Travel Health Kit - Part I

Yes! This is the time of the year where you finally get to take a break from your 9 to 5 job. Time for a short getaway! No matter you are heading to the hot and sunny beach in Port Dickson, up to cool and breezy Genting Highlands or even to a busy city in Japan, besides stuffing all basic necessities into your suitcase and your favourite Iphone 6s to capture those beautiful memories, another must need item is your travel medication kit.

You have the sunset right in front of your eyes, you have the breeze blowing right through your hair like a supermodel. But opps, you are sneezing away non-stop. Can’t let some minor runny nose ruin a beautiful day like this isn’t it. This is where your travel medication kit will come in handy.

Now, the most important question pops up. What should my travel medication kit consist?

A good travel health kit should contain enough supplies to prevent illness, handle minor injuries and illnesses, and manage pre-existing medical conditions longer than the duration of your trip. Below are some of the examples of the medicines for you to bring along:

Food poisoning

Travellers' diarrhea is the most common illness affecting travellers. It is usually caused by consumption of contaminated food or water. Although diarrhea is rarely serious or life-threatening in healthy adults, but it can certainly make your trip unpleasant. As diarrhea often leads to dehydration, it is very important to consume sufficient liquid. The oral rehydration salt is recommended for water and electrolyte depletion. 1 sachet is to be taken after every loose motion.

 

Oral Rehydration salt

Some anti-diarrheal medications such as loperamide can be bought over-the-counter to treat the symptoms of diarrhea. These drugs decrease the frequency and urgency of using the bathroom, and they may make it easier for a person with diarrhea to ride on a bus or airplane.

Dose: Initial dose for an adult is 2 capsule and for a child (6-17years) is 1 capsule.This is followed by 1 capsule after each subsequent loose stool. The maximum number of capsule per day for adult is 8.

Loparamide capsule

Activated charcoal is used to treat poisonings. It helps in diarrhea as it is good at trapping chemicals and preventing their absorption.

Dose:

Adults: 2-4 tablets are required 3-4 times a day.

Children: The dose for children is half the dose of an adult.

*** You can either dissolve the tablets in a cup of water by stirring before swallowing or take it whole with plenty liquid(around 2 glasses of water). Take at least 2 hours before or 2 hours after other medications. Activated charcoal is contraindicated in diarrhea accompanied by fever.

Activated charcoal

Motion sickness

Motion sickness happens when the motion you see is different from the motion sensed by your inner ear. For travellers who often experience motion sickness, don’t let it ruin your whole journey. Pop in an anti-motion sickness medication such as Veloxin ( Meclozine HCI 25mg and pyridoxine HCI 50mg)

Adult: Veloxin 1-2 tablets daily 1 hour before travelling. Dose may be repeated every 24 hours if necessary.

Children: Novomin syrup for children 7-12 years (10-15ml), children 2-6 years (2.5-5ml) Repeat 8 hourly if necessary. Take the first dose half and hour before the journey.

Veloxin

Novomin tablets and syrup

Other steps in preventing motion sickness include sitting in the front passenger seat or drive during the road trip or getting a central cabin on a cruise ride. Meanwhile, sucking on a ginger candy, or other flavored lozenges may help as well.

Cold and Flu

What’s worse than sneezing and wheezing throughout your holiday? Common flu symptoms such as runny nose or blocked nose, fever, headache and sore throat will usually come together like a 5-in-1 premix coffee.

Antihistamines such as loratidine (does not cause drowsiness) and chlorpheniramine (will cause drowsiness) will relieve runny nose while nasal decongestant such as pseudoephedrine can be used to relieve nose block.

Clarinase for runny and blocked nose

There are certain medications such as Clarinase that have both the combination (loratadine + pseudoephedrine) for people suffering from runny nose and blocked nose. Nevertheless, not everyone can take oral nasal decongestant as it might unknowingly increase the heart rate, leading to irregular heart beat. Besides that, it may lead to temporary increment in blood glucose level among diabetics. Further elaborations on ‘cold and flu’ medications can be viewed in our Keep those sneezing and wheezing away!!! article.

For fever in adults, 2 tablets of 500mg paracetamol  will do the trick. The maximum dose per day for adult is 8 tablets. Other options such as ibuprofen will work as well but it should not be taken if you ever suffered from a stomach ulcer or if you are allergic to aspirin, ibuprofen or any other NSAIDS. People taking other medications, asthma sufferers and pregnant women should only take it after consulting their doctors.

Sore throat can be a nuisance especially when it becomes so painful it is hard to even swallow your saliva. In this case, Strepsils or Difflam can help in soothing your throat.

Difflam and Strepsils lozenges for sore throat

Constipation

Travelers can experience constipation due to lack of fruits and vegetables in their diet. Usually, drinking plenty of liquid and taking fruits and vegetable will be able to prevent this. The Fybogel Hi-Fibre Orange drink can be another option as it is an easy and convenient way to increase fibre in your diet by helping your digestive system work more efficiently and gently relieving constipation the natural way. However, always remember that 8 cups of water a day is a necessity.

Fybogel Hi-Fibre Orange drink for constipation

Gastric/heartburn/ indigestion

Time really flies when you are having fun during your vacation. You will often find yourself forgetting your meals or probably regret having too much of those spicy chili crab. In this case, Zellox-II or Gaviscon may come in handy for symptomatic relief of gastric, heartburn or indigestion.

Zellox-II and Gaviscon

Skin Care

As you are planning a trip to a developing country, especially those places by the countryside and taking a walk in the rice plantations, the last thing that you would want for is a cut or continuous itchiness on your skin. Apart from the exotic wildlife and impressive landmarks, it is important that travelers are equipped with some basic over-the-counter (OTC) creams or ointments as a preventive measure when travelling to the countryside or somewhere near to mother nature.

So, what kind of creams or ointment to we need to have in hand?

Just a small tube of anti-itch (Hydrocortisone 1% Cream/ Ointment) or antifungal (Miconazole 2% Topical Cream, Terbinafine 1% Cream) should do. If you have enough space in your luggage, you can also opt for an antibacterial (Bactitracin/ Double Antibiotic Ointment) if you’re expecting cuts or falls during your trip. Put the creams or ointments into small, zippered, clear plastic bags for easy identification and packing.

These over-the-counter (OTC) medications do not require you to have a doctor’s prescription to purchase them, you can pack them in your checked luggage. However, you can keep some aside in your carry-ons or pockets should your luggage go astray.

You day of summer fun is ruined by sunburn and intense skin peeling. What should you do to protect your skin from them?

As you might already know that the best way to keep your skin healthy and youthful is to stay out of the sun during its peak hours and use sunscreen and protective clothing when exposing to the sun. Here are some facts that might not know how powerful the sun’s rays are:

★    The traditional Spanish Beach umbrellas found at beaches do not provide sufficient sun protection. Studies conducted had shown that ⅓ of UV rays are able to reach the skin. 5% of UV rays are still able to pass the umbrella and onto the skin.

★    UV radiation is the strongest between 11am and 4pm especially during summer months.

★    Sunburn can develop in just 15 minutes and you may not realize it until the symptoms appear 3 - 5 hours after sun exposure.

★    Reflection from the sand and water increases the amount of sun rays exposed to you. (P.S. Note that you are at a higher chance of getting sunburn when vacationing in snowy destinations, and it is because the sun ray reflecting off the snow increases too.)

★    Travellers travelling to destinations nearer to the equator (E.g. Ecuador, Colombia, Brazil. Republic of Congo, Democratic Republic of the Congo, Uganda, Kenya, Indonesia, Malaysia, Singapore, Phuket, Bali, Philippines) are at an increased risk of getting sunburn.

Dear readers, while the memory of your sunburn is still painfully fresh, it’s time to refresh yourself with the following steps on how to protect yourself from the sun rays.

1.    Apply sunscreen with a sun protection factor (SPF) between 15 - 30 and apply it 30 minutes before exposing to the sun. Don’t forget to protect your lips, ears, hands and back of your neck.

2.    If you’ve been under the sun or in the water, re-apply waterproof sunscreen every 2 hours.

3.    Stay hydrated. Remember to drink plenty of water (except caffeine-free and alcohol-free beverages) to keep yourself hydrated.

4.    However, if you have sunburn after long hours under the sun, remember to keep in mind these steps to avoid further damage to your skin.

a.    Use compresses such as cold water to cool down the pain and heat of the sunburn area. A cool shower or bath is also recommended to minimize the damage to sunburned skin. Avoid using SOAP!!!

b.    If you are having blisters, DO NOT burst or break them open. A padded bandage can also be used to cover the blisters when you’ve got blisters on area which tend to get irritated and frictioned by your clothes.

c.    Aloe vera does a great job in soothing your sunburned skin as well!

Furthermore, there are some examples of topical over-the-counter products which are available in all pharmacies for skin conditions (dry skin, fungal, mosquito bite, sunburn, itchy, rash, muscle aches, etc.)

●     Antiseptics

●     Antifungal

●     Anti-itch

●     Hand sanitizer gel

●     Calamine lotion

●     Aloe vera gel

●  Sunscreen / Lip balm (Banana boat, Coppertone Sport-SPF 50, No Ad-SPF 45, Bull Frog Sport-SPF 40, Blue Lizard Sensitive-SPF 30, Blistex Medicated Lip Balm SPF 15, Vaseline)

●     Insect repellent (Controlled Release DEET, Lemongrass, Minyak Kapak, Permethrin spray for clothes/gears)

●     Analgesic cream

●     Plasters/ Gauze pads/ Tape

Summary for your to-bring-list:

Antidiarrheal medication

Carbon in cases of food poisoning

Oral rehydration salt

Antihistamine for runny nose or allergies

Nasal decongestant for blocked nose (alone or in combination with antihistamine)

Drops for sore throat

Medicine for pain or fever

Anti-motion sickness medication

Mild laxative for constipation

Medication for gastric, heartburn or indigestion

Sunscreen and lip balm

Lotions or moisturisers for hydration

Creams and ointments for cuts and skin infections

Note: The above medications suggested are just examples. It is to be used as a guide for packing only. Dosage for children below 12 years old may vary. Always consult your nearby pharmacist or doctor to identify which medication suits best for your health condition.  Any long term medication prescribed by the doctor is required to be continue even though you are on your vacation.

Happy Holidays!!!

P/s: Stay tune for our Travel Health Kit Part II !!

Authors:

1.    Chang Jen Nee

BPharm (Hons) (IMU)

2.    Grace Ho Mee Yan

          BPharm (Hons) (IMU)

Editors:

1)   Ong Jijien

          BPharm (Hons) (IMU)

2)   Tan Sue Fern

           BPharm (Hons) (IMU) 

Keep Those Sneezing and Wheezing Away!!!

Asking medications for your "cold and flu" symptoms from a pharmacy is an easy way to relieve those irritating symptoms, such as blocked nose, running nose and sneezing, without paying for the consultation fees. But, have you ever asked yourself that what are those medications that you are taking to "eradicate" or relieve those annoying symptoms? Do you know that certain oral nasal decongestants can lead to insomnia problems or fluctuating blood pressure?

Here I am today to spill some little secrets of those medications in which some pharmacists may not share with you. 

1. Not all "cold and flu" medications can lead to drowsiness (make you feel sleepy).

There are other options available for you if you do not wish to have medication to make you feel drowsy. The sedative antihistamine inside the medication is the one that is responsible for making you feel drowsy.

Oh, wait! What is antihistamine?

Antihistamine is a class of medication which is usually used to relieve skin allergic responses (such as skin rashes and itchy skin) and symptoms of cold or allergic rhinitis ("sensitive nose" or "allergic nose problems", also known as hay fever), such as running nose and sneezing. Antihistamine can be classified into sedative or non-sedative.

Examples of Sedative Antihistamine: Chlorpheniramine, Dexchlorpheniramine, Tripolidine, Promethazine and Hydroxyzine.

Examples of Non-sedative Antihistamine: Cetirizine, Levocetirizine, Loratadine, Desloratadine, Fexofenadine and Bilastine.

The formulations shown below, which consist of non-sedative antihistamine in its combination, is unlikely to make patients feel drowsy (sleepy).     

Non-sedative antihistamines

The formulations shown below, which consist of sedative antihistamine in its combination, is very likely to make patients feel drowsy (sleepy).    

Sedative antihistamines

2. Oral "cold and flu" (CF) medications should be used with care in patients having heart problems, thyroid problems, high blood pressure and diabetes.

CF medications contain nasal decongestant, such as pseudoephedrine or phenylephrine.

Hmmm...What is nasal decongestant?

Nasal decongestant is a medication that is used to relieve nose block. Nasal decongestant can be classified into oral or topical (nasal).

Oral nasal decongestant, such as pseudoephedrine or phenylephrine, is also known as sympathomimetic. In other words, sympathomimetic is a stimulant which is able to increase the heart rate and blood pressure to make the person feel awake and energetic. Increasing heart rate and blood pressure in patients having heart diseases will definitely post a risk in worsening their conditions! 

Patient with active thyroid will have fast heart beat due to the active secretion of thyroid hormone. Taking oral nasal decongestant might unknowingly increase the heart rate, leading to irregular heart beat conditions.

Oral nasal decongestant will also affect the diabetic control in patients having diabetes, leading to temporarily increment in blood glucose level. The physicians might step-up the diabetic therapy unnecessarily because they are unaware that the patient is taking oral nasal decongestant.

So, please consult the physician or pharmacist before taking any medications for your "cold and flu" symptoms.

Compared to oral nasal decongestant, topical nasal decongestant can be used safely in patients with those medical conditions shown above. Besides that, topical nasal decongestant, such as oxymetazoline and xylometazoline, has a faster effect than oral nasal decongestant. Topical nasal decongestant works by constricting the veins in the nose which swell up during inflammation of any infection or allergic response.

The following diagrams shown below are the examples of topical nasal decongestant.

Topical nasal decongestant

However, topical nasal decongestant is not entirely safe to be used continuously due to the risk of rebound congestion. Hence, it is recommended to be used as necessary basics for continuous 3-5 days. The topical nasal decongestant should be withheld for 1-2 weeks before restarting.

3. Should all the oral nasal decongestants should be taken after meal?

Ans: This is not necessary. Most of the oral nasal decongestants can be either taken before or after meal. However, the formulation containing fexofenadine should be taken 1 hour before meal for better and complete absorption. 

Telfast D (Fexofenadine HCl + Pseudoephedrine HCl)

4. If the patient is allergic to sulphur, is the patient alright to take all types of oral nasal decongestants?

Ans: NO! Many formulations of CF medications use pseudoephedrine sulphate as nasal decongestant. You can opt for the formulations which use pseudoephedrine hydrochloride or phenylephrine hydrochloride.

5. Why does the pharmacist inform me to take the second dose of non-sedative oral nasal decongestant as early as possible, for example before 7 p.m. in the evening?

Ans: Due to the absence of sedative antihistamine in non-sedative oral nasal decongestant, the stimulant will slightly increase your heart rate and blood pressure to make you feel awake and energetic. This might lead to insomnia (unable to sleep) during the night.

6. Should I take my CF medications with paracetamol?

Ans: It depends on whether the oral nasal decongestant contains any paracetamol. The following products shown below contain paracetamol and should not be taken with paracetamol as it might lead to overdose of paracetamol.

7. If I am either pregnant or breastfeeding, should I take the oral nasal decongestant?

Ans: Most manufacturers advise to avoid using oral nasal decongestant during pregnancy and breastfeeding. However, there are no evidences of fetal abnormality or harmful effect to the baby, except Hydroxyzine (it is shown to be harmful). The use of sedative antihistamine is shown to cause irritability in the newborns.

The safest nasal decongestant which can be used by pregnant or breastfeeding mother will be the topical nasal decongestant or saline nasal spray.

Thank you so much for reading and I will be touching more on the allergic responses on antihistamines and nasal sprays in my future post! Stay tune!

Meanwhile, if you are anticipating for the next post and wondered what the next topic will be, just a little sneak peek that it will be related to travel medications! If you are always worried on what medication to prepare for travelling, this is the post that you should take note. Just follow our blog and keep yourself updated every Sunday! :)

Have a pleasant day!

Author:

Jordy Wong Der Yuan

BPharm (Hons) (IMU)

Editors:

1. Chang Jen Nee

BPharm (Hons) (IMU)

2. Grace Ho Mee Yan

BPharm (Hons) (IMU)

Inhaler Nasal Decongestant Stick

1) What are the ingredients that can be found inside the inhaler nasal decongestant stick?

Inhaler nasal decongestant stick contains menthol, camphor, Siberian pine needle oil and methyl salicylate. 

Functions of each of the ingredients

Menthol: Provides cooling sensation for stuffy nose. (Active ingredients-provide relief for stuffy nose)

Camphor: Relieves itchness during allergy. (Active ingredients)

Siberian pine needle: Refreshes the air. (Active ingredients)

Methyl salicylate: It is an inactive ingredient (do not provide any relief for stuffy nose).

2) What is the inhaler nasal decongestant stick for?

It is used to temporarily ease breathing and relieve stuffy nose, either caused by cold or allergy, by inhaling the vapours into each nostril.

3) Who are the recommended users of the inhaler decongestant stick?

Only for adults and children 6 years and over. It is not recommended for children below 6 years old.

4) How do we use the inhaler nasal decongestant stick?

Use the inhaler nasal decongestant stick as many times as needed. 

Step 1   : Unscrew the cap of the inhaler stick.

Step 2   : Insert well into a nostril and hold the other nostril closed.

Step 3   : Inhale deeply to make breathing feel clear and cool.

5) Is the inhaler nasal decongestant stick addictive?

Menthol may not be as addictive as nicotine. It is an active ingredient which provides cool and fresh sensation. Some evidences have shown that it can act as a local anaesthetic (numb the particular area to relieve pain). However, the cooling and numbing sensation of menthol may lead to physical dependence for menthol-lovers to continue using the menthol-containing inhaler. Besides that, some users claimed to have worsening nasal congestant when discontinuing the inhaler, which lead to dependence.

In short, until today, it has very limited evidence that demonstrate the menthol in inhalers may possibly lead to addiction among users. Nonetheless, users may be dependent on the menthol-containing inhaler to attain the desired breathing-ease effect.

6) How do we store the inhaler nasal decongestant inhaler?

It is preferably to store it at room temperature, in a cool and dry place. Do not store above 25°c.

7) What are the other precautions that I should be aware with?

Ø  If the symptoms do not improve, worsen or persist, consult your doctor or pharmacist as soon as possible.

Ø  If nasal discomfort occurs, stop using the inhaler stick and consult your doctor or pharmacist.

Ø  Do not use the inhaler stick after its expiry date or if you are known to be allergic to any of its ingredients.

Author:

Loh Pui Yee

BPharm (Hons) (IMU)

Editors:

Chang Jen Nee

BPharm (Hons) (IMU)

Jordy Wong Der Yuan

BPharm (Hons) (IMU)