Guest Post: What meds would you want in your personal SHTF pharmacy?


DISCLAIMER: Always consult a medical doctor before using any new medications, prescription or not. This information is intended to be used as a general guide of what types of medications would be most useful in a post-societal breakdown situation where there is no formal access to medical care, and you are forced to become your own doctor. In no way is this information intended to be formal medical advice, ergo I take no responsibility for what you do with this information after you read it – this does not substitute for medical school!


I was once asked what five drugs I’d want to have with me on a desert island if those and only those. At the time I wasn’t experienced enough in clinical practice to intelligently answer this question, but now reflecting back on this question I think I can come up with a half decent list.


My Top Five Medications:


1. Antidiarrheal such as Loperamide: In the event that your water purification system fails or is expended, water-borne disease will be a real life threatening problem. It’s important to be cautious with use of any antidiarrheal because it has the potential to cause a rare but serious complication of causing the intestines to be paralyzed. Also, be very cautious using this medication when there is blood in the stool because it can be a sign of a bacterial source (such as Shigella), which sheds a toxin that, in theory, if is kept in the intestines longer by promoting decreased bowel movements, will actually cause a longer duration of diarrhea, and hence more total water losses. If the diarrhea sticks around for more than a few days, it’s prudent to start an antibiotic such as levofloxacin or azithromycin.


2. Antiemetic such as Zofran ODT or Phenergan: Our largest amount of potential water loss is not in urine – it’s in secretions from our GI tract. Luckily our colon when disease-free is efficient and absorbs most of these secretions before they can escape. However, if we’re suffering from some viral illness that’s causing us to vomit, all of the stomach and intestinal secretions will be lost because they never get a chance to reach the colon, hence my choice of an antiemetic for the same reason as the antidiarrheal – just preventing losses from the opposite end. The first line of trying to keep vomiting minimal is diet modification: dry bland foods such as crackers, rice, bananas, toast, in addition to very small portions or sips of electrolyte replacement solutions such as pedialyte or a homemade solution (1L of water + 6 teaspoons sugar + ½ teaspoon salt, better to make a little more diluted than more concentrated which can be more harm than good). But when dry heaving prevents anything from staying down, I prefer using zofran oral dissolvable tablets (ODT) which can be absorbed under the tongue, eliminating the need to swallow and keep it down for it to be absorbed. Phenergan is also a very good option if you can keep down a pill.


3. Antihistamine such as Benedryl: Great for multiple scenarios. One it’s great for allergic reactions, insect stings, bites, swelling, whatever type of thing activates an immune response it usually does the trick. It’s also used to help with sedation (which in a SHTF scenario, may prove very useful when trying to calm down enough to get some much needed sleep). It can also be used to treat vertigo.


4. Antiinflammatory such as Aleve: This is a no brainer. You’ve got so many potential uses for an NSAID such as this. It’s great as a mild-moderate pain reliever. It can be used to treat sore throats, arthritis, injury pain, and fevers. The reason I chose Aleve instead of Ibuprofen or Tylenol is that you only need to take this once every 12h. The only real downfall of this medication is that since it’s more potent, it is more prone to cause stomach ulcers with prolonged use, and you need to take food with it to minimize that risk. Now when it comes to medications that kids use I’m assuming you always have children’s tylenol or motrin on-hand already. Just remember tylenol is the best for any age, but ibuprofen (motrin) can only be used if the child is 6 months of age or older. Also, in pregnant patients, you only want to use tylenol.


5. Antibiotic such as Levofloxacin or Azithromycin: This is a difficult one, but if I had to chose ONE antibiotic for adults it would be Levofloxacin (Levaquin) for it’s versatility and power. It can treat anything from pneumonia, skin infections, intra-abdominal infections, bacterial diarrhea, urinary-tract infections, to anthrax (if god forbid it came down to biological terrorism). It’s a potent drug, and usually is quite safe to use but like any drug has some side effects to watch out for being renal dysfunction (common) and tendon rupture (rare). Azithromycin is an excellent choice as well since it can be used for strep throat, pneumonia, ear infections, mild skin infections, or sexually-transmitted infections. A great strength of this drug is that it usually only requires a few days of treatment (3-5 days), meaning you can store a lot of this and then only need to give someone 3-5 pills to treat their infection, not exhausting your supply. Other antibiotics like amoxicillin is dosed 3 times a day for 10 days (30 pills) which is about 10 times more that you need to store.


Runners up include the following:

1. Prednisone (excellent for any type of respiratory exacerbation related to asthma or emphysema. Epi-pen (especially if you or your family members have any type of severe allergy).

2. Albuterol (easy to store up since most docs will give you refills on this, and remember that even if you have young children, an inhaler is just as effective as a nebulizer, and as long as you get a spacer for the inhaler, you can store extra albuterol inhaler refills much easier and they last longer than the ampules of liquid albuterol.

3. Narcotic such as Vicodin, norco, or percocet that may be useful for an injured person that requires good pain control for a repair or relocation of dislocated limb, reduction of fracture, etc.

4. Ativan – same reason as the narcotic, but to help calm down in a very stressful situation, or to help sleep if the Benadryl does not cut it.


***Note: if you have a family member that is dependent on certain medications for chronic use (insulin, blood pressure meds, anticoagulants) then this is obviously a backup storage priority, and hopefully your doc understands the need to store these for emergency sake.


Lastly, my take on fish antibiotics is this:

If you have the ability to stock something up that is *nearly* the name (and sometimes identical) to the human analog, and were unable to acquire a comfortable amount of “human-grade” antibiotics, wouldn’t you want to be able to have SOMETHING to treat your son with when they started to develop a skin infection after hurting himself playing outside, or when your wife contracted bacterial diarrhea from drinking a contaminated water source?


Hence my opinion on that is pretty clear – in a SHTF world, where a simple infection may mean the difference between life and death unless you have the proper antibiotic to treat the infection, the risk of surely dying outweighs the risk of using antibiotics intended for aquatic use, and if I had the option of using them or watching helplessly as my family died, I would definitely use those “aquatic” antibiotics if our society broke down and access to medical care was non-existent.


I’ll try to come up with a good next topic related to medical-preparedness for a future post, please post any comments about what you would like to know and I’ll try to address them to the best of my ability.


Good luck with the preps and thanks for reading!

-Doc Morgan

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14 thoughts on “Guest Post: What meds would you want in your personal SHTF pharmacy?”

  1. I think I need to add an antiemetic and some prednisone to my home pharmacy, thanks. Some other medications to consider:

    Antifungals – Clotrimazole / Miconazole for yeast infections, ringworm, athletes foot.

    Antiparasitics – Mebendazole/Albendazole for intestional worms, and Permethrin for lice/scabies.

    Flagyl – Giardiasis, dental infections, anaerobic bacteria

    Improperly stored/cooked food, poor sanitation, and crowded living conditions would seem likely in a prolonged event. Even if your family is isolated and can maintain sanitary conditions, extended family/friends may not. Diseases/infections normally associated with third world countries or in the homeless might be common. May be good barter items too.

    And one more, laxatives – Useless you’re used to a diet of beans, rice, wheat, and oatmeal every day then this might be helpful.

  2. 1 – aspirin; it is an anti-inflammatory and anti-pyretic (fever). But it is also useful for thinning blood for those with risk of blood clots, strokes, or heart disease. Lately, it has been asserted that it may even protect from colon cancer, and perhaps also inhibits other cancers from metastascising.

    2 – diphenhydramine (Benadryl): in addition to the anti-histamine and sedative effects, it also works as an H2 antagonist, which reduces stomach upset. It isn’t technically an anti-emetic, but it can help. It is also an anti-cholinergic, so it can be used in those with Parkinsons.

    3 – Loperimide; death from dehydration due to a GI pathogen is much more likely in a survival situation. So this one may be even more important than anti-biotics.

    4- Anti-biotic; yes Levaquin if I can’t have several types (very expensive).

    5 – toss up between an anti-fungal (much more common in a survival situation) versus a narcotic, versus an epi-pen. The epi-pen is useful for a sever anaphylactic reaction, but is also your last ditch med when someone has arrested and you’re doing CPR (almost completely ineffective in a survival situation). You can also use it for someone whose BP has dropped seriously, but again it is temporary and dangerous if you are just guessing.


  4. I’m prone to getting tooth infections from trapped food and I take fish antibiotics about four times a year. I keep them in my medicine cabinet just like other medicines and use them as needed. In my experience they are fine.

  5. Matt – Thanks for the comment, hope it’s helpful

    Midas – Definitely a great point on antifungals. Usually fungal infections don’t get too life threatening unless you’re immunocompromised, but I can definitely agree storing up some antifungal creams in the case where you needed to treat an athletes foot that inhibited mobility or vaginal candidiasis which can also be treated with topical cream.
    Flagyl is a great drug to have if you can put some back, but it’s a more narrow-spectrum antibiotic useful for gastrointestinal stuff. We use it often to treat people who come in with serious intestinal infections such as diverticulitis or C. difficile colitis. I agree it’s got a good niche for treating uncommon first world diseases that may become more prevalent with poorer sanitation and services in a SHTF scenario.

    Zoomer – definitely a great list, only suggestion is that aspirin is not recommended for children, and although is a decent NSAID, ibuprofen, tylenol, or naproxen would be my go to for that use. In regards to it’s blood thinning properties by inhibiting platelet adherence, it’s a great medicine to have in chewable form for those who may experience a heart attack since this is one of the MONAB’s we use to treat acute heart attacks (morphine,oxygen,nitroglycerin,aspirin,beta blocker).

    Overall I’d say consensus is that it’s a great idea to put away as much as you can, but be selective if you need to transport your pharmacy in a bug-out situation. Topical antifungals would definitely be a good one to bring.

    -Doc Morgan

  6. Nice article Doc,

    My own Prepper group has been discussing this same topic of late. We have come to the conclusion through research and personal experience that “Fish Antibiotics” are in fact the exact same thing as the human drug. All pills, well all pills I’m aware of have what is called an “Identifier number” on them This is usually a combination of several letters and numbers, This along with the color of the pill/capsule can be used with one of many free on line pill identifiers to show that the fish antibiotic is the exact same thing we get from our Doctors.

    I had a Sinus Infection not to long ago, something I get regularly so I feel confident in diagnosing and treating it. I had some “Fish-Mox”, (Amoxicillin) that I had recently bought. I did some online research, opened up the bottle and examined the capsule, looked it up on a pill identifier online. The website said it was 250 MG of Amoxicillin made by West Ward pharmaceuticals.

    Long story short I started taking the Fish Mox 3 times a day. I didn’t grow gills or anything. I got well, the Amoxicillin did just what it was supposed to do to my bacterial sinus infection, it killed it. It’s the same stuff and the Government is already working hard to close this loop hole. Get it while you can.

    Only problem is you can’t get all Antibiotics in fish form and the more powerful stuff does begin to get expensive. Ebay or a google search are good places to start.

  7. Outstanding! Thanks for the tips, I also include the “no brainers” such as aspirin, acetominophen, ibuprofen, Pepto Bismol, and a comprehensive first aid and trauma kit that has topical triple antibiotics, cortizone, and a good burn gel to name a few.

    I certainly appreciate your position on the fish antibiotics, problem is (for the layman) is how to use it, and how much to use.

    Thank you for the great post

  8. My question has always been when preparing my emergency supplies is how on earth do you get these important meds such as antibiotics and pain-relievers stronger than tylenol or even any meds requiring a prescription? Is there another way?

  9. Linda – it’s a difficult obstacle to try and get antibiotics prescribed unless you’re traveling overseas or have a doc who is OK prescribing for the reasons we are discussing. For the narcotics it’s even more difficult since these are controlled substances and docs are monitored in regards to these meds. Best ways are to save them from post-operative prescriptions for pain.

    Also it looks like the fish antibiotics are essentially the same as the human ones, unfortunately the supply seems to be drying up online since levofloxacin which was once available doesn’t seem to be available anymore per my searching today. Ciprofloxacin is an acceptable alternative which is still available, as well as azithromycin. Cephalexin is also good, equivocal to amoxicillin but also useful for treating skin infections not caused by MRSA.

    In regards to how to use these antibiotics…that’s a good point, and in order to do that you need to have the correct diagnosis, which can be simple or complicated, and sometimes need additional lab testing to confirm, and even then after that cultures usually are done to make sure the antibiotic that is started “empirically” is going to be effective against the bacteria that grows out of it. I’ll try and think of common infections requiring antibiotic usage and how to apply the antibiotics I recommended in a future post.

    Thanks for the comments.

  10. Thanks for this article. I’ve been trying to stock up on meds, recently purchased fish antibiotics. You included some meds I haven’t thought of yet. This article was very helpful for prepping.

  11. From Linda Merriam: “My question has always been when preparing my emergency supplies is how on earth do you get these important meds such as antibiotics and pain-relievers stronger than tylenol or even any meds requiring a prescription? Is there another way?”

  12. I thank Neal for posting a link for ‘bestmedmarket’. Reading the ‘about’ at the company’s website doesn’t give me any confidence in them because it is loaded with gramatical errors. Where (what country) is this company based? Does anyone have experience with this company and is it legit?
    Are there other sources that the author or other readers might recommend for genuine meds?

  13. To answer deb, I just tired to get some antibiotics, but was unable because the use of VISA and Mastercard were unavailable. The Mastercard option said to use VISA, then the VISA purchase said to use AMEX. I don’t have American Express, so I sent them an e-mail and closed out. I was just preparing to thank Neal for posting the link, as the previous link that I used (from Rourke on Emergency Essentials Forum) was closed. I was prompted to use Amazon, but when I searched for the meds, I just got a bunch of books. Anyway, I am posting a list of “Top Ten Survival Medications” that I found online last year. They may be from Cynthia Koelker or Dr. Bob on Survivalblog. I don’t recall. I did not print the list, I wrote it down. So, it may be a combination of opinions. First thing to stock is the RX(s) you take every day. Next: Ibuprofen, Aspirin/Acetaminophen, Dipenhydramine, Loperamide, Pseudoephedrine, Dramamine, Ranitidine, Hydrocortisone Cream, Bacitracin Ointment, Clotrimazole. Followed by: Oragel, Milk of Magnesia, Pepto-Bismol, Lidocaine, Multivitamin and Vitamin C.


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