Carbon Monoxide After the Storm

Carbon Monoxide After the Storm: The Symptoms Mistaken for the Flu

By the Jase Medical Team

The storm has passed, but the power is still out.

It’s raining, so the generator gets moved a little closer to the house—maybe under the porch or near an open garage. You’re making do, charging phones, keeping the refrigerator cold, trying to get through another day without power.

By day three, everyone feels terrible.

You’ve got a headache. Your spouse is nauseated. Someone feels weak and achy. Maybe the dog isn’t acting like itself either.

In February, it’s easy to think: The flu finally got us.

In July: Probably the heat. Maybe a stomach bug.

But there’s one question that should make you consider something entirely different:

Does everyone in the house feel sick at the same time—and do you start feeling better when you leave?

If the answer is yes, get everyone outside into fresh air and call 911. Carbon monoxide could be the reason.

Why Carbon Monoxide Can Look Like the Flu

Carbon monoxide (CO) is a colorless, odorless gas produced when fuels don’t burn completely. Generators, charcoal grills, vehicles, and other fuel-burning equipment can all produce it.

After storms and power outages, the risk increases because people start improvising.

A generator gets moved closer to the house because it’s raining. A grill gets pulled into a garage. A vehicle is left running in an enclosed or partially enclosed space.

The problem is that early carbon monoxide poisoning doesn’t necessarily look like poisoning.

It can cause headache, dizziness, weakness, nausea, vomiting, chest discomfort, and confusion.

Those symptoms overlap with plenty of ordinary illnesses.

That’s why the symptom list isn’t necessarily the most useful thing to remember.

The pattern is.

The Question That Can Break the Case Open

Imagine you’ve had a headache all morning.

You drive somewhere to pick up supplies and realize that after being away from the house for a while, you feel noticeably better.

You come home.

The headache returns.

Then you realize your spouse has a headache too. Someone else feels nauseated. The dog is unusually sluggish.

A virus can certainly spread through a household. But several people becoming sick at roughly the same time—and improving when they’re away from the same environment—is an important clue that the environment itself may be the problem.

Carbon monoxide exposure can affect multiple people sharing the same space.

So after a storm or during a power outage, remember this question:

Who else feels sick, and do we feel better when we leave?

If that pattern is present, don’t stay inside trying to determine whether it’s the flu, heat exhaustion, food poisoning, or carbon monoxide.

Get out.

A Normal Pulse Oximeter Doesn’t Rule Out Carbon Monoxide

This is an especially important misconception if you keep a fingertip pulse oximeter at home.

You feel terrible, put it on your finger, and see: 98%.

That can feel reassuring.

With suspected carbon monoxide poisoning, it shouldn’t.

A standard two-wavelength pulse oximeter cannot reliably distinguish normal oxygen-carrying hemoglobin from hemoglobin carrying carbon monoxide. As a result, the number displayed on a typical home pulse oximeter can appear normal even when significant carbon monoxide exposure has occurred.

A normal pulse ox reading does not rule out carbon monoxide poisoning.

If the circumstances and symptoms make you suspect CO, don’t use a reassuring-looking oxygen saturation number as a reason to stay inside.

What Should You Do If You Suspect Carbon Monoxide?

The immediate action is straightforward:

Get everyone out of the building and into fresh air. Then call 911.

Don’t remain inside looking for the source. Don’t wait to see whether the headache improves. Don’t rely on opening a window or door and staying in the home.

Emergency medical professionals can evaluate the exposure and provide oxygen and other treatment as appropriate.

If someone is confused, collapses, loses consciousness, has significant difficulty breathing, or is otherwise severely ill, treat it as an emergency.

And don’t forget everyone sharing the environment—including pets. If multiple members of the household seem unexpectedly sick at once, that’s part of the clue.

Generators Need Distance From the House

Generators are one of the most important carbon monoxide risks following storms.

They should be operated outdoors and away from the home, not inside a house, garage, basement, shed, carport, porch, or other enclosed or partially enclosed area.

Moving one “just under the porch” to keep it out of the rain can unintentionally move carbon monoxide closer to doors, windows, and vents where exhaust can enter the home.

The same principle applies to other fuel-burning equipment.

A charcoal grill doesn’t become safe to use indoors because the power is out. A vehicle shouldn’t be left running inside a garage to generate power or charge devices.

If it burns fuel, think about where the exhaust is going.

One of the Best Preparedness Tools Is Already on the Wall

There is a simple layer of protection that doesn’t require recognizing symptoms at all:

working carbon monoxide alarms.

Install CO alarms on every level of your home and outside sleeping areas, and make sure they’re functioning properly.

If an alarm sounds, move everyone outside and follow emergency guidance. Don’t assume it’s malfunctioning because nobody feels sick yet.

A CO alarm can identify the problem before your body has to.

Sometimes Preparedness Is Knowing Which Question to Ask

After a hurricane, tornado, winter storm, or extended power outage, there are plenty of things competing for your attention.

Is the refrigerator staying cold? Do you have enough fuel? When will the electricity come back? Is everyone hydrated? Can you get to the pharmacy?

Carbon monoxide doesn’t necessarily announce itself as a dramatic emergency. Sometimes it looks like a family that simply feels lousy on day three.

That’s why appropriate medical preparation isn’t just a shelf full of supplies.

Sometimes it’s knowing enough to notice when the story doesn’t fit.

At Jase Medical, we’re a family team of medical doctors, PAs, and pharmacists focused on that grey space—the moments when normal healthcare access and normal routines are disrupted, and knowing what to do next matters.

We’re not a replacement for primary care or emergency medicine.

We’d simply rather you recognize this pattern on day one:

If everyone in the house feels sick at the same time and starts feeling better when they leave, get out into fresh air and call 911.

Don’t let a normal pulse oximeter reading talk you out of it.


The Jase Medical Team is a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: clinically grounded readiness that complements, rather than replaces, the healthcare professionals you already trust.

This article was prepared by the Jase Medical content team for informational purposes only and does not constitute medical advice. Prescription requirements, emergency dispensing rules, insurance coverage, and controlled-substance regulations vary by medication, jurisdiction, and individual circumstances. Consult a licensed healthcare provider or pharmacist regarding your specific medications.

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Why Patients Run Out of Meds

Why Patients Run Out of Meds: Ordinary Disruptions

By the Jase Medical Team

Most people who unexpectedly lose access to a prescription didn’t lose it in a hurricane.

A bottle gets left in a hotel room. A suitcase doesn’t make the flight. Medication disappears during a move. A prescription is stolen from a car. A house fire destroys everything in the medicine cabinet. Someone accidentally knocks a bottle into water and the medication can no longer be used.

These are ordinary disruptions, and there’s an important difference between them and a declared disaster: the healthcare system may have more emergency mechanisms available during the hurricane than it does on an ordinary Tuesday.

When there’s no disaster declaration or emergency order, replacing medication often comes down to your insurance plan’s own lost, stolen, or damaged medication policy. Those policies can be surprisingly limited.

That’s why the most useful preparation isn’t necessarily having more medication. It’s knowing who to call, what your plan allows, and having the information you’ll need when you make that call.

Does Insurance Replace Lost Medication?

Sometimes, but don’t assume that it will automatically.

Health plans and pharmacy benefit programs can have specific limits on how often they’ll authorize an early refill or replacement because medication was lost, stolen, or damaged. Depending on your coverage, there may be restrictions on how frequently an override is available or additional steps required before the replacement can be processed.

That means one of the simplest medication-preparedness questions you can ask today is:

“What is my plan’s policy if my medication is lost, stolen, or damaged?”

Call the member-services number on your insurance card or ask your pharmacist how your plan typically handles a lost-medication override. You don’t need to wait until something is missing to understand the process.

If your medication actually is lost or damaged, contact your pharmacy and insurance plan promptly. They can tell you what your specific coverage allows and whether your prescriber needs to become involved.

A Replacement May Not Mean Another Full Month

There’s another detail that can surprise people: replacing a lost prescription doesn’t necessarily mean receiving an entirely new month’s supply.

Depending on the medication, prescription, insurer, and circumstances, the replacement process may account for how much of the original supply should still have remained.

For example, if you’re halfway through a prescription when the remaining medication is lost, the replacement may be handled differently than if an unopened prescription disappears the day you pick it up.

The important point isn’t to calculate the replacement yourself. It’s not to assume that “replacement” automatically means starting the prescription cycle over.

Your pharmacist and insurance plan can explain how the remaining quantity will be handled in your particular situation.

If Your Medication Was Stolen, Document It

Losing medication and having medication stolen may trigger different requirements.

If you believe a prescription was stolen, contact your pharmacy and insurer and ask exactly what documentation they require. A police report may be required before an insurer or pharmacy can move forward with certain replacement requests.

If you’re instructed to file one, keep a copy or the report information somewhere accessible. Having that documentation ready can prevent another round of calls when you’re already trying to replace something you need.

And be precise when you explain what happened. “I lost my medication” and “my medication was stolen” may not be treated as the same situation.

Controlled Substances Follow Tighter Rules

If the medication you’ve lost is a controlled substance, don’t assume the same replacement process applies.

Controlled medications are subject to additional federal and state requirements, and the rules can vary based on the medication’s schedule and circumstances. A pharmacist may not be able to simply replace the medication or process an ordinary early refill.

If you’ve lost a controlled-substance prescription, contact your prescriber promptly as well as your pharmacy. Your prescriber may need to issue a new prescription or determine the appropriate next step.

Don’t try to compensate for missing medication by stretching, skipping, changing, or rearranging doses yourself. Ask the clinician managing the prescription what they want you to do while the situation is being resolved.

This is also worth discussing before you ever lose the medication. If you regularly take a controlled substance, ask your prescriber what process they want you to follow if it is ever lost, stolen, or destroyed.

Why a Declared Disaster Can Be Different

A major disaster doesn’t make medication access easy, but it can activate systems that aren’t necessarily available after an ordinary medication loss.

Depending on the disaster, location, insurance coverage, and emergency declarations in effect, additional mechanisms may become available to help people maintain access to necessary prescriptions. Government programs, insurers, pharmacies, and state authorities may implement temporary policies designed specifically for affected communities.

That’s an important distinction.

A suitcase lost during an ordinary vacation and a medicine cabinet destroyed during a federally declared hurricane may leave you with the same practical problem – your medication is gone – while putting you into very different administrative systems for replacing it.

So don’t assume advice you read about emergency refills during hurricanes automatically applies when medication disappears during an ordinary week. Start with your pharmacist, insurance plan, and prescriber and ask what applies to your specific situation.

Keep One Medication Record You Can Grab Anywhere

Regardless of why medication goes missing, one simple piece of preparation makes almost every conversation easier: keep a current medication list.

For each prescription, record the medication name, dose, prescriber, and pharmacy. If you take several medications, keep the list somewhere you can access without relying entirely on a patient portal or pharmacy app.

That record isn’t a replacement prescription, but it gives the people helping you a much better starting point. If you’re standing at an unfamiliar pharmacy after losing your suitcase, calling an insurance company after a house fire, or trying to reach a prescriber about a controlled medication, you don’t want to reconstruct your medication history from memory.

This is one of the simplest forms of appropriate medical preparation because it costs nothing and doesn’t require accumulating additional medication. You’re preparing the information, not stockpiling the prescription.

Know the Process Before You Need It

At Jase Medical, we’re a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: understanding where normal healthcare access can break down and making clinically responsible plans before it does.

And sometimes the disruption isn’t dramatic at all. It’s a suitcase that didn’t arrive, a bottle damaged at home, a prescription stolen from a car, or a house fire that never makes the national news.

We’re not a replacement for primary care, your pharmacist, or your insurance plan. In this situation, those relationships are exactly what you need. We would simply rather you understand the process on a normal week than learn it while standing at the pharmacy counter without the medication you depend on.

So if you take regular prescriptions, do two things now: keep a current record of your medications, doses, prescribers, and pharmacy, and find out how your insurance plan handles medication that is lost, stolen, or damaged.

Because medication preparedness isn’t only about hurricanes, evacuations, or widespread emergencies. More often, it’s about being ready for the ordinary disruption you never expected to become a medical problem.


The Jase Medical Team is a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: clinically grounded readiness that complements, rather than replaces, the healthcare professionals you already trust.

This article was prepared by the Jase Medical content team for informational purposes only and does not constitute medical advice. Prescription requirements, emergency dispensing rules, insurance coverage, and controlled-substance regulations vary by medication, jurisdiction, and individual circumstances. Consult a licensed healthcare provider or pharmacist regarding your specific medications.

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Everyone should be empowered to care for themselves and their loved ones during the unexpected. Check out our recent lifesaving products today.

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For Clinicians | Why Patients Run Out of Medication

For Clinicians | Why Patients Run Out of Medication: The Ordinary Disruptions, Not the Disaster

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education
Medically reviewed and edited by Kristen Carpenter, PA-C

As a pharmacist, I’ve helped patients keep access to their medications through real disasters (especially wildfires out here in Utah). Much much more commonly, I spent my time behind the counter helping patients get access to their medications during ‘normal life.‘ No epic natural or structural disaster caused the disruption, but it was still a giant pain for my patients to deal with.

Some of what got in their way, patients could do something about: whether they had a ride that week, or whether they could pay for their medications when they got to the counter.

The rest was totally out of their hands. 

  • A manufacturer stops making a product and the shortage runs for months (and we covered how long those actually last here). 
  • The pharmacy that filled their prescriptions for twenty years just closed.
  • Their prescriber leaves the practice and the refill request sits in a queue nobody is watching. 
  • The insurance plan changes its coverage rules on January 1 and nobody clearly loops in the patient on that
  • The local chain pharmacy keeps temporarily closing due to staff shortages

Today we’re walking through both: what patients can stay ahead of, and what is out of their control. Most of the practical tips sit in that second group, because that’s where patients have the least wiggle room. It’s not quite as exciting as a full-scale disaster, but it’s a part of daily life I believe you should be prepared for because I dealt with it in some form daily with my patients for over a decade.

What patients can get ahead of

Cost is a big factor. 

  • About 8% of US adults taking a prescription didn’t take it as prescribed in order to save money¹. Patients are getting better about raising the issue of medication cost with you in the appointment. GoodRx is the best tool we have here, especially for anyone with a high copay or anyone choosing not to run it through insurance. It’s a good, simple way to eyeball the cash cost of an Rx ahead of time. 

Travel is the one that arrives as an emergency. 

  • Someone flies out Thursday and realizes Wednesday afternoon they don’t have enough medications for the trip. Their home pharmacy already has the prescriptions on file and can usually put together a vacation supply, but that takes lead time and sometimes a call to the plan. A pharmacy at their destination has none of their history and far less to work with. Tell patients to start working on their medications weeks before the departure date, not the night before (especially for overseas travel!). The more warning we in the pharmacy get, the more we can do, and their emergency doesn’t have to become ours.

For patients who depend on someone else for a ride, the best fix is usually removing the trip entirely. 

  • I worked for a big chain for years, and it was clear that delivery there is a low priority and gets missed very often. A locally owned pharmacy that delivers is a different experience: you get to work with the same humans every time, and they have a stake in it going right. Mail order can work as well, depending on how easy the company is to work with. Some are atrocious and others are the easiest thing in the world. 

And finally, theft. 

  • Theft as a loss for medications is more infrequent, and almost always a controlled substance and almost always someone living in the house with the patient. There isn’t much a pharmacy can do with it. The patient needs a police report, and for a Schedule II they need a new prescription from the prescriber, because those can’t be refilled at all.

What’s out of their hands:

  • The drug is on shortage: ASHP was tracking 227 active drug shortages as of mid-2026, the third straight quarterly increase². Even so, the pharmacy has more room here than patients expect. We can usually work with whatever we have of it in stock, and at a chain we can see which nearby stores are holding it and send the prescription over so it’s in process within minutes. Patients can call around themselves, and once they find a pharmacy that has it, that pharmacy can pull it across. When it’s really gone gone everywhere, that’s when we need a new prescription from you. 
  • Their pharmacy closed for good: Nearly one in three US retail pharmacies closed between 2010 and 2021, and roughly a third of counties ended that period with fewer pharmacies than they started with³. When a pharmacy closes, whoever bought the files now has the prescriptions, so nothing vanishes. Patients will feel friction on the first few fills, because pulling another location’s information into our system takes longer than it looks. They should have gotten a letter, but profile addresses are almost always outdated, so there’s no guarantee the patient heard anything ahead of time. Tell them to expect a few extra days and start the refill process early with a new pharmacy.
  • Their pharmacy is closed today: We’ve had a pharmacist shortage across Utah for a while, so stores that should be open Saturday aren’t, and some close mid-day when nobody can cover a shift. It’s not just Utah, but all across the US. Patients find out by driving there and seeing a handwritten sign: ‘closed due to pharmacist/staff shortage, will reopen on X date/time.’ Chains are more exposed to staffing shortages, and also easier to recover from, because any store in the chain can see the profile and patch around the closed one.
  • The refill request never reached you: This is usually a routing problem. Pharmacy systems grab the first address on file for a prescriber rather than the clinic the prescription came from, which breaks constantly for urgent care and for anyone practicing at several sites. If you’ve wondered where those requests go, that’s where.
  • It’s January: Formularies change, and the bigger shock is the deductible resetting. The patient who paid nothing in December pays full price until they clear it, up to $615 on Part D this year⁴. The year has a shape now: expensive at the start, copays through the middle, then nothing once they hit the $2,100 cap⁴. Insurance doesn’t explain any of that. We do, at the counter, and we hate it too. We don’t set the prices. We just charge what insurance tells us to charge. 
  • You don’t know whether the plan will cover it: Plan policies vary wildly, so don’t guess. Pharmacy billing is live, so as soon as we get the Rx we can tell you on the spot whether the plan will cover a vacation supply, an early refill, or a replacement. It isn’t a medical claim and it doesn’t take days. 

Two things from the pharmacy side prevent most of what’s in this article.

Write for 90 days at a time wherever the clinical picture allows it. I know most of you are doing that already. Keep it up! More insurers are covering 90 days supplies and it really does help a lot. 

This feels obvious, but make sure the right office phone number is on the prescription when you eRx it over. I’ve lost a lot of time calling the number on file and finding out the prescriber is somewhere else that day.

Last Thought

We’re a medical preparation company, and most of what we publish is about disasters. This is the other half of the same work. Appropriate medical preparation fits in daily life as well, not just big behemoth disasters. The same habits carry a patient through a wildfire, and they’ll use them far more often on an ordinary Tuesday. None of it replaces primary care. It’s the layer underneath, that keeps everything humming along.

Patients who are prepared are easier to take care of. They call before they’re out, they know what they take and who prescribes it, and the care goes better on both sides of the counter.


Sources

  1. Mykyta L, Cohen RA. Characteristics of Adults Aged 18–64 Who Did Not Take Medication as Prescribed to Reduce Costs: United States, 2021. NCHS Data Brief No. 470. National Center for Health Statistics, June 2023. Cost-saving measures included skipping doses, taking less medication than prescribed, or delaying filling a prescription. https://www.cdc.gov/nchs/data/databriefs/db470.pdf
  2. American Journal of Managed Care. Active US Drug Shortages Rise for Third Straight Quarter. 227 active shortages as of Q2 2026, reporting ASHP tracking data. https://www.ajmc.com/view/active-us-drug-shortages-rise-for-third-straight-quarter
  3. Health Affairs, December 3, 2024. DOI 10.1377/hlthaff.2024.00192. Nearly one in three US retail pharmacies closed between 2010 and 2021; roughly one-third of counties saw a net decline in pharmacies. Summary: https://schaeffer.usc.edu/research/pharmacy-closures-united-states-health-affairs/
  4. Centers for Medicare & Medicaid Services. Final CY 2026 Part D Redesign Program Instructions. Annual deductible $615; annual out-of-pocket threshold $2,100. https://www.cms.gov/newsroom/fact-sheets/final-cy-2026-part-d-redesign-program-instructions

 

Lifesaving Solutions

Everyone should be empowered to care for themselves and their loved ones during the unexpected. Check out our recent lifesaving products today.

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Keeping you informed and safe.

Why Patients Run Out of Meds

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read more
For Clinicians | Why Patients Run Out of Medication

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For Clinicians | Why Patients Run Out of Medication: The Ordinary Disruptions, Not the Disaster By Dr. Jamie Wilkey, PharmD, Director of Clinical EducationMedically reviewed and edited by Kristen Carpenter, PA-C As a pharmacist, I've helped patients keep access to...

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Join Our Newsletter

Our mission is to help you be more medically prepared. Join our newsletter and follow us on social media for health and safety tips each week!

The Drug Interactions You Create in an Emergency

The Drug Interactions You Create in an Emergency

By the Jase Medical Team

Most of the time, you don’t have to think very hard about drug interactions. Your doctor has your medication list. Your pharmacy has it too. When a new prescription comes through, software checks it against the medications already on file, and your pharmacist reviews the combination and steps in when something doesn’t look right.

Then the storm hits.

Your usual pharmacy is closed. You’re buying cold medicine at a grocery store two towns over. Maybe you’re dealing with an injury, respiratory illness, allergies, or another problem on top of the four or five prescriptions you already take every day. Suddenly, the drug-interaction check stops being software and becomes a person. And that person may be you.

The good news is that you don’t need to memorize a database of drug interactions to prepare for that possibility. For most people, there are two much more practical things to do: learn to spot duplicate ingredients in common over-the-counter medications, and have one conversation with your pharmacist about the prescriptions you already take.

First: Watch for the Same Ingredient in More Than One Product

One of the easiest medication mistakes to make during a stressful week doesn’t look like a drug interaction at all. You have a headache and fever, so you take acetaminophen. Later, your congestion gets worse, so you reach for a multi-symptom cold and flu product. That night, you consider something marketed for nighttime symptoms.

The problem is that more than one of those products may contain acetaminophen.

Acetaminophen appears in many over-the-counter cold and flu products, combination pain relievers, nighttime formulas, and some prescription pain medications. That means it’s possible to take the same active ingredient from multiple products simply because each package has a different name and purpose.

During an emergency, you’re probably not shopping for something labeled simply “acetaminophen.” You’re shopping for “Cold + Flu,” “Severe,” “Nighttime,” or “Pain Relief.” Those names describe what the product is marketed to treat, but they don’t necessarily make it obvious what’s actually inside.

Before combining over-the-counter medications—or taking one alongside a prescription medication—turn the package around and look at the Active Ingredients section. If you see acetaminophen listed in more than one product you’re considering, stop and ask a pharmacist or another qualified healthcare professional before combining them.

The goal isn’t to start calculating or rearranging doses yourself. It’s simply to know what’s actually in what you’re taking.

A Disaster Adds Medications to a List You Already Had

Think about what happens medically during an ordinary bad week after a storm. Someone hurts their back clearing debris and wants a pain reliever. Someone develops a respiratory illness and reaches for cold medicine. Someone gets stung or develops a rash and considers an antihistamine. Someone develops an infection and is prescribed an antibiotic.

None of those situations is particularly unusual. But those new medications aren’t entering an empty medicine cabinet. They’re being added to the blood pressure medication, anticoagulant, diuretic, psychiatric medication, heart medication, diabetes medication, or other prescriptions someone was already taking before the storm arrived.

That’s where the interaction question lives: between what you already take and what the disruption adds.

Under normal circumstances, several layers of the healthcare system help catch those potential problems. Your medical record contains your prescriptions. Your regular pharmacy knows what it has dispensed. Pharmacy software flags potential interactions. A pharmacist can review the combination before handing you the medication.

During a disruption, some of those layers may disappear. You may be using a different pharmacy, buying an over-the-counter medication somewhere that doesn’t have your prescription history, or receiving care from a clinician who has never seen you before.

The Emergency Can Change More Than Your Medication List

There’s another reason medication safety can become more complicated during a disaster: your body and circumstances may be different too.

You may be spending hours working outside in the heat, drinking less because clean water is limited, dealing with vomiting or diarrhea, or eating very differently than usual. At the same time, access to routine lab work, follow-up appointments, and medication monitoring may be interrupted.

A medication combination isn’t used in a vacuum. Your hydration, health conditions, and other medications all matter. That’s why a combination you’ve taken without problems under ordinary circumstances shouldn’t automatically be assumed to be problem-free when new medications and unusual physical stressors are added.

This doesn’t mean you need to understand every possible interaction yourself. It means the person helping you make a medication decision needs to see the whole picture.

Your Medication List Is Part of That Picture

We’ve said this before at Jase, but this is one more reason to keep a current written medication list. For each prescription, include the medication name, dose, prescriber, and pharmacy, and keep that information somewhere you can access even if your phone is dead, the patient portal isn’t loading, or you’re standing in a pharmacy that has never filled a prescription for you before.

That list isn’t only there to help you remember what you take. It gives a pharmacist or clinician the information they need to check what you’re about to add against what’s already there.

Your regular pharmacy computer may have been quietly helping catch these interactions for years. It can’t do that for you from a parking lot.

Ask Your Pharmacist One Question Before the Storm

The best time to discover an important medication interaction isn’t while you’re sick, evacuated, or trying to find an open pharmacy. The next time you have an appropriate opportunity to speak with your pharmacist, bring your current medication list and ask:

“If I end up needing an antibiotic or a pain reliever during an emergency, are there any of my regular medications that I need to be especially careful about combining with them?”

Then write down what they tell you somewhere you can find it during an emergency.

You don’t need to become your own pharmacist or memorize every possible combination. You simply want to know where the potential trouble spots are in your medication list so that, if normal systems aren’t available, you know when you need to stop and get professional guidance rather than guessing.

Appropriate Medical Preparation Includes What You Already Take

Emergency medical preparation often focuses on what you might need to add: wound supplies, contingency medications, pain relievers, cold medicine, or other essentials. But preparedness also means understanding how those things fit alongside the medications already keeping you healthy.

At Jase Medical, we’re a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation—clinically grounded readiness for the moments when normal healthcare access becomes harder to reach. We’re not a replacement for primary care or your pharmacist. In fact, this is exactly why we want them in the conversation before you need the backup plan.

So before the next storm or disruption, read the active ingredients before combining medications, and ask your pharmacist which common additions could cause problems with the prescriptions you already take.

Because during an emergency, the safest medicine cabinet isn’t necessarily the one with the most medication in it. It’s the one where somebody has already checked how the pieces fit together.


The Jase Medical Team is a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: clinically grounded readiness that complements, rather than replaces, the healthcare professionals you already trust.

This article was prepared by the Jase Medical content team for informational purposes only and does not constitute medical advice. Prescription requirements, emergency dispensing rules, insurance coverage, and controlled-substance regulations vary by medication, jurisdiction, and individual circumstances. Consult a licensed healthcare provider or pharmacist regarding your specific medications.

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For Clinicians | Drug Interactions in a Disaster

For Clinicians | Drug Interactions in a Disaster: The Combinations a Bad Week Creates

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education
Medically reviewed and edited by Kristen Carpenter, PA-C

When we think about prescription medicine in a disaster, we most often think about supply. Does the patient have enough of what they’re already taking? Can we get them something for the wound or the infection that happened because of the disaster?

I’m a pharmacist, so I also think about another way that disasters mess with our medications and that is drug interactions. Drug interactions are what happens when one thing changes what another thing does inside the body. Two prescriptions can do it. So can a prescription and something off a shelf, an ibuprofen, an antihistamine, a supplement nobody thinks to mention. And so can a prescription and the shape the patient is in, which is the version a disaster is good at making. Most of the year a computer catches these. In a disaster people take more medication and newer medication with less prescriber and pharmacist oversight, because we aren’t as easily reached.

Adverse drug events send about 4 of every 1,000 Americans to an emergency department each year, and the top two classes are anticoagulants and antibiotics.¹ A disaster does three things at once. It puts new drugs in people’s hands. It also can lead to dehydration. And lastly, it takes away convenient lab work. Today I’ll walk through the three dangerous drug interaction combinations that can result from a disaster, a few smaller traps, and how to keep an eye out for your patients ahead of time. 

Few New Medications

It’s easy to picture a disaster putting everybody on a pile of new medication. That isn’t what happens. Most people are taking what they were taking a week ago. A smaller group picks up something new, and it lands in three classes: an antibiotic, an NSAID, and an antihistamine.

As far as medications go those drug classes are generally basic and largely benign. What I want to talk with you about is that these are three drug classes you’d hand someone without a second thought because two of them produce all three of the cases below. Ordinary is what makes them dangerous, because nobody stops to check an ordinary drug.

The antihistamine is the odd duck here, because it doesn’t need a collision with another drug or new health condition to cause a problem. Diphenhydramine sits on the Beers list as highly anticholinergic, and clearance falls with age, so confusion, dry mouth and constipation all get more likely in an older patient, and cumulative anticholinergic exposure carries its own risk of falls and delirium.² Beers still says it may be appropriate for acute treatment of a severe allergic reaction, which is the disaster presentation, so here is a tricky medication that should be used in an emergency, but also watched very carefully for anyone over 65 years old.

 The Kidney Triple Whammy from Dehydration

A patient on a diuretic and an ACE inhibitor or ARB has been fine on that combination for years. Then comes three days of hauling debris in the heat, less water than they should be drinking, maybe some diarrhea. Their back hurts, so they take an ibuprofen.

Those three together have a name, the triple whammy, and the kidney is what gets walloped. A kidney filters by holding pressure across the filter, and when blood volume drops it protects that pressure two ways: it widens the vessel coming in and tightens the one going out. The NSAID blocks the widening. The ACE inhibitor or ARB blocks the tightening. Both of the kidney’s own defenses are gone at the same moment the diuretic and the dehydration are sending it less blood to work with. A 2025 meta-analysis of four studies and 42,367 patients put the odds of acute kidney injury at about double, OR 2.01 (95% CI 1.30 to 3.10).³ One study inside that review found the three-drug combination carried 1.64 times the risk of the two-drug version,³ so the ibuprofen really is what tips the scales here.

Nothing about their prescription changed. The dehydration and the extra NSAID broke a smooth-running system. 

Warfarin Plus an Antibiotic, With No Lab Draw

The second case here is the same story, but mixing it up with a different organ. This interaction will surprise nobody because it is warfarin–the medication that is ultra sensitive and seems to interact with everything. Warfarin plus a handful of common antibiotics pushes the INR up, partly because the antibiotic slows the enzyme that clears warfarin, partly because it kills off the gut bacteria that make vitamin K. The high-risk list is pretty short: TMP-SMX, ciprofloxacin, levofloxacin, metronidazole, fluconazole, azithromycin and clarithromycin.⁴

Disasters make blood draws a lot harder to get and they aren’t particularly top of mind in an event like that. In a cohort of 22,272 warfarin patients, TMP-SMX carried a hazard ratio of 2.09 for serious bleeding and ciprofloxacin 1.87, and 9.7% of the patients given fluconazole ended up with an INR above 6.⁴ Then the part that matters for a storm: patients who got an INR within 3 to 14 days of starting the antibiotic had a lower risk of serious bleeding, HR 0.61 (95% CI 0.42 to 0.88).⁴

The interaction was always there. The lab is what disappeared in a disaster.

Bactrim +  Spironolactone

This third and final big interaction is kind of the opposite because nobody expects it. Bactrim for a UTI, in a patient on spironolactone for heart failure, and both drugs are holding onto potassium like it is going out of style. Trimethoprim blocks the same channel in the kidney that amiloride does, so it behaves like a potassium-sparing diuretic stacked on top of the one the patient is already taking.

In a population study of Ontario patients 66 and older who were taking spironolactone, sudden death within 14 days of an antibiotic prescription was more than twice as likely with TMP-SMX as with amoxicillin, adjusted OR 2.46 (95% CI 1.55 to 3.90).⁵ Ciprofloxacin came in elevated too, at 1.55.

Here’s why it belongs in a disaster article. This is the combination you’d normally check a potassium on, and in a really bad week nobody is checking anything. The good news is that the fix is so easy: just picking a different antibiotic. Amoxicillin is the drug everything else in that study was measured against.

A Few Smaller Traps

These don’t each need their own section, but they come up every time.

  • Know the acetaminophen ceiling. FDA’s over-the-counter limit is 4,000 mg in 24 hours for adults,⁶ Tylenol’s own Extra Strength label lowered it to 3,000, and the label warns separately about 3 or more alcoholic drinks a day.⁷ Prescription combination products have been capped at 325 mg per unit since 2014, but over-the-counter cold, flu and sleep products never were, which is how somebody stacks two products and blows past the ceiling without exceeding a single label.⁶
  • Know which way to swap between ibuprofen and acetaminophen. For the patient who is dehydrated, on a diuretic with an ACE inhibitor or ARB, or on warfarin, acetaminophen is the safer analgesic. Use ibuprofen when the liver is the bigger worry: heavy alcohol use, liver disease, or a patient already getting acetaminophen from a combination product.
  • Don’t let thirst be the cue. CDC lists diuretics, ACE inhibitors and ARBs as reducing thirst sensation, so the patients who most need to drink are the least likely to feel like it.⁸ Tell them to drink on a clock whether they feel thirsty or not.
  • Watch what may bind with the antibiotic. Antacids, calcium and iron cut absorption of both doxycycline and the fluoroquinolones,⁹ and bismuth subsalicylate, the Pepto in the cabinet, is on doxycycline’s list too.¹⁰
  • Address the sun! Doxycycline causes an exaggerated sunburn reaction and the and the fluoroquinolones carry their own photosensitivity warning.⁹ The doxycycline label says to stop the doxycycline at the first sign of skin redness,¹⁰ which is a hard instruction in a week with nothing else on the shelf, so make sure they know to cover up and stay out of direct sun for the whole course.

Where This Fits

We want everyone looking at the whole picture of a patient’s medications in a disaster. We’re a team of pharmacists, physicians and PAs, and we catch these same interactions in ordinary clinic weeks: the ibuprofen on top of the ACE inhibitor, the Bactrim in the spironolactone patient. The chemistry doesn’t change in a disaster. What changes is that the catching stops. The screen, the lab and the pharmacist who would have caught it all get harder to reach in an emergency.

So, Jase does the clinical work early. A licensed provider reviews the request and writes the prescription ahead of time, for a short list of predictable problems, for emergency use only and after the patient has tried to reach a qualified provider. That’s what we mean by appropriate medical preparation. We also mean helping patients know, before a disaster, which items on their own medication list are most likely to cause trouble.

The drugs a disaster adds are boring. What makes them dangerous is the patient’s existing medication list. 


Sources

  1. Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US emergency department visits for outpatient adverse drug events, 2013-2014. JAMA. 2016;316(20):2115-2125. https://pmc.ncbi.nlm.nih.gov/articles/PMC6490178/
  2. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. https://doi.org/10.1111/jgs.18372
  3. Calvo DM, Saiz LC, Leache L, Celaya MC, Gutiérrez-Valencia M. Acute kidney injury and morbi-mortality associated with “triple whammy” combination: systematic review and meta-analysis. Br J Clin Pharmacol. 2025;91(11):3031-3041. https://pmc.ncbi.nlm.nih.gov/articles/PMC12569550/
  4. Lane MA, Zeringue A, McDonald JR. Serious bleeding events due to warfarin and antibiotic co-prescription in a cohort of veterans. Am J Med. 2014;127(7):657-663.e2. https://pmc.ncbi.nlm.nih.gov/articles/PMC4116816/
  5. Antoniou T, Hollands S, Macdonald EM, Gomes T, Mamdani MM, Juurlink DN. Trimethoprim-sulfamethoxazole and risk of sudden death among patients taking spironolactone. CMAJ. 2015;187(4):E138-E143. https://pmc.ncbi.nlm.nih.gov/articles/PMC4347789/
  6. US Food and Drug Administration. Acetaminophen. Safe Use of Over-the-Counter Pain Relievers and Fever Reducers. https://www.fda.gov/drugs/safe-use-over-counter-pain-relievers-and-fever-reducers/acetaminophen
  7. Tylenol Extra Strength (acetaminophen) Drug Facts label. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=59773893-09a8-47a2-943a-e9ea9da4458a
  8. Centers for Disease Control and Prevention. Heat and Medications: Guidance for Clinicians. https://www.cdc.gov/heat-health/hcp/clinical-guidance/heat-and-medications-guidance-for-clinicians.html
  9. CIPRO (ciprofloxacin hydrochloride) tablets, prescribing information. US Food and Drug Administration, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/019537s095,020780s050lbl.pdf
  10. Doxycycline hyclate tablets and capsules, prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fad03768-f1d2-459f-965e-0ec29f189f1f

 

Lifesaving Solutions

Everyone should be empowered to care for themselves and their loved ones during the unexpected. Check out our recent lifesaving products today.

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Keeping you informed and safe.

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Join Our Newsletter

Our mission is to help you be more medically prepared. Join our newsletter and follow us on social media for health and safety tips each week!