You should always have verbal orders or written protocols from your Medical Director to administer prescription medications in the field. You should have verbal orders or written protocols from your Medical Director to administer over-the-counter medications to minors.  Without these protocols, you are potentially practicing medicine without a license, which is illegal.  In addition to having medication administration protocols, you should obtain informed consent for medication administration, even non-prescription medication.  Inform the recipient of the indications, contraindications and possible side effects of the medication and obtain consent to administer.

Before administering any medication read the protocols, confirm the dosage, read the label and confirm the medication, ask the patient about previous history with this medication and any known allergies, ask the patient if they are currently on any medication and if so, review the protocols for contraindications.Please note that the following medication information is for medication available in the United States.  Outside of the Unites States medication may carry different trade names.  Some medication available only by prescription in the United States may be available without a prescription in other countries and may be prepared in different dosing.  If you purchase medication outside of the United States you should confirm classification, dose, indication, contraindication and possible side effects before administering it. 

All dosing is indicated for adults. Pediatric dosing should be dictated by your Medical Director.ATC medical advisor represents that the information provided was developed utilizing current resources and standards.  Medication administration is a complex decision that requires consultation with a Physician.  The information below is not a substitute for a Medical Director, nor should it be used without authorization and approval by a Physician.  Italiaoutdoors does not endorse or recommend specific medications.


:PO:  Oral
SQ:  Subcutaneous injection
IM:  Intramuscular injection

Drug Information Provided OnAnalgesic (Painkillers)-Over-The-Counter
    Acetaminophen (e.g. Tylenol)
    Aspirin (e.g. Bayer, Ecotrin)
    Ibuprofen (e.g. Advil, Motrin)
    Ketoprofen (e.g. Orudis KT)
    Naproxen (e.g. Aleve)
    Phenazopyridine hydrochloride (e.g. Pyridium, Uristat)
Analgesics (Painkillers)-Prescription
    Hydrocodone bitartrate/acetominophen (e.g. Vicodin)
    Oxycodone/acetominophen (e.g. Percocet, Roxicet)
    Phenylephrine (e.g. Neo-Synephrine)
    Hydrocortisone acetate (e.g. Cortaid)
    Diphenhydramine hydrochloride (e.g. Benadryl)
    Pseudoephedrine hydrochloride (e.g. Sudafed)
    Epinephrine (e.g. Adrenalin or EpiPen)
    Polymyxin B sulfate/bacitracin (e.g. Polysporin)
    Trimethoprim Sulfamethoxazole (e.g. Septra or Bactrim)
    Cephalexin (e.g. Keflex)
    Ciprofloxacin hydrochloride (e.g. Cipro)
    Tolnaftate (e.g. Tinactin)
    Miconazole nitrate (e.g. Monistat 3)
    Fluconazole (e.g. Diflucan)
Anti-Emetics (Anti-Vomiting) and Anti-Acids-Over-The-Counter
    Calcium carbonate (e.g. Tums, Maalox)
    Bismuth subsalicylate (e.g. Pepto-Bismol)
Anti-Emetics (Anti-Vomiting) and Anti-Acids-Prescription
    Prochlorperazine (e.g. Compazine)
    Promethazine (e.g. Phenergan)
Anti-Vertigo (Anti-Motion Sickness)-Over-The-Counter
    Meclizine (e.g. Antivert, Bonine)
Anti-Vertigo (Anti-Motion Sickness)-Prescription
    Scopolamine (e.g. Trans-Derm Scop)
    Loperamide hydrochloride (e.g. Imodium)
    Diphenoxylate hydrochloride with atropine sulfate (e.g. Lomotil)
    Acetazolamide (e.g. Diamox)
    Dexamethasone (e.g. Decadron)
    Nifedipine (e.g. Procardia) Analgesics (Painkillers)-Over-The-CounterAcetaminophen (e.g. Tylenol)

Classification: Non-narcotic analgesic, antipyretic
Dose: 650mg/4-6 hours PO (Regular strength), 1000mg/6 hours PO (Extra strength).  Maximum dose 4g/24 hours PO.
Indications: For relief of pain due to headache, cold and flu discomfort, minor muscle and joint discomfort and menstrual cramps. For reduction of fever. Especially useful for those allergic to aspirin or aspirin-containing products. Does not control inflammation.
Contraindications: Hypersensitivity, active alcoholism, liver disease, hepatitis.  Acetaminophen is a common ingredient in over-the-counter pain, cold and flu medicine.  Be careful of accidental overdose in combination with other products.
Side Effects: Hypersensitivity is rare.Aspirin (e.g. Bayer, Ecotrin)

Classification: Analgesic, Non-Steroidal Anti-Inflammatory Drug (NSAID), antipyretic, anticoagulant.
Dose: 325-650 mg/4 hours PO (Regular strength), 500-1000mg/4-6 hours PO (Extra strength), 162-325mg/24 hours PO for cardiac chest pain.  Maximum dose 4g/24 hours PO.
Indications: For relief of pain due to headache, cold and flu discomfort, minor muscle and joint discomfort and menstrual cramps. For reduction of fever. Controls inflammation. Can be used to “cauterize” exposed tooth pulp. For use
with cardiac chest pain.
Contraindications: Allergic sensitivity.  Gastrointestinal bleeding, bleeding disorders, impaired liver function.  Do not give to children under 12.
Side Effects:  Gastrointestinal distress, allergic reaction.Ibuprofen (e.g. Advil, Motrin)

Classification: Analgesic, Non-Steroidal Anti-Inflammatory Drug (NSAID), antipyretic.
Dose: 400-800mg/4-8 hours PO
Indications: For symptomatic relief of pain associated with headache, colds, flu, frostbite, toothache, arthritis, burns and menstrual cramps. May be used to reduce fever. For pain of inflammation and reduction of inflammation associated with muscle, joint and over-use injuries.
Contraindications: Active peptic or gastrointestinal ulcer, gastrointestinal bleeding disorder, history of hypersensitivity to aspirin or other NSAIDs.
Side Effects:  Nausea, epigastric pain, dizziness and rash.  Ketoprofen (e.g. Orudis KT)

Classification: Analgesic, Non-Steroidal Anti-Inflammatory Drug (NSAID).
Dose: 75mg/8 hrs PO
Indications: For symptomatic relief of pain associated with headache, colds, flu, frostbite, toothache, arthritis, burns and menstrual cramps. May be used to reduce fever. For pain of inflammation and reduction of inflammation associated with muscle, joint and over-use injuries.  
Contraindications: Active peptic or gastrointestinal ulcer, gastrointestinal bleeding disorder, history of hypersensitivity to aspirin or other NSAIDs.
Side Effects: Nausea, diarrhea and epigastric pain.Naproxen (e.g. Aleve)

Classification: Analgesic, Non-Steroidal Anti-Inflammatory Drug (NSAID).
Dose: 550mg/12 hrs PO
Indications: For symptomatic relief of pain associated with headache, colds, flu, frostbite, toothache, arthritis, burns and menstrual cramps. May be used to reduce fever. For pain of inflammation and reduction of inflammation associated with muscle, joint and over-use injuries. .
Contraindications: Hypersensitivity to aspirin or other NSAIDs.
Side Effects: Nausea, constipation, abdominal pain, headache, dizziness and drowsiness.Phenazopyridine hydrochloride (e.g. Pyridium, Uristat)

Classification: Urinary tract analgesic
Dose: 100-200mg/6-8 hrs PO
Indications: For symptomatic relief of burning, pain, urgency and frequency associated with urinary tract/bladder infections. Should be used concurrently with an antibiotic.
Contraindications: Hypersensitivity. Renal/liver insufficiency.
Side Effects:  Headache, gastrointestinal disturbance and rash.  Dye stains clothing.Analgesics (Painkillers)-PrescriptionHydrocodone bitartrate/acetominophen (e.g. Vicodin)

Classification: Narcotic analgesic, antitussive.
Dose: 5-10mg/4-6 hours PO
Indications: For moderate to severe pain. Narcotic. Good for musculoskeletal
and dental pain. Good for people allergic to codeine.  Suppresses cough reflex.
Contraindications: Hypersensitivity.
Side Effects: Sedation, decrease in blood pressure, sweating and flushed face, drowsiness and dizziness.Oxycodone/acetominophen (e.g. Percocet, Roxicet)

Classification: Narcotic analgesic.
Dose: 5-10mg/ 4 hours PO
Indications: For severe pain.
Contraindications: Hypersensitivity.  Caution with CNS depression, respiratory depression, seizures and shock.
Side Effects:  Drowsiness, dizziness, hypotension, anorexia, nausea,vomiting and constipation.Anti-Allergy-Over-The-CounterPhenylephrine (e.g. Neo-Synephrine)

Classification: Nasal decongestant
Dose: Blow nose before medication is administered, tilt head back, apply 2-3 drops or 1-2 sprays in each nostril.  Wait 5 minutes between nostrils.
Indications: For relief of nasal congestion that accompanies colds and allergies. May be useful to help stop nosebleed. May be useful to relieve sinus “squeeze” associated with diving.
Contraindications: Severe hypertension, ventricular tachycardia, pancreatitis, hepatitis, thrombosis, heart disease, narrow angle glaucoma.
Side Effects:  Rebound nasal congestion due to overuse (>3 days), stinging, burning, drying of nasal mucosa.Hydrocortisone acetate (e.g. Cortaid)

Classification: Glucocorticoid
Dose: Topical 1% cream, 2-4 times/day
Indications: For relief of pain and itching of nematocyst stings, poison ivy, oak and sumac, insect bites and other allergic skin reactions. May help dry up oozing rash of allergic skin reactions.
Contraindications: Serious infections, viral, fungal or tubercular skin lesions.
Side Effects: Itching, redness and irritation.Diphenhydramine hydrochloride (e.g. Benadryl)

Classification: Antihistamine
Dose: 25-50mg per 4-6 hours
Indications: For temporary relief of respiratory allergy symptoms and cold symptoms. Helps relieve the itching of allergic skin reactions. Useful in treatment of moderate allergic and anaphylactic reactions. May be used as a mild sedative and for insomnia. May help alleviate seasickness.  Can be used to treat distonic reations.
Contraindications: Hypersensitivity, acute asthma attack, glaucoma, peptic ulcer, hypertension and COPD.
Side Effects: Drowsiness, dizziness, weakness, hypotension, dry mouth, thickening bronchial secretions and urinary retention.Pseudoephedrine hydrochloride (e.g. Sudafed)

Classification: Nasal decongestant
Dose: 60mg per 4-6 hours
Indications: Decongestant useful in treating upper airway sinuses and nasal passages. Use of more that 5 days may cause reverse effects.
Contraindications:  Severe hypertension, coronary artery disease, lactating women, MAO inhibitor therapy.
Side Effects: Nervousness restlessness, insomnia, trembling and headache.Anti-Allergy-PrescriptionAlbuterol

Classification: Bronchodilator
Dose: Two puffs of metered dose inhaler (MDI) with use of a spacer every 4 hours and as needed.
Indications: Shortness of breath or respiratory difficulty thought to be secondary to reactive airway dysfunction (asthma) or HAPE.
Contrainidications: Tachycardia secondary to underlying heart condition.
Side Effects: Palpitations, tachycardia and tremor.Epinephrine (e.g. Adrenalin or EpiPen)

Classification: Bronchodilator, antiallergenic, cardiac stimulant.
Dose: .3ml 1:1000 SQ or IM. Repeat as necessary.
Indications: For severe allergic reactions including anaphylaxis and status asthmaticus.
Contraindications: No true contraindications with anaphylaxis.  Hypertension, cardiac disease, glaucoma and shock.
Side Effects: Increased heart rate, nervousness, dizziness, lightheadedness, nausea and headache.Antibiotic-Over-The-CounterPolymyxin B sulfate/bacitracin (e.g. Polysporin)

Classification: Antibiotic
Dose: Topical
Indications: Contains ingredients for prevention of infection in minor wounds. Works as a lubricant, offers some relief from itching.
Contraindications:   Hypersensitivity.
Side Effects: Hypersensitivity reactions-burning, itching, inflammation, contact dermatitis.Antibiotic-PrescriptionErythromycin

Classification: Antibiotic
Dose: 250mg/6 hrs for 5 days.  Take with food.
Indications: For sinus, pulmonary, ear, eye, respiratory and soft tissue infections.
Contraindications: Hypersensitivity, liver disease, hepatitis.
Side Effects: Abdominal discomfort and cramping, nausea, vomiting, diarrhea and rash.Trimethoprim Sulfamethoxazole (e.g. Septra or Bactrim)

Classification: Antibiotic
Dose: Single strength tablet contains 80mg trimethoprim and 400mg sulfamethoxazole.  Double strength tablet contains 160mg trimethoprim and 800mg sulfamethoxazole.  Dose is 2 single strength tablets or 1 double strength tablet/12 hours PO.  Recommended length, 5 days for UTI and infectious diarrhea, 10-14 days for  kidney infection.
Indications: For marine wounds, kidney, ear, sinus and some respiratory infections. Best for urinary tract infections. Works with infectious diarrhea if ciprofloxacin unavailable.
Contraindications:  Hypersensitivity, anemia.
Side Effects: Nausea, vomiting, diarrhea, decreased appetite, stomach cramps, headache.Cephalexin (e.g. Keflex)

Classification: Antibiotic
Dose: 250-500mg per 6 hours for at least 5 days.
Indications: For skin, bone, pnuemonia and urinary tract infections.
Contraindications: Hypersensitivity. Sensitivity to penicillins.
Side Effects:  Oral and vaginal fungal infections, diarrhea and abdominal cramping.Ciprofloxacin hydrochloride (e.g. Cipro)

Classification: Antibiotic
Dose: 250mg/12 hours PO for UTI.  500mg/12 hours PO for kidney infection, infectious diarrhea, bone and joint infection.  See Physician for length of course.
Indications: Best for infectious diarrhea. Okay for bone and urinary
tract infections.
Contraindications: Hypersensitivity.
Side Effects:  Nausea, diarrhea, vomiting and constipation.Anti-Fungal-Over-The-CounterTolnaftate (e.g. Tinactin)

Classification: Antifungal
Dose: Topical, 2 applications/day
Indications: For treatment of superficial skin fungi such as ringworm, jock itch and athlete’s foot.
Contraindications: Hypersensitivity.
Side Effects:  Mild irritation.Miconazole nitrate (e.g. Monistat 3)

Classification: Antifungal
Dose: 200mg vaginal suppositories nightly for three nights or topical cream as needed.
Indications: Vaginal candidiasis.
Contraindications: Hypersensitivity, first trimester of pregnancy.
Side Effects:  Itching, burning and stinging.Anti-Fungal-PrescriptionFluconazole (e.g. Diflucan)

Classification: Antifungal
 Dose: 150mg once.
Indications: Vaginal candidiasis.
Contraindications: Hypersensitivity.
Side Effects: Fever, chills, dizziness, drowsiness, headache, constipation, diarrhea, nausea, vomiting, abdominal pain.Anti-Emetics (Anti-Vomiting) and Anti-Acids-Over-The-CounterCalcium carbonate (e.g. Tums, Maalox)

Classification:  Antacid
Dose: 500mg tablet as needed
Indications: For symptomatic relief of heartburn, acid indigestion, sour stomach and other conditions related to an upset stomach, including intestinal gas problems.
Contraindications: Hypersensitivity.
Side Effects: Swelling of legs and feet, fecal impaction, metabolic alkalosis.Bismuth subsalicylate (e.g. Pepto-Bismol)

Classification:  Antidiarrheal, antinauseant.
Indications: For use in the control of diarrhea, nausea and upset
stomach. May help prevent “traveler’s diarrhea.”
Contraindications: Bleeding ulcers, hemophilia, kidney impairment.  Should not be taken by the aspirin allergic.
Side Effects: May turn tongue and stool black.Anti-Emetics (Anti-Vomiting) and Anti-Acids-PrescriptionProchlorperazine (e.g. Compazine)

Classification: Antiemetic
Dose: 5-10mg/6-8 hours PO or 10mg/12 hours PO (Extended release) or 25mg/12 hours rectal suppository.
Indications: Nausea and vomiting.
Contraindications: Hypersensitivity.  Glaucoma, bone marrow suppression, liver or cardiac impairment, blood pressure problems, CNS depression.
Side Effects: Muscle spasms of the neck are a common side effect, but are treatable with diphenhydramine.Promethazine (e.g. Phenergan)

Classification: Antihistamine, antiemetic.
Dose: 12.5-25mg/4-6 hours rectal suppository
Indications: Nausea and vomiting, motion sickness.
Contraindications: Glaucoma, CNS depression, intestinal or urinary tract obstruction.
Side Effects: Drowsiness, disorientation, hypotension and syncope.  Muscle spasms of the neck are a common side effect, but are treatable with diphenhydramine.Anti-Vertigo (Anti-Motion Sickness)-Over-The-CounterMeclizine (e.g. Antivert, Bonine)

Classification: Antiemetic, antivertigo
Dose: 25-50mg PO per day, I hour before exposure to motion.
Indications: Prevention and treatment of motion sickness, vertigo.
Contraindications: Hypersensitivity.
Side Effects: Drowsiness.Anti-Vertigo (Anti-Motion Sickness)-Prescription Scopolamine (e.g. Trans-Derm Scop)

Classification: Antinausea, antiemetic
Dose: 1.5 mg transdermal patch. Keep out of eyes. Put one patch behind ear 4-5 hours before needed.  Remove after 72 hours.
Indications: Prevention of motion sickness.
Contraindications: Glaucoma, urinary or intestinal obstruction, tachycardia.
Side Effects: Dry mouth, drowsiness, blurred vision, hallucinations, confusion.
Anti-Diarrheal-Over-The-CounterLoperamide hydrochloride (e.g. Imodium)

Classification: Antidiarrheal
Dose: 4mg PO initially followed by 2mg PO after each loose stool
Indications: For use in the control of diarrhea. Thought to limit peristalsis. Helpful in evacuating someone with severe diarrhea.
Contraindications:  Hypersensitivity.  Diarrhea secondary to certain bacteria (e.g., E.Coli)
Side Effects:  Dry mouth, dizziness, abdominal discomfort.Anti-Diarrheal-PrescriptionDiphenoxylate hydrochloride with atropine sulfate (e.g. Lomotil)

Classification: Antidiarrheal
Dose: 5mg/6 hours PO
Indications: For severe diarrhea.  Evacuate after 24 hours with no improvement.
Contraindications:  Liver disease, dehydration, glaucoma.
Side Effects:  Drowsiness, lightheadedness, dizziness, nausea.Anti-Altitude-PrescriptionAcetazolamide (e.g. Diamox)

Classification: Diuretic.
Dose: 250mg/6 to 12 hours PO (prevention dose = 125mg/12 hours PO)
Indications: For prevention and treatment of mild to moderate acute mountain sickness.
Contraindications: Sulfa-allergies, pregnancy, dehydration or renal disease.
Side Effects: Dehydration, tiredness, altered taste, nausea, numbness in extremities and lips. Dexamethasone (e.g. Decadron)

Classification: Corticosteroid.
Dose: 8mg PO or 10mg IM initially then 4mg/6 hours PO or IM during evacuation.
Indications: For treatment of High Altitude Cerebral Edema and increasing ICP from head trauma.
Contraindications: No absolute contraindications for short-term emergency use except hypersensitivity.
Side Effects: Cough, dry mouth, throat irritation, blurred vision, indigestion, personality and behavioral changes, muscle weakness.Nifedipine (e.g. Procardia)

Classification:  Antihypertensive
Dose:  10mg/8 hours PO or 30-60mg/24 hours PO (Extended release).
Indications: High Altitude Pulmonary Edema (HAPE).
Contraindications:  Hypersensitivity. Hypotension.
Side Effects:  Peripheral edema, headache flushed skin, dizziness.

Referenes: Mosby’s 2005 Drug Consult for Nurses.  Elsevier Mosby, St. Louis, MO.  2005.  ISBN 0-323-02847-0.Ogden MD, Herb and Tod Schimelpfenig.  Edited by Drew Leemon.  NOLS Field Medical Protocols and Drug Orders 2004.  Unpublished document.Saunders Nursing Drug Handbook 2004.  Saunders, St. Louis, MO.  2004.  ISBN 0-7216-0300-9.

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