Hawaii pharmacist spells out rules for travelers

Your patient exclaims, “We’re going to Hawaii! I can’t wait to get some sun, walk on the beach, and have some drinks by the pool. Let’s see - I’ll be there six days, so I’ll need six pills of my atenolol and simvastatin, and 12 pills of my Eliquis.” Your response? “Not so fast."

I work in community pharmacy on the island of Maui, in Hawaii, in a store that fills roughly 60% tourist prescriptions, and as we prepare for our winter tourist season, I would like to offer you some advice to pass along to your patients.

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Don’t take “just enough medicine” for your trip. You are planning on being away six days, but then there is a flight delay, a family member gets sick, you get sick or hurt, and the trip gets extended. Or you just plain miscount how many pills you will need. In the high seaso, we see this at least 15 to 20 times per week. I once transferred about 10 to 15 prescriptions for a family because of this, and about half were too soon on insurance. Remember, you can always take the extra medication home.

Someone once came to me because she needed a few doses of her Pradaxa 110 mg and had gotten an Rx from a local urgent care that just copied the label on her bottle. Confused? So was I. Even though we got the local doctor to rewrite for 75 mg, she was completely unable to get the dose she was put on at home. My point: this mistake is even worse overseas.

If you are going overseas, take some OTCs with you. From what I hear, in Canada the following items are OTC: Voltaren gel, Diflucan One, promethazine with codeine, Robaxacet (methocarbamol and acetaminophen), and antibiotic eye/ear drops. I’ve seen quite a few people go to urgent care to obtain something they could have bought OTC at home. If there are OTC medicines you might need and you are going outside the United States, it is best to take a small supply with you. While you should remember to check medication importation laws, personal supplies of substances that are not controlled are typically okay.

Remember, state laws vary. Hawaii, for example, does not allow Rxs from out-of-state mid-level practitioners or for out-of-state controls. Quite a few patients have said to me, “My pharmacist at home told me I could just get it transferred.” (By the way, please do us a favor and don’t be one of those pharmacists. If you call any of us in Hawaii, we will be glad to tell you about our state laws, so that you can better prepare your patients).

Take your insurance cards, or copies/pictures, with you. If you end up needing something at 7 pm in Hawaii, your home pharmacy is probably closed. (Depending on the time of year, we are five to six hours behind EST.) The result: you pay cash or miss doses.

Put your medication into your carry-on, not your checked bag. It is much harder and more expensive to replace your medications than it is your clothes. Every week I hear, “The airline lost my luggage and all my medicine was in it.” If you keep your drugs in a carry-on that an airline won’t check - and remember, sometimes they have to check the larger carry-on bags on a full flight or a small plane - you will avoid this problem.

Yes, you will burn on Maui/in the tropics. I can’t count how many people have actually had to go to the doctor because they are fair-skinned and decided they wanted to spend the afternoon in the Maui sun without protection and then came to me looking as red as a lobster. Vacation doesn’t make this risk any safer. Also, remember your lip balm with sunscreen; this is a precaution that is often overlooked.

Enjoy your trip. I hope to see you on my next dive - and not in my pharmacy.

Alex Evans works in community pharmacy in Kihei, Hawaii. He is also a PADI assistant scuba instructor.