 300 mg base (500 mg salt), taken orally, 1×/week

Begin taking 1–2 weeks before travel to malaria-endemic areas.

Take 1×/week, on the same day each week, while in malaria-endemic areas.

Continue taking 1×/week for another 4 weeks after leaving endemic areas.

100 mg taken orally, 1×/day

≥8 years of age: 2.2 mg/kg, up to a maximum dose of 100 mg, taken orally, 1×/day

Take 1×/day, at the same time each day, while in malaria-endemic areas. Continue taking 1×/day for another 4 weeks after leaving endemic areas.

Contraindicated in children aged <8 years and in people who are pregnant.

HYDROXY-CHLOROQUINE

An alternative to chloroquine for prophylaxis only in areas with chloroquine-sensitive malaria

310 mg base (400 mg salt) taken orally, 1×/week

5 mg/kg base (6.5 mg/kg salt), up to a maximum dose of 310 mg base (400 mg salt), taken orally, 1×/week

Prophylaxis in areas with mefloquine-sensitive malaria

228 mg base (250 mg salt) taken orally, 1×/week

Weight-based weekly dosing schedule (taken orally, 1×/week) ≤9 kg: 4.6 mg/kg base (5 mg/kg salt) >9–19 kg: 1/4 tablet >19–30 kg: 1/2 tablet >30–45 kg: 3/4 tablet >45 kg: 1 tablet

Begin taking ≥2 weeks before travel to malaria-endemic areas.

Contraindicated in people allergic to mefloquine or related compounds (quinidine, quinine) and in people with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures.

Use with caution in people with psychiatric disturbances or a previous history of depression.

PRIMAQUINE 1

Prophylaxis for short-duration travel to areas with principally P. vivax . Terminal prophylaxis (presumptive antirelapse therapy) to decrease the risk for relapses of P. vivax and P. ovale .

30 mg base (52.6 mg salt) taken orally, 1×/day. Same dose used for both primary and terminal prophylaxis; duration of therapy differs.

0.5 mg/kg base (0.8 mg/kg salt), up to maximum dose of 30 mg base (52.6 mg salt), taken orally, 1×/day Same dose for used both primary and terminal prophylaxis; duration of therapy differs.

Terminal prophylaxis indicated for people with prolonged exposure to P. ovale , P. vivax , or both. Take daily for 14 days after departure from the malaria-endemic area.

Contraindicated in people with G6PD deficiency.

Also contraindicated during pregnancy and breastfeeding unless the breastfed infant has a documented normal G6PD level.

TAFENOQUINE 1

200 mg orally

Not indicated for use in children

Begin taking 3 days before travel to malaria-endemic areas. Take 1×/week, on the same day each week, while in malaria-endemic areas. Take 1 additional dose 1 week after leaving endemic areas. Contraindicated in people with G6PD deficiency. Also contraindicated during pregnancy and breastfeeding unless the breastfed infant has a documented normal G6PD level.

1 Before prescribing primaquine or tafenoquine to any patient, document a normal G6PD level using a quantitative test.

Chloroquine & Hydroxychloroquine

Chloroquine phosphate or hydroxychloroquine sulfate (Plaquenil) can be used to prevent malaria only in destinations where chloroquine-resistant Plasmodium spp. are not active (see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country ). Prophylaxis should begin 1–2 weeks before travel to malaria-endemic areas. Travelers should continue taking the drug once a week, on the same day of the week, during travel in malaria-endemic areas, and for 4 weeks after they leave endemic areas (see  Table 5-28  for recommended dosages).

Reported side effects of chloroquine and hydroxychloroquine include blurred vision, dizziness, gastrointestinal disturbance, headache, insomnia, and pruritus, but generally, these effects do not require travelers to discontinue the drug. High doses of chloroquine (e.g., those used to treat rheumatoid arthritis) have been associated with retinopathy; this serious side effect appears to be extremely unlikely when chloroquine is used for routine weekly malaria prophylaxis. Chloroquine and related compounds reportedly can exacerbate psoriasis. People who experience uncomfortable side effects after taking chloroquine might tolerate the drug better by taking it with meals. As an alternative, a traveler experiencing side effects might better tolerate the related compound, hydroxychloroquine sulfate.

Doxycycline

Doxycycline prophylaxis should begin 1–2 days before travel to malaria-endemic areas. Doxycycline should then be taken once a day, at the same time each day, during travel in malaria-endemic areas and daily for 4 weeks after the traveler leaves endemic areas. Insufficient data exist on the antimalarial prophylactic efficacy of related compounds (e.g., minocycline, commonly prescribed for the treatment of acne). People on a long-term regimen of minocycline who need malaria prophylaxis should stop taking minocycline 1–2 days before travel and start doxycycline instead. Minocycline can be restarted after the full course of doxycycline is completed (see  Table 5-28  for recommended dosages).

Doxycycline can cause photosensitivity, usually manifested as an exaggerated sunburn reaction. The risk for such a reaction can be minimized by avoiding prolonged, direct exposure to the sun and by using sunscreen (see Sec. 4, Ch. 1, Sun Exposure ). In addition, doxycycline use is associated with an increased frequency of vaginal yeast infections.

Gastrointestinal side effects (nausea, vomiting) can be minimized by taking the drug with a meal or by specifically prescribing doxycycline monohydrate or the enteric-coated doxycycline hyclate, rather than the generic doxycycline hyclate, which is often less expensive. To reduce the risk for esophagitis, advise travelers to swallow the medicine with sufficient fluids and to avoid taking doxycycline shortly before going to bed.

Doxycycline is contraindicated in people with an allergy to tetracyclines, in pregnant people, and in infants and children aged <8 years. Vaccination with the oral typhoid vaccine Ty21a should be completed ≥24 hours before taking a dose of doxycycline.

Mefloquine prophylaxis should begin ≥2 weeks before travel to malaria-endemic areas. Travelers should continue taking the drug weekly, on the same day each week, during travel in malaria-endemic areas and for 4 weeks after leaving endemic areas (see Table 5-28 for recommended dosages).

At prophylactic doses, mefloquine has been associated with rare but serious adverse reactions (e.g., psychosis, seizures); these reactions are more frequent with the higher doses used for treatment. Other side effects reported in prophylaxis studies include abnormal dreams, anxiety disorder, depression, dizziness, gastrointestinal disturbance, headache, insomnia, and visual disturbances. Other neuropsychiatric disorders occasionally reported include aggressive behavior, agitation or restlessness, confusion, encephalopathy, forgetfulness, hallucinations, mood changes, panic attacks, paranoia, and sensory and motor neuropathies (e.g., ataxia, paresthesia, tremors). On occasion, psychiatric symptoms have been reported to continue long after mefloquine has been stopped. FDA also includes a boxed warning about rare reports of persistent dizziness after mefloquine use.

Mefloquine is contraindicated for travelers with a known hypersensitivity to the drug or related compounds (e.g., quinidine, quinine) and in people with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia and other major psychiatric disorders, or seizures. Mefloquine should be avoided in people with psychiatric disturbances or a history of depression.

A review of available data suggests that mefloquine can be used safely in people concurrently taking beta-blockers if they have no underlying arrhythmia. Mefloquine is not recommended for people with cardiac conduction abnormalities, however. Any traveler receiving a prescription for mefloquine must also receive a copy of the FDA medication guide  [PDF].

Primaquine can cause potentially life-threatening hemolysis in people with glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Rule out G6PD deficiency with a quantitative laboratory test before prescribing primaquine to patients.

Primaquine phosphate has 2 distinct uses for malaria prevention in people with normal G6PD levels: primary prophylaxis in areas with primarily P. vivax , and terminal prophylaxis for travelers who have had prolonged exposure in malaria-endemic areas. Among people with normal G6PD levels taking primaquine, the most common adverse event is gastrointestinal upset; this occurs most commonly if the drug is taken on an empty stomach, and can be minimized or eliminated if it is taken with food.

Primary Prophylaxis

When taken for primary prophylaxis, primaquine should be taken 1–2 days before travel to malaria-endemic areas, daily (at the same time each day) while in the malaria-endemic area, and daily for 7 days after leaving the area (see Table 5-28 for recommended dosages).

Terminal Prophylaxis

In addition to primary prophylaxis, terminal prophylaxis (also known as presumptive antirelapse therapy) generally is indicated for long-term travelers (e.g., military personnel, missionaries, Peace Corps volunteers) with prolonged exposure to P. ovale or P. vivax malaria. Terminal prophylaxis involves taking primaquine toward the end of the exposure period (or immediately thereafter) for the presumptive purpose of eliminating hypnozoites (dormant liver stages) of P. ovale or P. vivax , thereby preventing relapses or delayed-onset clinical presentations of malaria. Because most malaria-endemic areas of the world (except the Caribbean) have ≥1 species of relapsing malaria, travelers to these areas have some risk for acquiring either P. ovale or P. vivax , although the actual risk for an individual traveler is difficult to define.

When indicated, travelers should take primaquine for 14 days after leaving a malaria-endemic area, concurrently with their primary prophylaxis medication. If chloroquine, doxycycline, or mefloquine are used for primary prophylaxis, prescribe primaquine for travelers to take during the last 2 weeks of postexposure prophylaxis. When atovaquone-proguanil is used for primary prophylaxis, travelers can take primaquine during the final 7 days of atovaquone-proguanil, and then for an additional 7 days. If concurrent administration of primary and terminal prophylaxis is not feasible, instruct travelers to take primaquine after completing their primary prophylaxis medication. Primary prophylaxis with primaquine or with tafenoquine (see the following section) obviates the need for terminal prophylaxis.

Tafenoquine

Tafenoquine can cause potentially life-threatening hemolysis in people with G6PD deficiency. Rule out G6PD deficiency with a quantitative laboratory test before prescribing tafenoquine to patients.

Tafenoquine (Arakoda 100 mg tablets) can be used to prevent malaria in adults (see  Table 5-28  for recommended dosages). Travelers should take a daily loading dose of tafenoquine for 3 days before leaving for a malaria-endemic area; starting 7 days after the loading dose is complete, they should take a weekly maintenance dose while in the malaria-endemic area; then take a final dose in the week after leaving the malaria-endemic area. Doses should be taken on the same day each week.

Tafenoquine is contraindicated in pregnant people and during breastfeeding. Avoid prescribing tafenoquine for people with a history of psychotic disorder; rare psychiatric adverse events have been observed in people with a history of psychotic disorder using higher doses of tafenoquine. The most common adverse events reported with use of tafenoquine are dizziness, gastrointestinal disturbances, headache, and clinically insignificant decreases in hemoglobin. Tafenoquine should be taken with food.

As of 2020, CDC no longer recommends tafenoquine for terminal prophylaxis of P. ovale or P. vivax malaria.

Prophylaxis for Infants, Children & Adolescents

All children traveling to malaria-endemic areas should use recommended prevention measures, which often include taking an antimalarial drug. In the United States, antimalarial drugs are not available in liquid formulation and can taste bitter. Calculate pediatric doses carefully according to the patient’s body weight, but never exceed the adult dose. Pharmacists can pulverize tablets and prepare gelatin capsules for each measured dose. If a child is unable to swallow capsules or tablets, parents should prepare the child’s medication dose by breaking open the gelatin capsule or crushing the pill and mixing the drug with a small amount of something sweet (e.g., condensed milk, chocolate syrup, chocolate spread) to ensure the entire dose is delivered to the child. Giving the dose on a full stomach can minimize stomach upset and vomiting.

Atovaquone-proguanil can be used as prophylaxis for infants and children weighing ≥5 kg (11 lb); prophylactic dosing for children weighing <11 kg (24 lb) constitutes off-label use in the United States. Chloroquine and mefloquine are options for infants and children of all ages and weights, depending on drug resistance at the destination. Doxycycline can be used for children aged ≥8 years. Primaquine can be used for children who are not G6PD-deficient and who are traveling to areas with principally P. vivax. Pediatric dosing regimens are included in Table 5-28 .

Prophylaxis During Pregnancy

Malaria infection can be more severe in pregnant than in nonpregnant people. Malaria increases the risk for adverse pregnancy outcomes, including premature birth, spontaneous abortion, and stillbirth; thus, because no prophylaxis regimen is completely effective, advise people who are pregnant or likely to become pregnant to avoid travel to areas with malaria transmission if possible (see Sec. 7, Ch. 1, Pregnant Travelers ). If travel to a malaria-endemic area cannot be deferred, an effective prophylaxis regimen and mosquito avoidance measures are essential.

Pregnant people traveling to areas where chloroquine-resistant P. falciparum has not been reported can take chloroquine prophylaxis. Chloroquine has not been found to have harmful effects on the fetus when used in the recommended doses for malaria prophylaxis; therefore, pregnancy is not a contraindication for malaria prophylaxis with chloroquine or hydroxychloroquine.

For travel to areas with known chloroquine-resistant Plasmodium , mefloquine is the only medication recommended for malaria prophylaxis during pregnancy. Studies of mefloquine use during pregnancy have found no indication of adverse effects on the fetus.

Atovaquone-proguanil is not recommended for use during pregnancy because of limited availability of data on its safety, and because other options are available. If other antimalarial drug options are not feasible, however, clinicians and patients should weigh the options, risks, and benefits of using atovaquone-proguanil to make the best decision for the patient. Doxycycline is contraindicated for malaria prophylaxis during pregnancy because of the risk for adverse effects seen with tetracycline, a related drug, on the fetus. These adverse effects include discoloration and dysplasia of the teeth and inhibition of bone growth. Neither primaquine nor tafenoquine should be used during pregnancy; both drugs can be passed transplacentally to a G6PD-deficient fetus and cause hemolytic anemia in utero.

People planning to become pregnant can use the same medications recommended for use during pregnancy (chloroquine or mefloquine, depending on the area of travel). CDC does not make recommendations about delaying pregnancy after the use of malaria prophylaxis medicines. If the traveler or their health care provider wishes to decrease the amount of antimalarial drug in the body before conception, however, Table 5-29 provides information on the half-lives of the recommended malaria prophylaxis medicines. After 2 half-lives, ≈25% of the drug remains in the body, ≈6% remains after 4 half-lives, and ≈2% remains after 6 half-lives.

Table 5-29 Malaria chemoprophylaxis: half-lives

Prophylaxis during breastfeeding.

The quantities of antimalarial drugs excreted in the breast milk of lactating people are insufficient to provide adequate protection to nursing infants. Therefore, infants who require prophylaxis should receive the recommended dosages of antimalarial drugs listed in Table 5-28 . Because chloroquine and mefloquine can be prescribed safely to infants, infants also can be safely exposed to the small amounts excreted in breast milk. Data about the use of doxycycline in lactating people are very limited; most experts, however, consider the theoretical possibility of adverse events to the infant to be remote.

Although no information is available on the amount of primaquine or tafenoquine that enters human breast milk, test both the person breastfeeding and the infant for G6PD deficiency before initiating chemoprophylaxis with either one of these drugs. Because data are not yet available on the safety of atovaquone-proguanil prophylaxis in infants weighing <5 kg (11 lb), CDC does not recommend this drug to prevent malaria in people who are breastfeeding infants weighing <5 kg. Atovaquone-proguanil can, however, be used to treat people who are breastfeeding infants of any weight when the potential benefit outweighs the potential risk to the infant (e.g., treating a breastfeeding person who has acquired P. falciparum malaria in an area of multidrug-resistant strains and who cannot tolerate other treatment options).

Travel to Areas with Chloroquine-Resistant Malaria

Chloroquine-resistant P. falciparum is found in all parts of the world except the Caribbean and countries west of the Panama Canal. Although chloroquine-resistant P. falciparum predominates in Africa, it is found in combination with chloroquine-sensitive P. vivax malaria in South America and Asia. Chloroquine-resistant P. vivax has been confirmed only in Papua New Guinea and Indonesia. For destinations with known chloroquine-resistant Plasmodium spp., in addition to mosquito avoidance measures, prescribe atovaquone-proguanil, doxycycline, mefloquine, or tafenoquine as prophylaxis.

Travel to Areas with Chloroquine-Sensitive Malaria

Areas with chloroquine-sensitive Plasmodium spp. include many Latin American countries where malaria predominantly is caused by P. vivax . Chloroquine-sensitive P. falciparum is present in the Caribbean and Central American countries west of the Panama Canal. For destinations with known chloroquine-sensitive Plasmodium spp., in addition to mosquito avoidance measures, the many effective prophylaxis options include chloroquine, atovaquone-proguanil, doxycycline, mefloquine, and tafenoquine. In countries where P. vivax predominates, primaquine is also an option.

Travel to Areas With Mefloquine-Resistant Malaria

Mefloquine-resistant P. falciparum has been confirmed in Southeast Asia on the borders of Thailand with Burma (Myanmar) and Cambodia, in the western provinces of Cambodia, in the eastern states of Burma on the border between Burma and China, along the borders of Burma and Laos, and in southern Vietnam. For destinations with known mefloquine-resistant Plasmodium spp., in addition to mosquito avoidance measures, prophylaxis options are atovaquone-proguanil, doxycycline, and tafenoquine.

Travel to Areas With Limited Malaria Transmission

For destinations where malaria cases occur sporadically and risk for infection to travelers is considered low, CDC recommends that travelers use mosquito avoidance measures only, and no chemoprophylaxis (see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country ).

Changing Medications as a Result of Side Effects During Prophylaxis

Medications recommended for malaria prophylaxis have different modes of action that affect the parasites at different stages of the life cycle. Thus, if the medication needs to be changed because of side effects before a full course has been completed, some special considerations exist (see Table 5-30 ).

Table 5-30 Malaria chemoprophylaxis: changing medications due to side effects

Obtaining medications overseas.

Medications recommended for malaria prophylaxis might be available at overseas destinations. Combinations of these medications and additional drugs that are not recommended might be commonly prescribed and used in other countries, however. Strongly discourage travelers from obtaining prophylaxis medications while abroad. The quality of these products is not known; products might be produced under substandard manufacturing practices, be counterfeit, contain contaminants, not be protective, or be dangerous. Additional information on medications obtained while traveling can be found in Sec. 6, Ch. 3, . . . perspectives: Avoiding Poorly Regulated Medicines & Medical Products During Travel , and on the FDA website .

Blood Donation After Travel to Malaria-Endemic Areas

People who have been in an area where malaria transmission occurs should defer donating blood after returning from the malaria-endemic area to prevent transmission of malaria through blood transfusion (see Table 5-31 ).

Risk assessments can differ between travel health providers and blood banks. A travel health provider advising a traveler going to a country with relatively low malaria transmission for a short period of time and engaging in low-risk behaviors might suggest the traveler use only mosquito bite precautions and no prophylaxis. Upon the traveler’s return, however, a blood bank might still choose to defer blood donations from that traveler for 1 year because of travel to an area where transmission occurs.

Table 5-31 US Food and Drug Administration recommendations for deferring blood donation in people returning from malaria-endemic areas

CDC website: Malaria

The following authors contributed to the previous version of this chapter: Kathrine R. Tan, Paul M. Arguin

Bibliography

Andrejko KL, Mayer RC, Kovacs S, Slutsker E, Bartlett E, Tan KR, Gutman JR. The safety of atovaquone-proguanil for the prevention and treatment of malaria in pregnancy: a systematic review. Travel Med Infect Dis. 2019;27:20–6.

Angelo KM, Libman M, Caumes E, Hamer DH, Kain KC, Leder K, et al. Malaria after international travel: a GeoSentinel analysis, 2003–2016. Malar J. 2017;16(1):293.

Boggild AK, Parise ME, Lewis LS, Kain KC. Atovaquone-proguanil: report from the CDC expert meeting on malaria chemoprophylaxis (II). Am J Trop Med Hyg. 2007;76(2):208–23.

Davlantes EA, Tan KR, Arguin PM. Quantifying malaria risk in travelers: a quixotic pursuit. J Travel Med. 2017;24(6):tax066. Hill DR, Baird JK, Parise ME, Lewis LS, Ryan ET, Magill AJ. Primaquine: report from CDC expert meeting on malaria chemoprophylaxis I. Am J Trop Med Hyg. 2006;75(3):402–15.

Hwang J, Cullen KA, Kachur SP, Arguin PM, Baird JK. Severe morbidity and mortality risk from malaria in the United States, 1985–2011. Open Forum Infect Dis. 2014;1(1):ofu034.

Lupi E, Hatz C, Schlagenhauf P. The efficacy of repellents against Aedes , Anopheles, Culex and Ixodes spp.—a literature review. Travel Med Infect Dis. 2013;11(6):374–411.

Mace KE, Arguin PM, Lucchi NW, Tan KR. Malaria surveillance—United States, 2016. MMWR Surveill Summ 2019;68(SS-5):1–35.

Novitt-Moreno A, Ransom J, Dow, G, Smith B, Read LT, Toovey S. Tafenoquine for malaria prophylaxis in adults: an integrated safety analysis. Travel Med Infect Dis. 2017;17:19–27.

Tan KR, Magill AJ, Parise ME, Arguin PM. Doxycycline for malaria chemoprophylaxis and treatment: report from the CDC expert meeting on malaria chemoprophylaxis. Am J Trop Med Hyg. 2011;84(4):517–31.

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Generic name: meclizine [  MEK-li-zeen  ] Brand names: Antivert , Bonine , Bonine Max, Dramamine Less Drowsy , Dramamine Nausea Long Lasting, ... show all 14 brands Travel-Ease, Medivert, Dramamine II, D-Vert, Driminate II, Meclicot, Ru-Vert-M, Meni-D, VertiCalm Dosage forms: oral tablet (12.5 mg; 25 mg; 50 mg), oral tablet, chewable (25 mg; 50 mg) Drug class: Anticholinergic antiemetics

Medically reviewed by Sanjai Sinha, MD . Last updated on Mar 22, 2024.

What is meclizine?

Meclizine is used in adults and children aged 12 years and older to treat or prevent nausea , vomiting and dizziness caused by motion sickness .

Meclizine is also used in adults to treat symptoms of vertigo (dizziness or spinning sensation) caused by disease that affects your inner ear.

Meclizine is most effective if taken before symptoms appear.

Meclizine side effects

Get emergency medical help if you have signs of an allergic reaction to meclizine : hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Common meclizine side effects may include:

drowsiness ;

dry mouth ;

vomiting; or

feeling tired.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Use meclizine only as directed. Tell your doctor if you use other medicines or have other medical conditions or allergies.

You should not take this medication if you are allergic to meclizine.

Before you take this medicine, tell your doctor if you have liver or kidney disease, asthma, glaucoma, an enlarged prostate, or urination problems.

Meclizine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Drinking alcohol can increase certain side effects of meclizine.

Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by meclizine.

Related/similar drugs ondansetron , hydroxyzine , clonazepam , lorazepam , olanzapine , dexamethasone , promethazine

Before taking this medicine

You should not use meclizine if you are allergic to it.

Do not give meclizine to anyone younger than 12 years old without medical advice.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

breathing problems such as asthma , emphysema , or chronic bronchitis ;

an enlarged prostate or urination problems;

recently used alcohol, sedatives, or tranquilizers; or

liver or kidney disease.

Tell your doctor if you are pregnant or breastfeeding.

How should I take meclizine?

Take meclizine exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Swallow the tablet whole and do not crush, chew, or break it.

You must chew the chewable tablet before you swallow it.

To prevent motion sickness, take meclizine about 1 hour before you travel or anticipate having motion sickness. You may take meclizine once every 24 hours while you are traveling, to further prevent motion sickness.

To treat vertigo, you may need to take meclizine several times daily. Follow your doctor's instructions.

Store at room temperature away from moisture, heat, and light.

Dosing information

Usual Adult Dose for Vertigo:

-25 to 100 mg orally per day in divided doses -Dosing dependent upon clinical response. Use: Management of vertigo associated with diseases affecting the vestibular system.

Usual Adult Dose for Motion Sickness:

-Initial Dose: 25 to 50 mg orally 1 hour before travel -Maintenance Dose: Repeat dose every 24 hours if needed Use: Management of nausea, vomiting, and dizziness associated with motion sickness.

Usual Pediatric Dose for Vertigo:

Age 12 years and older: -25 to 100 mg orally per day in divided doses -Dosing dependent upon clinical response. Use: Management of vertigo associated with diseases affecting the vestibular system.

Usual Pediatric Dose for Motion Sickness:

Age 12 years and older: -Initial Dose: 25 to 50 mg orally 1 hour before travel -Maintenance Dose: Repeat dose every 24 hours if needed Use: Management of nausea, vomiting, and dizziness associated with motion sickness.

What happens if I miss a dose?

Meclizine is used when needed. If you are on a dosing schedule, skip any missed dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking meclizine?

Avoid driving or hazardous activity until you know how meclizine will affect you. Your reactions could be impaired.

Avoid drinking alcohol. Drinking alcohol with this medicine can cause side effects.

What other drugs will affect meclizine?

Using meclizine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures .

Sometimes it is not safe to use certain medicines at the same time. Some drugs can affect your blood levels of other drugs you use, which may increase side effects or make the medicines less effective.

Other drugs may interact with meclizine, including prescription and over-the-counter medicines, vitamins , and herbal products . Tell your doctor about all other medicines you use.

More about meclizine

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Patient resources

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Other brands

Antivert , Meclicot , Dramamine II , Meni-D , Travel Sickness

Professional resources

• Meclizine monograph
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Related treatment guides

• Meniere's Disease
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Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use meclizine only for the indication prescribed.

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Popular prescription drug Ozempic seized by Cincinnati CBP

CINCINNATI– Many people know Ozempic for its prescribed use in the treatment of type 2 diabetes. Over the last few years, the medication has grown in popularity for alternative means of weight loss with incredible results. Ozempic is Food and Drug Administration (FDA)-approved for the treatment of type 2 diabetes. U.S. Customs and Border Protection (CBP) officers in Cincinnati recently seized 11 shipments packed full of the pre-filled prescription medication.

Officers at the Port of Cincinnati were conducting inspections on freight out of Colombia when they discovered shipments containing pre-filled injection pens containing Ozempic. A total of 11 FDA-regulated Ozempic shipments have been seized so far this calendar year at the Port of Cincinnati, with the first shipment detected in February. Each shipment originated in Colombia and were destined to New York, Massachusetts, and Texas. Most of the shipments held over 100 pre-filled injection pens. Had all 11 shipments been legitimate with FDA approval, they would have had a combined value of $887,000.

Officers reached out to FDA to confirm the drug cannot be imported into the United States without going through the proper steps and presenting the required documentation. Unfortunately, very few online pharmacies are compliant with the U.S. pharmacy standards. This poses health risks to consumers who purchase what they believe is a genuine product at a much lower cost. The product they receive may be inferior. Risks posed by using medications from unfamiliar sources include unknown ingredients, unusual side effects, and lack of effectiveness of the product.

“Prescription drugs that are smuggled from outside the U.S., particularly injectable products that should be sterile, can present a serious health risk to those who use them. The drugs have not undergone the proper import processes and may contain unknown or dangerous ingredients,” said Dan Solis, FDA Assistant Commissioner for import operations. “We will continue to be vigilant at ports of entry to interdict these potentially dangerous products, preventing them from reaching U.S. customers and protecting the public health.”

“Collaborative work with FDA has proven to help combat the soaring sales in E-commerce of illegal medications from overseas entities that fail to abide by the rules set in place,” said LaFonda D. Sutton-Burke, Director Field Operations-Chicago. “One of CBP’s mission priorities is to facilitate lawful trade. Stopping illegal shipments of Ozempic saves consumers a substantial amount of money and potentially dangerous health risks.”

CBP enforces laws for partner agencies including FDA. CBP works jointly with the FDA to combat the importation of illegal medications and beauty products that pose health risks for consumers. If you would like to find out more information, the FDA provides  guidance  on how human drugs can be legitimately imported into the United States.

Follow CBP on Twitter @CBPChicago and @DFOChicago . Visit CBP’s YouTube channel to learn more about how CBP’s Office of Field Operations secures our nation’s borders.

U.S. Customs and Border Protection (CBP) is America's frontline: the nation's largest law enforcement organization and the world's first unified border management agency. The 65,000+ men and women of CBP protect America on the ground, in the air, and on the seas. We facilitate safe, lawful travel and trade and ensure our country's economic prosperity. We enhance the nation's security through innovation, intelligence, collaboration, and trust.