Travelling with Chronic Conditions

Travel vaccines aren't the only pre-travel job

For travellers on regular medication, the vaccine list is just the start. Insulin in checked baggage can freeze at altitude. Mounjaro and Wegovy KwikPens have specific cold-chain requirements. Long-acting basal insulins need re-timing for >4-hour zone shifts. Some HIV antiretrovirals interact dangerously with mefloquine. Inhaled corticosteroids may be confiscated at certain Middle East borders without proper documentation. Stimulant ADHD medication and codeine-containing analgesics need customs paperwork for Japan, UAE, Singapore, and several other destinations.

None of this gets caught by a 5-minute online travel-jab booking. A 30-minute pre-travel pharmacist review at Trafford Clinic does.

The six categories we work through

1. Transport and cold chain

Insulin and GLP-1 injections always go in hand luggage — the cargo hold drops below freezing on most long-haul flights, and a single freeze episode renders insulin biologically inactive. UK and EU security regulations allow medication in carry-on without special declaration if the quantity matches a personal prescription. A Frio cooling case (about £30 from any pharmacy) keeps insulin stable for several days in hot climates without needing a fridge. Mounjaro and Wegovy KwikPens are licensed up to 30°C for 30 days unrefrigerated, so for a 2-week beach holiday a Frio isn't strictly required — just keep the pen out of direct sunlight.

2. Time-zone dose adjustment

For zone shifts under 4 hours, no adjustment is usually needed. For 4–12 hours, we calculate a personalised dose-timing chart. The basic principle for once-daily basal insulin (e.g. Lantus, Tresiba): one dose every 24 hours by your watch — set the watch to destination time on arrival and continue. For metformin and other oral hypoglycaemics, spread the transition over 2–3 days. For weekly GLP-1 injections, choose a 'shift day' and move forward or back by no more than 24 hours.

3. Vaccine–medication interactions

Mefloquine (Lariam) interacts with several SSRIs (notably fluoxetine and sertraline), antiepileptics, and beta-blockers — we typically choose doxycycline or atovaquone-proguanil instead for these patients. Yellow Fever vaccine (Stamaril) is contraindicated in immunosuppression (HIV with CD4 <200, biologics, high-dose steroids). Live vaccines should be deferred during immunosuppressant therapy.

4. Customs and controlled medications

Japan restricts stimulants (Concerta, Adderall) and pseudoephedrine. UAE restricts opioid analgesics including codeine combinations. Singapore restricts diazepam and sleeping tablets. Saudi Arabia has variable enforcement. The fix is usually a doctor's letter stating the diagnosis, the medication name, dose, and that it is for personal use — we write these as part of the consultation.

5. Sufficient supply

Carry 10–20% more than the trip duration. Lost luggage and delayed return flights are real. For long trips, carry a written prescription as backup.

6. What to do if you run out abroad

Most common medications are available in destination pharmacies under different brand names. We'll list the international non-proprietary names (INNs) for your prescriptions so a foreign pharmacist can find an equivalent. Embassy guidance covers controlled substances. The British Embassy in each country has a 24-hour line for medical emergencies including medication assistance.

What we'll go through in your consultation

Bring everything: prescription medications, OTC supplements, inhalers, contraception, and any 'as-needed' medications you might take. We review the lot, map it against your destination, climate, time zones, and trip activities, and produce a personalised plan: dose-timing chart for time-zone shifts, transport instructions, doctor's letter for customs where needed, vaccine plan, and emergency contact list. Travel vaccines are administered at the same visit.