Holiday Medication Safety: What Changes When Your Routine Changes

Travel and time zones

Travel within the United States rarely requires changes to most medication schedules, but a few situations do.

• Insulin and other diabetes medications. Long flights crossing multiple time zones may require dose timing adjustments. Coordinate with your prescriber or pharmacist before the trip.
• Birth control pills. Take at the same body clock time, which may mean an unusual time on the local clock for a few days.
• Time sensitive medications including transplant medications, seizure medications, and certain heart medications. Plan timing carefully.
• Refills running out mid trip. Refill before departure. Pack extra in case of travel delays.

Packing medications correctly

• Always pack medications in carry on luggage. Checked bags get lost.
• Keep medications in original containers with labels.
• Bring a written list including generic names in case you need care while traveling.
• For insulin, keep in temperature controlled storage. Do not check it in the cargo hold (can freeze).
• Bring extra for delays. A 7 day buffer beyond your trip length is reasonable.

Alcohol and your medications

Alcohol interacts with many common medications in ways that range from mildly increased side effects to dangerous. Common high impact combinations:

• Sedating medications including sleep medications, benzodiazepines, certain antidepressants, and certain pain medications. Combination amplifies sedation, breathing depression, and impairment.
• Acetaminophen. Daily alcohol use combined with regular acetaminophen raises liver injury risk.
• Metronidazole and certain other antibiotics. Combination with alcohol causes a severe disulfiram like reaction.
• Warfarin. Alcohol can affect INR.
• Diabetes medications including insulin and sulfonylureas. Alcohol can cause delayed hypoglycemia.
• Blood pressure medications. Alcohol can increase orthostatic dizziness.

If you plan to drink at holiday events, know your interactions. Your pharmacist can review your specific medications.

Food and rich meals

Holiday meals affect medication regimens in several ways.

• Blood pressure can spike with heavy salt intake.
• Diabetic patients often see blood sugar excursions from large carbohydrate loads.
• Patients on warfarin should keep vitamin K intake (leafy greens, certain other foods) consistent week to week. Dramatic increases or decreases affect INR.
• GI side effects of medications can intensify with rich, fatty meals.
• Heartburn, reflux, and bloating commonly increase, prompting overuse of antacids and PPIs.

Patients with diabetes, hypertension, heart failure, or warfarin therapy benefit from a quick chat before the holidays about how to handle the predictable issues.

Missed doses during travel and chaos

Holiday weeks have more missed doses than any other time of year. Patterns that help:

• Set a phone alarm for daily medications, including during travel.
• Pack a weekly pill organizer for trips.
• Identify a backup pharmacy near your destination in case of refill problems.
• Make a list before you leave of every medication and time taken.
• If a dose is missed, look up what to do for that specific medication rather than guessing. Some require taking as soon as remembered; others require skipping.

Holiday stress and mental health

Holidays raise stress, disrupt sleep, increase alcohol use, and intensify grief for patients who have lost family. Mental health symptoms commonly worsen between Thanksgiving and January. For patients on mental health medications:

• Stay on schedule, even when routines are disrupted.
• Plan for refills before travel.
• Watch for sleep disruption that may worsen mood symptoms.
• Limit alcohol if depression or anxiety are not well controlled.
• Identify a person to call if you are struggling.

If you or someone you know is in crisis, call or text 988, the Suicide and Crisis Lifeline.

Children visiting and medication storage

Households that do not normally have children may have grandchildren visiting during the holidays. Several safety considerations:

• Keep all medications in their original containers with safety caps.
• Store medications high and out of sight, not on kitchen counters or nightstands.
• Iron containing supplements and adult medications can be lethal to a small child. Take care.
• If a child does ingest something unintended, call Poison Control immediately at 1-800-222-1222. Do not wait to see if symptoms develop.

When to talk to a pharmacist

• You are traveling and want to confirm medication timing.
• You take medications that interact with alcohol.
• You have diabetes, hypertension, or heart failure and want to plan for holiday meals.
• You take warfarin and want to discuss vitamin K consistency.
• You are caring for a family member during the holidays and want a refill plan.
• You have running mental health symptoms that may worsen during the season.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.