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.

Good luck with the preps and thanks for reading!

-Doc Morgan

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15 thoughts on “What meds would you want in your personal SHTF pharmacy?”

  1. I would go with lomotil or even paregoric for diarrhea, flagyl or doxycycline for antibiotic ( maybe even Bactrim DS), I agree with the zofran ( side effects and limited dosing in young children against phenergan), ibuprofen and straight morphine injection. Alternative – lidocaine injection, mupiricin ointment, prednisone,

  2. Although you covered this in your disclaimer, I would encourage families to use Zofran only on those for whom it has already once been prescribed, and then only sparingly Zofran is implicated in a few deaths from sudden arrhythmic death syndrome (Long WT Syndrome, Short QT Syndrome, Brugada Syndrome, WPW etc. etc.) Since SADS is much more common than it was (and it actually happened to our family without the Zofran) I have a new appreciation for caution with regard to qt interval and drugs. Thanks for a wonderful article. It will help many.

  3. I really like this list of meds – and alternates. I recommend peppers begin with developing countermeasures for their most likely threat scenario thence proceeding to less likely. Disease and trauma seem to be an underlying motif hence my enthusiasm for this list. When stockpiling human meds, I look at such things as broad spectrum application, efficacy, and shelf life. I store almost all of my dedicated SHTF drugs in .50 cal ammo boxes along with dessicant, in a refrigerator kept at 45 degrees, because most studies indicate temperature and moisture are shelf life killers.

    Meds like Phenergen can do double duty when combined with pain killers such as morphine or morphine derivatives such as morphine/morphone hydrochloride/sulphate in order to control nausea produced by the narcotic.

    For what it’s worth, I have all the recommended and alternates in my supplies.

    For those readers who are MDs, it would be helpful to have your opinions on prescribing drugs from the national formulary for SHTF use.

    Thanks again,

  4. Pepto-Bismol tablets for heartburn and anti-diarrhea.
    Foot powder and anti-fungal for those who must walk a long way.

    These are not medicines, but they keep the body functioning comfortably –
    Extra reading glasses.
    Extra nail clippers.
    Dental floss.
    Cotton swabs for the ears.

  5. What I learned traveling to Tropical “Other Countries” .. You can’t count on the meds you get there even though they look identical, nor necessarily the diagnosis of the “Medical” person you might see. That being said my doc supports learning how to self diagnose and self prescribe for common ailments. So happens most of these are the ones that can get you when SHTF or whatever you want to call it Tornado/Earthquakes etc.. Anything that pits you against the elements, water and food sources. You can deal with a lot if you are not dehydrated and dying due to flu, dysentery from water or food, or serious infection.

    As with my travels the first medication is avoid the issue. Water/food etc .. and don’t get sick .. not being a smart alik.. Just that everyone needs to learn the things to do and not to do. When you do get sick, because stuff happens.. .. I learned how to identify and diagnose what it most likely is.. All this to say that My Doc prescribes travel meds sufficient for me to resolve common medical conditions .. a lot of what you mention above.. some different meds .. based on what I have responded to well in the past… or what is most likely to help if needed. The good part is .. travel meds including renewal of all the childhood vaccinations are covered by insurance .. I renew them yearly and keep them on hand (they recommend replacing yearly, but they are actually good for a while longer) .. and no freezing does not make them last longer .. per the mfg’s.

    If you are against vaccinations and all .. I am not saying you should .. Just that tropical Other countries have lots of bad water, poor sanitation and zero insect control .. I don’t know what they eat when I am not there .. but I do know what they eat when I do visit .. I do not want the parasites they carry .. IMO.. the vaccinations are a minor risk comparatively. To each his own… so don’t fuss at me.

    Much of this is good for Infections and pain due to trauma.. but I am not advocating it takes care of emergency care .. Trauma is special and something discussed in an earlier article by John. That is whole different set of learning I am working on and not yet qualified to comment much on.. It doesn’t make up for long term SHTF or exotic scenarios .. but it would cover a couple weeks worth for family members, at lower expense if insured.. while you are saving your pennies and learning for all the Other things you need to get … If it helps someone cool .. if not .. well it still works for me and I lose nothing by sharing it I don’t think. Good luck ..
    Be cautious with medication .. If you are allergic or take the wrong thing, or to much of the right thing .. the treatment can definitely be worse than the problem ..
    Docs and educated medial advice is always my first choice .. but I don’t want to be stuck if it’s not available right?

  6. John, be careful with Levaquin. It has a history of serious adverse side effects. The most notable is swelling and/or rupturing the Achilles tendon. I was prescribed this drug for a serious upper respiratory infection. After less than a week, I couldn’t walk. I ended up wearing an orthopedic boot for about 6 weeks. It took months to get over it. There has been a huge class action lawsuit over this. I talked to one of the lawyers on the team and he told me horror stories of people rupturing the tendon and the surgeries they ended up going thru. Even after that, an Achilles tendon “repair” never gets you back to where you were before the injury. Needless to say, if the SHTF, you don’t need this to happen.


    • Yup you are right Oren .. I’ve had a 3-4 that have the same contraindications and “possible” side effects… I was cautioned to “Not go Heavy ” in weights .. I kept heavy .. but did use a high degree of aerobic warm up/stretching prior to weighted or strength movements. You could definitely feel the stiff fullness of the tendons .. and feel your way through it .. I can see an all or nothing sprint blowing a tendon ..

  7. I’ve used “Fishicillin” to kill a respiratory problem. I used it just like “real” medicine and had no ill side effects. I would certainly use it again if I had similar symptoms as the last time.

  8. Not in the same league as those listed above, but I go nowhere without a tube of Neosporin. With a diabetic in residence, we’re accustomed to treating even minor cuts and scrapes immediately so that they don’t get infected. It wouldn’t do much for a major injury, but too many people in the not-so-distant good ol’ days died from tetanus and blood poisoning due to what began as a simple skin puncture.

  9. Oren, my husbands own Dr. ruptured his achilles tendon while on Levaquin.
    I have had great success fighting a very severe brochial infection with an herb called Astragalus and Hylands homeopathic bronchial formula..The Hyland company puts out exc. homeopathic meds.
    Folks also remember if you take an antibiotic please have either yogurt or acidophilus on hand.Start it when you start the antibiotic and this will help to prevent a yeast infection (vaginal or rectal) . The reason being the anti biotic kills the good and bad bacterial . The yogurt and or acidophilus protects the good bacteria.
    PSI dont have a spleen so I must be careful.

  10. as an aside warning – some folks taking benadryl for sedation – might get the opposite effect and get a little wired. you should probably try it at home and check your response than trying it for the first time when you really need it.


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