Walking Well: Trail Medications

The AT crosses the Hudson on Bear Mountain bridge in New York.

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Many hikers get sick and need medications on long-distance trails. Which drugs should they carry with them? "Vitamin I" (ibuprofen) is probably the most popular medication, and with good reason. It has probably displaced aspirin as the most used drug.

Drugs needed on the trail fall into roughly two classes: 1) General, for run-of-the-mill everyday problems and 2) Specific Treatment for preexisting or anticipated medical disorders. Hikers with any known disorder should consult their doctor before attempting the trail. For those with medical clearance, the drugs for use on the trail include:

General:

• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) for musculoskeletal problems
• Analgesics for pain
• Antihistamines for allergy
• Antibiotics for specific infections
• Dermatologicals
• Anti-diarrheal drugs
• Vitamins

Specific Treatments for Preexisting Conditions:

• Cardiovascular drugs (for example, anti-hypertensives)
• CNS (Central Nervous System) drugs (for example, anti-epilepsy)
• Endocrine and metabolic drugs

These are some of the medications hikers commonly take on the trail and an explanation of how they are best used.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
These include ibuprofen, the active ingredient in Advil, Nuprin, and Motrin IB. Ibuprofen is available in over-the-counter (OTC) strength (200 mg) and labeled generically or as one of the brands. (When sold by prescription it is supplied as Motrin in 300 mg or higher dose tablets.) Aspirin is the oldest drug in this category. There are many newer prescription drugs in this class. These drugs are good for minor aches and pains, sprains, strains, and muscle and joint difficulties. The next time you buy a bottle of ibuprofen, take a few minutes to read the instructions leaflet in the package. (It's best to read it three times: first for general format and content, second for comprehension, third for critique and ability to explain it to someone else.)

Take one tablet every four to six hours as necessary, preferably with some food. Sometimes two tablets are needed for relief. It is best not to take more than eight tablets daily unless prescribed by a doctor. Hikers sensitive to aspirin should be careful. In my case, I found that in medical school I was allergic to aspirin and I never took it again. However, I have been able to take ibuprofen for trail-related musculoskeletal problems without adverse consequences. Instead of ibuprofen, two aspirin tablets (325 mg each) can be used. Overuse of NSAIDs can lead to gastrointestinal upset or worse. Acetaminophen (Tylenol, 325 mg and other strengths) can be used as an analgesic for pain but has much less anti-inflammatory action (an important effect on the trail) than the above agents.

Prescription Analgesics
A common example of these includes codeine, either alone or in mixtures (for example, Tylenol plus codeine). These can be helpful in cases of more severe types of pain, but are only available with a prescription.

Over-The-Counter Antihistamines
Antihistamines such as Benadryl (25-mg tablets) or Chlor-Trimeton (4-mg tablets) are very important to have with you in case of allergic responses to stinging or biting insects (bees, hornets, wasps, ants) and plants (nettles), food reactions, and other allergies. These and other antihistamines also have anti-itch action, cause sedation, and have been used at night as anti-insomnia drugs.

Antibiotics
Most antibiotics are prescription drugs and can be carried for specific indications if you expect infections. They include the various forms of penicillin (for example, Dicloxacillin or Ciprofloxacin). Hikers who have or who are prone to urinary infections (many women, and some men with prostatic hypertrophy) should consider carrying Bactrim or Septra, other tablets, or a prescription. Some hikers have carried topical antibiotics (ointments and creams), but I doubt their efficacy and do not recommend them.