I am a registered pharmacist licensed in both an American Redoubt state and a state in the Ozarks. I own my pharmacy in a small town in a rural area. I have had many discussions with patients about larger than normal supplies, rotating stock, ‘vacation supplies’ and various ways to accumulate a stockpile of prescription medicines. The content in this article is for informational purposes only and should not be considered professional medical advice.
Having your personal pharmacist on board with your prepping list of medications, is probably the cheapest way to accumulate a stockpile. I have compared prices at JASE Medical and HoneyBee Pharmacy which both have been mentioned in previous SurvivalBlog articles on stocking up, and both charge more than I would. Your options are limited if your doctor or your pharmacist won’t cooperate. These online firms do give you a choice. If just your doctor won’t cooperate, then check the tele-health doctors via the Internet in your state. After Covid-19 many of these tele-health doctors are still available to consult with and send prescriptions to your pharmacy. I would ask for a year supply, especially on the cheaper generics that you are taking regularly, see if they can be dispensed in the original unopened bottle with the expiration date showing.
Your goals and future dictate what to stock. If you are a health-care professional teaming up with other health-care professionals to provide a mini-clinic after the ‘crunch’, your goals will be different than a family of 4 just trying to secure the basics. In a previous article the author mentions the book “Wilderness Medicine” by Dr. William Forgey but did not elaborate on his suggestions for Over-The-Counter (OTC) and prescription (Rx) medicines to have available.
Here are Dr. Forgey’s lists:
OTC Drugs
Percogesic (back when Dr. Forgey wrote the book it contained Acetaminophen and Phenyltoloxamine, it has been reformulated with Acetaminophen & Diphenhydramine. Phenyltoloxamine is an antihistamine with sedative & analgesic properties, probably did a better job with back pain than Diphenhydramine.
Ibuprofen 200mg good for pain, fever, menstrual cramps, and inflammation. Otc dose is 2 tablets 4 times a day, maximum Rx dose is 4 tablets (800mg) 4 times a day.
Diphenhydramine 25mg (Benadryl) is good as an antihistamine for rashes, allergic reactions, insect bites, etc. Dosage is 1-2 capsules every 6 hours. Can be used as a sleep aid (2 capsules at bedtime), as a cough suppressant (1 capsule every 6 hours), for muscle spasm relief (1 or 2 capsules with 2 tablets of Ibuprofen). For nausea or motion sickness 1 capsule every 6 hours.
Bisacodyl 5mg is a laxative, take 1 tablet as needed with a large glass of water.
Loperamide 2mg (Imodium) is an anti-diarrheal, dosage is 2 tablets after loose stool, followed by 1 tablet after each loose stool, max of 16mg/day.
Cimetidine 200mg (Tagamet) this medication suppresses acid formation in the stomach. OTC dosage is 2 tablets four times a day, Rx dosage is as high as 4 tablets (800mg) four times a day. This drug contains some antihistamine properties. (My opinion; this drug is not used much today or recommended much. The drug has a lot of drug interactions, that they did not know of when this book was written. My advice is to substitute Famotidine 20mg tablets, dosage is 1 tablet twice a day, or 2 tablets (40mg) once daily at bedtime.
DOctor Forgey’s RX list
Hydroxyzine (Atarax) 25mg tablets can be used for nausea, anxiety, antihistamine, pain medication augmentation, as a sleep aid. For sleep the dose is 2 tablets (50mg) at bedtime, other indications are 1 tablet every 4 to 6 hours as needed.
Desoximetasone 0.25% (Topicort) is a topical steroid to treat allergic skin rashes. Dosage is a thin coat twice a day. More potent than OTC hydrocortisone 1% which could be substituted if the Rx was unavailable.
TOBRAMYCIN/DEXAMETHASONE Ophthalmic drops (Tobra-dex) is an antibiotic and steroid to treat infections and allergies in the eye and ear. Dosage is 1-2 drops in eye(s) every 4 to 6 hours. Place 5 drops twice a day in ears. Duration is usually 5-7 days, only if improvement is noted after 2 days.
Tetracaine 0.5% ophthalmic drops is used to numb pain in the eyes or ears. “Do not reapply to eye if pain returns without examining eye for foreign body very carefully. Try not to use it repeatedly in the eye as over-use delays healing. Continued pain may also mean you have missed a foreign body. Do not use in ears if considerable drainage is present; an eardrum may have ruptured and if this medicine gets into the middle ear through a hole in the eardrum, it will cause profound vertigo (dizziness).”
Stadol Nasal Spray (Butorphanol Tartrate) is a powerful pain medication absorbed by the lining of the nose, use 1 spray wait 60-90 minutes before using a second spray, can be repeated every 3-4 hours. This is a controlled substance; all DEA laws would apply. Dr. Forgey could carry this in his kit, but it might not be available to us.
Diamox (Acetazolamide) 250mg tablets is used in the prevention of acute mountain sickness for elevations above 9,000 feet. Dosage is 125mg (one-half tablet) twice daily, start day before ascent, take daily until 2-3 days after peak arrival or upon descent. Altitude sickness: 250mg (1 tablet) twice daily.
Decadron (Dexamethasone) 4mg tablets is a very potent steroid, his recommendations for acute mountain sickness is 4mg every 6 hours until below the altitude that symptoms appeared.
Flagyl (Metronidazole) 250mg tablets is an antibiotic useful in treating diarrhea caused by giardia, dosage is 250mg 3 times a day. Also useful in treating Entamoeba Histolytica (water infected with human feces) and Trichomonas vaginalis and certain other bacteria. (dosage is the same for all)
Lariam (Mefloquine) 250mg is used to prevent malaria and treat uncomplicated malaria. Dosage: Start at least 2 weeks before exposure, take with food, 250mg (1 tablet) once per week. Stop treatment 4 weeks after exposure. Malaria treatment: 750mg (3 tablets) for first dose, then 500mg (2 tablets) 6 to 12 hours later (one day treatment, then follow up with Primaquine (daily for 14 days).
Famvir (Famciclovir) 125mg tablets used as prophylaxis to treat Herpes Simplex lip lesions, which are often activated by high altitude or reflective ultraviolet light exposure, should be included if persons are known to have recurrent problems. Dosage is 125mg (1 tablet) 3 times a day.
Doxycycline 100mg capsules is useful in treating many travel-related diseases. Dosage is 100mg (1 capsule) twice a day for 10 days. May cause sun sensitivity, one of the few drugs that go toxic after expiration, have your pharmacist right the actual drug expiration date on the label. Very useful according to Dr. Forgey in malaria prevention, dosage 1 capsule daily. Drug of choice for tic borne diseases like Lyme’s disease, dosage 1 capsule twice a day for 10 days.
Zithromax (Azithromycin) Z-pack 250mg tablets a cheap broad-spectrum antibiotic for pneumonia, strep throat, skin infections, some venereal diseases. Dosage is 2 tablets (500mg) the first dose on day one, following by 1 tablet daily for 4 more days.
Levaquin (Levofloxacin) 500mg tablets another broad-spectrum antibiotic useful in treating diarrhea, skin infections, pneumonia, urinary tract infections, kidney infections. Dosage is 500mg (1 tablet) once daily for 5-7 days. Even has indications for Anthrax (750mg daily for 14 days) and the Plague (500mg daily for 10-14 days).
Doctor Forgey’s injectable Rx med kit recommendations
Nubain (Nalbuphine) 20mg/ml a strong synthetic non-controlled narcotic analgesic, dosage is 10mg (0.5ml) intramuscularly every 3-6 hours, max dose is 20mg (1ml) IM every 3 hours. Can be mixed with 25mg to 50mg Vistaril in the same syringe for increased analgesia.
Lidocaine 1% this injection is used to numb wounds, typically before suturing. Can also be used for the diluent for Rocephin injectable.
Rocephin (Ceftriaxone) 500mg or 1gm vials is a broad-spectrum antibiotic to treat pneumonia, bronchitis, skin infections, deep wounds (think knife stabs or bullet wounds), urinary tract infections, kidney infections, gonorrhea, pelvic infections, bone & joint infections. This can be reconstituted with Lidocaine 1%.
Decadron (Dexamethasone) 4mg/ml for use in allergic reactions give 4mg IM daily for 5 days. For acute mountain sickness give 4mg IM every 6 hours until descent.
Vistaril (Hydroxyzine) 50mg/ml can be given IM to treat nausea/vomiting, can be mixed with Nubain for additional pain relief, can be used to sedate a patient.
You will also need a supply of syringes and needles.
Dr Forgey is an experienced mountain climber and his recommendations are of course geared toward that activity, but I found many of his suggestions spot-on for what I would recommend for a kit at home after the ‘Crunch’.
Let’s look at what Jase Medical’s antibiotic kit contains:
Augmentin (Amoxicillin/Pot Clavulanate 875/125mg quantity 28 tablets
“Augmentin can be used to treat multiple types of infections like skin, sinus, throat and dental infections, urinary tract infections, pneumonia, bite wounds, and intra-abdominal infections”. This is a common antibiotic, the dosage is for an adult, typical duration would be 7 to 10 days, so this could be 2 rounds of therapy. This is antibiotic that typically wipes out the normal flora in the GI tract, I often recommend taking a probiotic or greatly increasing your cottage cheese, yogurt intake to restore your normal GI flora.
Azithromycin Z-pak quantity 6 tablets (one pack)
“Azithromycin is a common antibiotic often used when someone has a penicillin allergy. Frequently used to treat respiratory infections, ear and throat infections, infectious diarrhea, some sexually transmitted diseases, and typhoid fever”. Another broad-spectrum antibiotic that should be in everyone’s kit. With smaller adults/children I recommend spacing the first 2 tablets apart to decrease GI distress. Normally this drug is well tolerated. It does have a serious interaction with anti-arrhythmia drugs like Flecainide, the combination may increase the risk of QT prolongation and cardiac arrhythmias. So use in caution with cardiac patients.
Ciprofloxacin 500mg tablets quantity is 28 tablets. “Cipro can be used to treat a variety of ailments like urinary tract infections, kidney infections, prostatitis, bone and joint infections, infectious diarrhea, intra-abdominal infections, bioterrorism infections (like anthrax and plague), typhoid fever, meningitis, and more”. Another very useful broad-spectrum antibiotic, typical dosing is 250mg to 500mg twice a day for 7-10 days, so this could be 2 rounds of therapy.
Doxycycline 100mg capsules quantity is 120 capsules. “Doxy is a common antibiotic that can be used to treat many conditions including skin and soft tissue infections, ear and sinus infections, pneumonia, bioterrorism infections (like anthrax, plague, and tularemia), malaria, lyme disease and more. This antibiotic has been shown to treat MRSA, or methyl-resistant staph aureus”. A very useful broad-spectrum antibiotic that should be in everyone’s kit. Typical dosing is 100mg twice a day for 10 days, so this would be 6 rounds of therapy. Once again, keep an eye on the expiration date.
Metronidazole 500mg tablets quantity is 30 tablets. “Metronidazole can be used for a number of conditions including amoebas, skin infections, intra-abdominal infections, C. diff diarrhea, tetanus, and sexually transmitted diseases”. A useful broad-spectrum antibiotic, typical dosing is 500mg 3 times a day for 10 days, so this would be 1 round of therapy.
The current price at Jase Medical for this kit is $269.95.
(To be concluded tomorrow, in Part 2,)