6 Essentials Every Backpacker Should Have in Their First Aid Kit, According to a Pharmacist

This is a guest post by Paul “Aragorn” Larrat.

Extended travel in the wilderness necessitates carrying your “life support system” on your back, including your “trekking pharmacy.” As a long distance backpacker and, coincidentally, a pharmacist, I am frequently asked for advice on medication to include in a wilderness first aid kit. Here are some thoughts.

First, some general information about the medications that might accompany you.

Ed. note: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have questions regarding a medical condition, always consult your healthcare provider.

Storage

Tablets and capsules are very sensitive to humidity, so waterproof storage is critical. Wet tablets can turn to mush and capsules create an interesting, but unusable, blob when wet. I have had good luck storing my tablets and capsules in little zip lock bags (2×3 inches) and then placing them in a second waterproof sack.

Resupply

To avoid carrying several months’ worth of meds with me for a lengthy adventure, I break them into 30-day supplies and mail them ahead to a convenient post office. Luckily, there are quite a few pharmacies and markets along some trails, so resupply is relatively straightforward.

Should you need a prescription medication along the way, community pharmacists can usually contact your physician or home pharmacy for a prescription refill. If you fill your prescriptions at a large chain pharmacy, their computer system will have your prescription information on file and possibly expedite your refill while in a trail town.

Administration, Interactions, and Side Effects

Be prepared. Have a basic knowledge about your medications before you go. Some of the medications noted here cause drowsiness or make you susceptible to a painful sunburn. Others need to be taken on an empty stomach to effectively work. Some are rendered inactive if taken with vitamin and mineral supplements. Read your medication package labels, do some research on the internet or talk to your pharmacist.

So, with all those caveats in place, let’s answer the question about what medication to bring on an extended adventure.

What’s in Your Backpacker First Aid Kit?

1. Your Prescription Meds

This may sound obvious, but stock up and carry your routine prescription medications with prescription information in case of the need for a refill.

As a more “experienced” trekker, I am now plagued by a couple of chronic conditions. I package my meds in waterproof zip-lock baggies, label them, and keep information about the prescription (such as pharmacy, prescription number, drug name and dose) in my iPhone.

2. Antihistamines

Oral antihistamines (such as Benadryl and Claritin) are effective in treating a range of conditions on the trail. On my SOBO backpack through the southern Appalachian Trail during the spring, I ran into plenty of “triggers” for allergic reactions.

Antihistamines effectively control the runny nose of seasonal allergies and the itch and swelling of exposure to bug bites and poison ivy.

A word of warning: some antihistamines (particularly Benadryl) cause marked drowsiness. Perhaps helpful for a full nights’ sleep in a shelter, but maybe a challenge while hiking.

3. Antibiotics

Oral antibiotics such as ciprofloxacin (Cipro) are commonly prescribed for treating the inevitable gastrointestinal issues such as “traveler’s diarrhea.” In most cases, a single dose of 750mg of ciprofloxacin quickly resolves the issue. Be sure to increase your fluid and electrolyte intake when this ailment strikes!

Several over-the-counter agents, such as loperamide (Lomotil) and Pepto Bismol, are also effective for the same conditions. I have had good luck carrying loperamide as my drug of choice.

For travel in areas where Lyme disease is endemic from tick bites, you might consider carrying the oral antibiotic doxycycline. A single 200mg dose of doxycycline within the first 72 hours of having been bitten by a deer tick has been shown to prevent or lessen the effects of the disease.

Oral antibiotics need a prescription, so consultation with your physician or a travel clinic is often necessary.

4. Anti-Inflammatory Agents

Ibuprofen (Motrin, “Vitamin I”) is amongst the most common meds in a trekker’s pack. From the joint aches brought on by a 20-mile day to the occasional headache or pain from an injury, agents in this family are considered essential on the trail. Similar drugs, such as naproxen (Aleve) and aspirin are effective alternatives. They do tend to irritate the stomach, so take with food.

5. Topicals

A couple of medications that you apply directly to the skin are worth including in your trek pharmacy. Include an antibiotic ointment (such as Neosporin or Bacitracin) for cuts and blister care and an anti-inflammatory cream (such as hydrocortisone) for the swelling and itch of poison ivy and insect bites, as well as the discomfort of sunburn. Both agents are available in small tubes or single use packets. Use these meds early and often!

6. Emergency Medication

Many people have asked me whether they should carry an epinephrine injector like an Epipen for severe anaphylactic (allergic) reactions to insects, such as bees and wasps. If you are me, you carry two, as I discovered that I was severely allergic to yellow jackets on a canoe trek on the Saranac River in the Adirondacks.

For some this is a “life or death” medication. Some trekkers who do not know if they are allergic to insects or just want to be prepared for themselves or others opt to carry the Epipen. Their high cost, extra weight and prescription-only status make routine inclusion in a trekker’s gear uncommon, unless they are at risk of severe anaphylaxis.

Another easy emergency medication to carry is baby aspirin (aspirin 84mg). Coming upon someone in the beginning stages of a heart attack is very rare, but having aspirin available to prevent blood clots from forming and further damaging the heart could be game-changer. Two tablets chewed is the best you can do as you wait for assistance to arrive.

I consider the medications discussed above to be essential components of the trek pharmacy. Except perhaps for the Epipen, weight really is a minor issue.

Rummaging through the first aid kits of fellow trekkers reveals other medications you might consider having on hand. Eye drops, cold tablets, Tums, first aid cream, and sunscreen are but a few of the common options.

What About Vitamins?

Finally, just to tiptoe around a current controversy: is it worth taking vitamins/mineral supplements on the trail? I’ll leave that decision to the trekker, but will caution that some minerals affect the absorption of many prescription drugs, rendering them less effective. Again, do a little research about what medications you are putting into your body.

Closing Thoughts

And the concluding caveat: do your homework before hitting the trail and be sure to consult a pharmacist or your physician provider with questions. Know the uses, side effects, administration and drug interactions of all these medications. You will be largely off of the health system grid for an extended period, so prepare ahead.

Have a healthy and rewarding trek!

About the Author: Paul Larrat (AKA Aragorn)

I am an avid outdoorsman, spending time mountaineering, backpacking, whitewater canoeing, and sailing. I’ve been married to a very understanding and supportive partner, Amey Larrat, for 40 years and have two grown children, Meghan and Eric, and now a granddaughter (Adelyn).

My favorite climbs have been Mt. Rainier in Washington, Gannett Peak in Wyoming, and Mt. Kilimanjaro in Tanzania, and I have reached my goal of climbing the 48 high points of the continental US with Eric.

I am working on completing the Appalachian Trail in 2024 as a LASHer and look forward to more long-distance hiking in the western states. In my day job, I am a pharmacist, epidemiologist, and dean emeritus of the College of Pharmacy at the University of Rhode Island.

Featured image: Graphic design by Zack Goldmann.

Correction 4/23/2024: The article originally stated that the author completed the AT in the spring of 2024. The author has not yet finished the trail but expects to complete his multi-year section hike of the AT in 2024.