Everything you need to know about foreign pharmacies

Counterfeit pills are a real concern

At some point during your travels abroad, you might catch a bug that requires greater attention than a bowl of soup and an early bedtime. If the illness is mild or familiar, a quick trip to the pharmacy can help you get your bounce back.

“The pharmacy is a good first stop for triage,” said Karl Hess, an associate professor at the Chapman University School of Pharmacy in California.

Unfortunately, some pharmacies can do more harm than good, especially in destinations with less rigorous drug oversight. A recent study by researchers with the University of California at Los Angeles discovered that pharmacies in northern Mexico are selling counterfeit pills containing fentanyl, heroin and methamphetamine to tourists.

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“Counterfeit medication is actually a huge problem worldwide,” said Hess, who is also chair of the Pharmacist Professional Group with the International Society of Travel Medicine. “In places like Asia and Africa, up to 30 percent of medications may be counterfeit. In India, it may be as high as 40 percent.”

By following a few cautionary steps, travelers in foreign destinations can find pharmacies that will improve — not imperil — their health.

What medicines to pack — just in case

To paraphrase Benjamin Franklin: An ounce of prevention can save you an urgent trip to the pharmacy.

“You may not need any of the medicines that you take with you,” said K. Ashley Garling-Nañez, a clinical assistant professor at the University of Texas at Austin College of Pharmacy, “but if you do need them, you are going to be very thankful.”

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Before you sweep CVS’s shelves into your toiletry bag, consult with a travel medicine specialist. The physician or pharmacist can provide you with a list of general medications to pack, as well as ones specific to your destination, such as anti-malarial drugs.

The experts should also know a country’s importation laws, which could include restrictions on medicines containing certain chemicals. For example, Japan requires international visitors to acquire an importation certification for more than two dozen pharmaceutical ingredients, including propranolol hydrochloride, which is found in beta blockers and migraine and anxiety medications.

“Many common medications and over-the-counter drugs in the United States are illegal in Japan,” warns the U.S. Embassy and Consulates in Japan. “It does not matter if you have a valid U.S. prescription for a medicine/drug which is illegal in Japan: if you bring it with you, you risk arrest and detention by the Japanese authorities.”

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Hess recommends meeting with a specialist at least four weeks before your trip. The International Society of Travel Medicine has compiled an online clinic directory for more than 90 countries. The Centers for Disease Control and Prevention created a database of yellow fever vaccination clinics that offer services beyond the injection. Hess said many pharmacies are also expanding into travel medicine.

Most of the pills and potions you’ll need for your first-aid kit are available at any neighborhood pharmacy. The Netherlands-based International Pharmaceutical Federation recommends painkillers, such as paracetamol, ibuprofen or aspirin; a nasal decongestant; an anti-diarrheal medicine, such as Imodium or Pepto Bismol; oral rehydration salts; disinfectants, such as iodine and alcohol gel; and motion sickness tablets, if you easily turn green.

Garling-Nañez throws into her mobile medicine cabinet an antihistamine such as Benadryl, which can also act as a sleep aid. For gastrointestinal issues, she recommends Pepcid Complete. “It will help for anything from an upset stomach to acid reflux,” she said.

Travelers prone to urinary tract infections (common causes include dehydration and an overabundance of coffee or alcohol) should carry Azo (or phenazopyridine), which can relieve painful symptoms in 30 minutes or less. To kill the infection, however, you’ll need an antibiotic, such as Cipro (ciprofloxacin), which requires a prescription in the United States but is available over the counter in many other countries. The drug can vanquish other maladies as well, such as sinus infections, diarrhea and bronchitis.

“You should get broader antibiotics that cover a variety of things,” Garling-Nañez suggested.

How to find a reputable pharmacy abroad

Don’t pretend to be a doctor. If you fall ill while traveling, consult with a medical professional. That said, sometimes you already know the quick cure to feeling better, and you just need to get your hands on the right meds.

Finding a reputable pharmacy is critical. U.S. embassies and consulates provide medical assistance, and in many countries, this responsibility includes the names and addresses of pharmacies.

If the State Department does not have options in your location, look for pharmacies that are affiliated with a hospital or medical clinic or that are part of a large pharmacy chain, such as Shoppers Drug Mart in Ontario, Canada; Clicks in South Africa; and Raia Drogasil S.A. in Brazil. Some major supermarkets also have on-site pharmacies, such as Tesco in England and select Carrefour stores in Belgium. And there’s always Walmart, which has stores in about two dozen countries.

Most important, steer clear of open markets and street vendors, where illegal sales of tainted drugs can be rampant.

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“All pharmacies sell medicines all over the world, but the types of medicines that are available, or those you may be able to obtain with or without a prescription, may vary from country to country,” said Lars-Ake Söderlund, vice president of the International Pharmaceutical Federation.

Bradley and Jenny Urias, who share their adventures at Eat Wander Explore, have visited countless pharmacies since they left Orlando to pursue a nomadic lifestyle five years ago. The couple, who have two young children, have picked up medications at pharmacies in Scotland, Italy, South Africa, Thailand, Malaysia, Australia, Costa Rica, Mexico, Germany and Albania. They typically seek out chain drugstores in well-populated areas with heavy foot traffic.

“I went to a brand-name pharmacy in the main square of Tirana,” Bradley said, referring to the Albanian capital, which they visited in fall 2021. “It seemed like they knew what I needed, and they told me all the stuff that a normal pharmacy would.”

Best of all: The medicine he purchased in Albania did not require a prescription and cost less than a penny per day. In the United States, Urias would have paid more than 170 times as much for the prescription drug, at $4.25 per day.

How to check pills for tampering

Even if you feel confident with your self-diagnosis, consult with a pharmacist. Foreign pharmacies do not often stock the same brands as U.S. retailers. Provide the pharmacist with the active ingredients in your preferred medication, although Garling-Nañez said sometimes the chemical names are also different.

However, symptoms are universal, so overshare with the pharmacist, if necessary.

“In some countries, pharmacies have prescribing abilities. They will also be very knowledgeable about what is legal for you to have and to get, and need a script for,” Garling-Nañez said.

If language is an issue, bring along a reliable interpreter. When I needed Cipro in Fez, Morocco, an Arabic-speaking guest at my riad lodging offered to accompany me to the pharmacy. She doubled as a navigator, asking for directions as we wended our way through the mazelike medina.

“It’s always good to find someone you trust who can speak the native language, because medical information is tough to translate,” Garling-Nañez said.

Bradley said that, in Albania, the pharmacist spoke English but also provided him with the Albanian word for the medicine he needed. He powered up Google Translate and verified the name.

“I’ll look online to see if the brands that pharmacies are selling are legitimate and decent,” he said from New Zealand, where he and his family will spend the next several weeks.

Though you might want to tear open the box of pills with your teeth, take a beat and inspect the packaging for tampering. The medicine should be in its original container (no plastic bag) and tightly sealed. The label should be clearly printed, with no misspellings or inky smudges, which can be indications of a counterfeit product.

After opening the bottle, check the pills for flaws. Jose Lucar, an infectious-disease physician and associate professor of medicine at George Washington University’s School of Medicine and Health Sciences, said to pay attention to the color, size and shape. If pills are sticky, cracked, spotted or discolored, toss the batch.

If the med comes in liquid form, Hess said to shake the bottle. If it “goes into suspension,” it’s safe. If it clumps, it could be a fake.

Before departing, ask an employee for a receipt for tracking purposes or for your health insurance company, depending on your plan’s reimbursement policy. The proof of purchase is also a good test of character: An upstanding pharmacy will willingly furnish one.

What meds you can bring back to the U.S.

Medications do not make good travel mementos. The Food and Drug Administration dissuades travelers from bringing back drugs procured from abroad, with a few exceptions.

“It is illegal for individuals to import drugs or devices into the U.S. for personal use because these products purchased from other countries often have not been approved by the FDA for use and sale in the U.S.,” the agency states.

However, travelers can enter the United States with meds that are not intended for a serious ailment or that have a low health risk. Even so, most pharmacies offer more desirable souvenir ideas than bismuth subsalicylate or diphenhydramine.

Pick up fancy lotions, scented soaps, skin-care products or cosmetics exclusive to that country. Unlike the medical items, you don’t need to be sick to enjoy these pharmacy finds.

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