How Pharmacists Can Assist Patients Traveling Abroad

The US Centers for Disease Control and Prevention (CDC) maintains an excellent resource known as the Yellow Book that includes travel information on medications and vaccines.¹ This free resource is right at the pharmacist’s disposal, and it is even available as an app for Apple and Android products with an option to purchase additional content.

If a patient presents to your pharmacy with a prescription for malaria prevention, try to determine his or her destination so that the appropriate medication is selected. The traveler’s health section of the CDC website includes a destination page for consumers and health care professionals alike.²

Some travel destinations have chloroquine resistance, so this medication would not be effective for malaria prophylaxis in these regions. Atovaquone-proguanil and doxycycline are good options for malaria prophylaxis, since they can be used in all regions.

Atovaquone-proguanil is taken as 1 tablet orally once daily with food or a milky drink. Treatment starts 1 to 2 days prior to travel and is taken each day in the travel destination and for 7 days after leaving the area. It is contraindicated in individuals with severe renal impairment.

Doxycycline is dosed 100 mg orally once daily beginning 1 to 2 days prior to travel, taken daily in the travel destination, and continued for 4 weeks after leaving the area. Doxycycline can cause photosensitivity, so sunscreen is recommended. Also, calcium products should be separated from doxycycline by at least 2 hours. Doxycycline should not be used in pregnant patients and children aged under 8 years.

While mefloquine is another option for malaria prophylaxis, there are serious adverse effects associated with this medication.³ A black box warning was added in 2013 outlining neurologic and psychiatric adverse effects that can be permanent.³ Therefore, mefloquine should not be used as a first-line agent for malaria prophylaxis.

Pharmacists can recommend that patients consult with their physician at least 4 to 6 weeks before they travel.² Ensure that patients are up-to-date with the following vaccines: measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis, varicella, polio, and influenza.

In light of the recent measles outbreaks, it is crucial for patients to be up-to-date on their MMR vaccines. Countries have different recommendations for additional travel vaccines, so it is always best to consult the CDC travel site.

Based on state laws, pharmacists can provide patients with some of the vaccines they may need for travel. Pharmacists can also ensure that patients have sufficient prescription and OTC medications for their travels.

Considering all of these points, pharmacists can play an important role in assisting patients traveling abroad.

References

• US Centers for Disease Control and Prevention. Yellow Book homepage. Available at: http://wwwnc.cdc.gov/travel/page/yellowbook-home-2014. Accessed March 23, 2015.
• US Centers for Disease Control and Prevention. Destinations. Available at: http://wwwnc.cdc.gov/travel/destinations/list#group-s . Accessed March 23, 2015.
• FDA. FDA drug safety communication: FDA approves label changes for antimalarial drug mefloquine hydrochloride due to risk of serious psychiatric and nerve side effects. Available at: http://www.fda.gov/drugs/drugsafety/ucm362227.htm. Accessed March 23, 2015.