NASA-STD-3001 Technical Brief

Relevant Technical 

Requirements

Pharmaceutical Care

OCHMO-TB-006

Rev A

NASA-STD-3001 Volume 1, Rev C

[V1 3004] In-Mission Medical Care

[V1 4009] Sensorimotor Countermeasures

[V1 4016] In-Mission 

Hematological/Immunological 

Countermeasures

[V1 4027] In-Mission Bone Countermeasures

[V1 5001] Medical Training

[V1 5007] Support Personnel Training

[V1 6001] Circadian Shifting Operations and 

Fatigue Management

[V1 7001] Crew Health Results

[V1 7002] Crew Records Transmission

[V1 7003] Crew Records Security

NASA-STD-3001 Volume 2, Rev D

[V2 7038] Physiological Countermeasures 

Capability

[V2 7042] Orthostatic Intolerance 

Countermeasures

[V2 7043] Medical Capability

[V2 7045] Medical Equipment Usability

[V2 7115] Medical Treatment, Personal 

Supplies, and Impacts to Environmental 

Systems

[V2 7050] Stowage Provisions

[V2 7051] Personal Stowage

[V2 7052] Stowage Location

[V2 7055] Priority of Stowage Accessibility

[V2 7059] Inventory Tracking

[V2 11027] Suited Medication Administration

[V2 11125] Suit Materials Compatibility

Executive Summary

Pharmaceutical Care refers to the dispensing of drug 

therapy to achieve outcomes that improve a patient's 

quality of life including management of a medical 

condition, elimination or reduction of patient 

symptomatology, and stopping or slowing disease 

progression or illness. The spaceflight environment leads 

to a host of factors that must be considered when 

choosing treatment, including anticipating medication 

needs to establish an optimal formulary, pharmaceutical 

shelf life and time to resupply, medication degradation 

and impurity considerations, and effective packaging. 

Vehicle constraints include weight and volume limits, 

storage, and inventory systems. Physiological 

considerations include alterations of pharmacokinetics 

and pharmacodynamics, response to gravity transitions, 

vibration, and radiation exposure. Low Earth Orbit (LEO) 

experience and studies have not shown changes in 

medication stability, dosing, or effectiveness leading to 

poor health outcomes. Further study is taking place 

regarding medication use and challenges during longer 

duration spaceflights beyond LEO. 

Related OCHMO Technical Briefs

1. OCHMO-TB-016 Behavioral Health

2. OCHMO-TB-030 Bone Loss

3. OCHMO-TB-019 Orthostatic Intolerance 

4. OCHMO-TB-037 Decompression Sickness

5. OCHMO-TB-013 Food and Nutrition

6. OCHMO-TB-020 Radiation Protection

7. OCHMO-TB-041 Sleep Accommodations

8. OCHMO-TB-027 Water
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

11/21/2023

Rev A 2

effectiveness

Medications for spaceflight are chosen based on individual crewmember needs, clinical practice guidelines, 

flight surgeon expertise, historical review, and probabilistic risk assessment (PRA) tools. 

Choosing appropriate pharmaceuticals for flight is crucial as they significantly affect spaceflight human 

system risks including but not limited to those listed in the text, as interventions or countermeasures.

• Risk of Bone Fracture Due to Spaceflight-induced Changes to Bone

• Risk of Renal Stone Formation

• Risk of Cardiovascular Adaptations Contributing to Adverse Mission Performance and Health 

• Risk of Adverse of Health Event Due to Altered Immune Response

• Risk of Adverse Cognitive or Behavioral Conditions and Psychiatric Disorders

• Risk of Spaceflight-Associated Neuro-Ocular Syndrome (SANS)

• Risk of Performance Decrements and Adverse Health Resulting from Sleep Loss, Circadian 

Desynchronization, and Work Overload

[V1 3004] In-Mission Medical Care All programs shall provide training, in-mission medical capabilities, 

and resources to diagnose and treat potential medical conditions ... including Medical kits (personal, 

routine, emergency, and survival) and resources, including appropriate pharmaceuticals, equipment, and 

supplies selected for ease-of-use, and personal protective equipment (e.g., biohazards and sharps 

containment). From NASA-STD-3001 Vol 1, Rev C

Overview

Spaceflight Factors That Affect Medication Selection and Efficacy

Spaceflight 

Factors That 

Affect 

Medication 

Selection and 

Efficacy
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

11/21/2023

Rev A 3

To date, LEO spaceflight experience and studies have shown limited changes in medication composition 

or crewmember physiology that adversely affect pharmaceutical stability, dosing, or effectiveness 

leading to negative health outcomes.

Radiation Concerns include exposure to potentially damaging galactic cosmic rays (GCRs), solar particle 

events ejecting damaging high-dose radiation charged particles, and potential alteration of medication 

chemistry, especially in liquid pharmaceuticals thought to be more vulnerable to radiation exposure. 

Ionizing radiation exposure in LEO, within the Earth’s protective magnetic field which minimizes 

radiation exposure, has not been found to significantly interfere with the usability of medications. 

Limited radiation studies at Brookhaven NASA Space Radiation Laboratory (NSRL) found small 

alterations of API or physical characteristics. Most cases were within acceptable limits at the time for 

study analysis (Blue et al., Limitations in predicting radiation-induced pharmaceutical instability during long-duration 

spaceflight)

. Future long-duration missions will have a vastly different radiation environment than during 

LEO and will require additional considerations.

Medication Stability refers to how well a substance maintains consistent properties and characteristics 

within specified limits during use and storage. Stability concerns include if conditions of altered gravity, 

radiation, temperature/humidity, and the spaceflight environment effects the ability of medications to 

maintain their physical/chemical structure and effectiveness. 

Crewmembers in LEO have not been affected by lack of medication effectiveness due to stability or 

radiation exposure. Studies have shown limited alteration in physical/chemical changes including 

increased rate of degradation, however most medications lost less than 20% of medication active 

pharmaceutical ingredients (API) in one study (Du et al., Evaluation of Physical and Chemical Changes in 

Pharmaceuticals Flown on Space Missions), and less than 5-10% degradation after 550 days on ISS for a select set of 

medications (see page 4, Wotring, 2016).

Expiration Concerns include long duration spaceflight planned for 1-5 years which will be beyond the 

current average medication expiration dates of 1-2 years.

Terrestrial studies show expiration dates of many medications extend long (1-10 years) after published 

expiration dates of 1-2 years (US Food and Drug Administration Federal shelf-life extension program (SLEP) 

updated 04/2023).

Effectiveness Concerns include considering above situations/stability/expiration conditions that could 

adversely affect medication effectiveness

Studies have shown medications used in LEO are perceived by crew as >80-90% effective, with 85% 

experiencing no side effects (Putcha et al., Pharmaceutical Use by U.S. Astronauts on Space Shuttle Missions 

1999).

Use How are medications being used, will we be able to treat medical conditions?

To date, medication use is similar to terrestrial ambulatory medicine with exception of sleep 

medication, which has increased use in space (Putcha et al., Pharmaceutical Use by U.S. Astronauts on Space 

Shuttle Missions 1999, Wotring ISS Medication Use, 2015).

Overview
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Physiological Changes

Although medications have been able to treat medical conditions as they have arisen in LEO, long duration 

spaceflight beyond LEO introduces additional challenges including lack of resupply capability, prolonged exposure 

to the space radiation environment, and the absence of emergency medical return capability. These 

challenges as well as the physiological crewmember changes (shown below) that occur in all spaceflight 

must be considered when choosing medications for long duration spaceflight. Reference OCHMO-TB-007 

Mission Duration

11/21/2023

Rev A 4

Physiological changes in the human body during spaceflight

• Fluid shifts – altered volume distribution

• Intracellular fluid alteration – altered metabolism; altered drug uptake and clearance

• Altered plasma protein concentration – altered free drug concentration; altered renal/hepatic 

clearance

• Cell membrane permeability – altered drug distribution and uptake

• Hepatic metabolism – altered hepatic blood flow; altered hepatic enzyme expression

• Gut motility and absorption – altered gastric emptying from space motion sickness (SMS) or 

medications to address SMS; faster and more variable intestinal transit rate

• Alterations in immune response

• Potential increased antibiotic resistance of spaceflight cultured bacteria

Environmental changes contributing to physiological changes

• CO2 changes

• Pressure changes

• Gravity changes

• Radiation exposure

• Other atmospheric considerations (humidity, temperature, etc.)

Definitions

• Pharmacokinetics (PK) what the body does with a drug, including how medications are absorbed into the 

body, transported throughout, and degraded or eliminated. The extent of absorption can depend on route 

of administration and physical and chemical properties.

• Pharmacodynamics (PD) how a drug interacts with tissues, cells, and organs and if the drug formulation 

(i.e., tablet capsule, liquid, or aerosol) produces the desired effects. 

• Active Pharmaceutical Ingredient (API) The ingredient or active pharmaceutical substances intended for 

incorporation into a finished drug product and is intended to furnish pharmacological activity or 

other direct effect. FDA establishes percentages of API for medications.

• Degradation products or unwanted chemicals that can develop during the manufacturing, 

transportation, and storage of drug products and can affect the efficacy of pharmaceutical 

products.

Background
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

11/21/2023

Rev A 5

Stability Studies

Medications aboard the International Space Station (ISS) have maintained usability in LEO gravity and 

radiation conditions and are restocked before their expiration dates. These conditions may be more 

challenging and resupply not possible on future long-duration missions. To help ensure future optimal use of 

medications, studies have, and continue to be performed, regarding medication use beyond expiration date and 

how alterations in environment affect concentration of API and possible degradation of pharmaceuticals in longduration missions.

Timeline (left) of 

medication ages 

relative to expiration 

dates. All 

medications aged on 

ISS for 550 days. 

Medications had 

varied expirations 

but were tested at 1 

point, thus show 

different points on 

timeline. Melatonin 

had been expired by 

the most time (11 

months) and was the 

only medication not 

to contain API within 

USP guidelines.

Medication Results (mg) % Label 

API

Aspirin 325mg 313.7±0.5 96.5

Acetaminophen 325 315.4±3.2 97.0

Ibuprofen 400mg 399.6±7.1 99.9

Loratadine 10mg 10.0±0.3 99.9

Loperamide 2.0mg 2.0±0.6 96.3

Pseudoephedrine 120mg 118.9±3.3 99.0

Melatonin 3mg 2.7±0.1 89.2

Zolpidem 10mg 10.07±0.09 100.6

Modafinil 200mg 201.2±2.4 100.6

Results of 550 Day Study Medication API Assays

Background

Wotring 550 Day study (2016) -- Analyzed nine 

medications for API content and degradant amounts after 

being flown on ISS for 550 days. Medications were 

repackaged prior to flight, and after return to Earth were 

tested at one time point, with results normalized to each 

medication’s expiration date. 

Hypothesis -- Medication degradation on ISS does not differ 

from that typically seen on Earth.

Results: 

• All medications but one (Melatonin) found to contain 

API within USP guidelines (90-110%) of label claim. 

Only Melatonin had degradation products identified 

above USP limit. 

• No unusual degradation products identified, some 

common degradation products with specific USP 

guidelines were noted in aspirin, ibuprofen, 

loratadine, and zolpidem. Other degradation 

products were noted in other samples, at amounts 

too small for further analysis with USP methods.

Source: Wotring (2016) Chemical Potency and Degradation Products of Medications Stored 

over 550 Earth Days

• Samples for this study were opportunistically 

obtained, therefore no ground samples were

available for analysis
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Du et al. Pharmaceuticals Evaluation Study (2011) – Compared 35 pharmaceuticals commonly used in 

spaceflight med kits stowed on ISS and Earth, observed for physical and chemical changes at 4 check 

points (14, 353, 596, and 880 days) over a 28-month period. 

• Quantities of each medication, from same lot were packaged in 

ground control and flight payload kits.

• Kits equipped with passive radiation dosimeters, temp and 

humidity recorders.

• Four kits were stowed onboard space transport systems for 

delivery to ISS, 4 matching kits stored at JSC

Photo: Du et al. Evaluation of Physical and Chemical Changes in 

Pharmaceuticals Flown on Space Missions (2011)

Examples of data (left) shows 

degradation of antibiotic tablets 

based on days of stowage. Each point 

represents one payload. The shaded 

area represents USP range for label 

claim. Dotted line is expiration date. 

Results

• Physical changes were observed but inconsistent.: No changes in ground 

samples 1-3, total of 21 changes in 13 medications in payloads 1-4, 

however changes not consistent. For example; medication changed in 

appearance in payload 1 but not in 2 or 4.

• Chemical content: Number of formulations that did not meet API 

requirements were higher among in-flight kits in all 4 payloads. After 880 

days, 27% solid formulations met API of loss of less than 10% of label, 

however most medications lost less than 20% (see samples below).

• Rate of degradation faster in space but most meds still met USP 

standards for dissolution.

• Cumulative radiation dose was higher and increased with time in space.

• Temp and humidity environment of flight medications remained similar 

to ground medications.

Limits were set at 90-110% for these formulations in this study; Numbers in red indicate below lower limit of % chemical content.

Percent API Content in Unstable Formulations with Chemical Potency below Acceptable Limit (Partial list)

USP Content Acceptance Criteria

• Chemical potency or ≤10% 

decrease in percent content 

from label strength.

• Appearance, physical attributes 

(e.g., discoloration, phase 

separation), and physical 

performance test of hardness 

and friability.

• Acceptance criterion for pH 

(liquid formulations).

• USP limits for microbiological 

contamination (sterile liquid 

formulations).

• USP acceptance criteria for API 

dissolution performance.

Background

11/21/2023

Rev A 6

Du et al. Evaluation of Physical and Chemical Changes in Pharmaceuticals Flown 

on Space Missions (2011)
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

11/21/2023

Rev A 7

Medication Tracking

Medication use during spaceflight historically has not been comprehensively monitored due to conflicting 

crew time demands, effective tracking procedures, and crew preference. Crewmembers are able to take 

certain medications (mainly over-the-counter) without discussing with their flight surgeon, and while 

astronauts are encouraged to discuss medications with their flight surgeon, this discussion may occur 

without documentation. Studies have been performed to better discern crewmember use and effectiveness 

or perceived effectiveness of medications.

Dose Tracker Study 

The Dose Tracker project was designed to more completely and efficiently track crew medication use and 

side effect information. “Dose Tracker” is an iOS application allowing easier recording of medication use and 

events. Six crewmembers were monitored during their 5 to 6-month missions on ISS. The study showed a 

large increase in reported medication use compared to previous reporting, which is believed to be a result 

of better reporting as opposed to increased use of medications.

• Expeditions 1–20, relied on crewmember 

volunteer reporting and flight surgeon 

documentation Documented 12.6 doses 

taken per crewmember per mission.

• Expeditions 21–40, crewmembers were 

queried during PMCs on medication use for 

documentation by flight surgeons. 20 

crewmembers reported an average of 23.1 

doses.

• In 2017, the Dose Tracker study monitored 

use by six crewmembers during their 5 to 6-

month missions. An average of 453 

medication uses were reported per 

crewmember during their missions, 

approximately four medications per 

crewmember per week.

Blue et al. (2019) Supplying a pharmacy for NASA 

exploration spaceflight: challenges and current 

understanding

“Dose Tracker Application uses an iPad for fast and efficient collection of data regarding crewmembers’ medication 

use on a near real-time basis, eliminating the current problems associated with recall. The crewmember unstows 

their personal iPad and enters medication usage into the Dose Tracker Application. The questionnaire asks if the 

crewmember has used medications since the last entry, what prompted him/her to use the medication, how well it 

seemed to work, how frequently doses were repeated, and if the medication seemed to cause side effects. Specific 

questions regarding medication use are asked of each crewmember. The data is streamlined by using a 

programmed, computerized survey application reflecting the medication choices, the doses available, typical 

dosing frequency, and side effects associated with each medication.” Dose Tracker Application for Monitoring 

Medication Usage, Symptoms, and Adverse Effects During Missions NASA (Wotring, 2015).

Background
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Medication Use and Effectiveness

Wotring ISS Medication Use (2015) – Examined medication use during long duration flights (>30 days) to determine 

the effect spaceflight conditions (vibration, gravity transitions, radiation exposure) have on crewmember 

physiological conditions (PK/PD, immune, fluid shifting, muscle/bone, cell alteration) and medication effectiveness. 

Medication records were analyzed from 24 crewmembers on 20 missions over a 10-year period, observing trends in 

usage rates, efficacy, and adverse events.

Results

• Medication use was similar to

space shuttle and adult 

ambulatory medicine, with 

exception of sleep aids which 

were used 10 times more during 

spaceflight. 

• Medications used for </= 7 days 

were used for ordinary 

complaints and use was 

comparable to any healthy group 

of adults. 

• 3 reports of apparent treatment 

failures occurred, all in cases of 

skin rash.

• 71% of crewmembers reported 

using sleep medications.

• Most medication use linked to 

EVA, exercise protocols, or 

equipment and operationally 

driven schedule changes (lighting 

and schedule-shifting).

• This was a retrospective study 

with medication data based on 

medical records and physician 

notes. OTC or previously 

prescribed medications were not 

formally monitored, possibly 

introducing errors.

Medication use by U.S. crewmembers on the International Space Station Wotring 2015

Background

Medication Class

Crewmembers 

Reporting Use 

(%)

Reported Efficacy

Sleep aids 71 Somewhat-very effective

Alertness aids 21 Very effective

Pain relivers

For back pain 21 Somewhat-very effective

For joint pain 46 Somewhat-very effective

For muscle pain 21 Somewhat-very effective

For headache 54 Somewhat-very effective

Congestion/allergy 

treatments

55 Somewhat-very effective

Rash treatments 25 Ineffective (2 reports)

SAS treatments 21 Ineffective (1 report)

SAS prophylaxis 25 Very effective

• Most medications were reported being somewhat/very effective.

• 3 reports of ineffective medication use involved topical rash treatments. 

• Medication reports were given retrospectively, some medication use may 

be complicated as the condition for the treatment may have been unclear, 

for example a headache can be caused by congestion, fluid shifts, 

elevated CO2, or caffeine withdrawal and if given medication that treat 

the wrong condition, it may be incorrectly deemed as less or ineffective 

when it actually was an incorrect treatment. 

11/21/2023

Rev A 8
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Medication Effectiveness

Gravity transitions, radiation, and a variety of potential physiological changes all are concerns that can 

potentially impact medication effectiveness during spaceflight. The previously mentioned underreporting of 

medication use as well as lack of metabolism half-life, or peak concentrations, has complicated medication 

effectiveness reporting. Studies have occurred that describe crewmember feedback regarding effectiveness 

or perceived effectiveness of medications.

Putcha et al. Pharmaceutical Use Study (1999) – Evaluated crewmember reporting after 79 shuttle 

missions and 219 reports which showed 94% of crewmembers used medications, 85% doses had no side 

effects, 80% doses perceived effective by recipient. Medication ineffectiveness reporting was highest in the 

first day.

• Doses in order of use were sleep, headache, 

congestion, and space motion sickness (SMS).

• 47% took SMS formulations (most often the first day).

• 44.7% used sleep aids (throughout the mission).

• Pain medications most often in first 4 mission days.

• Decongestants used throughout. 

• When effectiveness and side effects were examined 

simultaneously over the course of the missions, most 

of the adverse events were found to occur during the 

first mission day.

Drugs taken were most often reported as effective, with 54% reported as being "very efficacious," 30% 

"moderately efficacious," and 7% "mildly efficacious." Only 8% of all drug treatments were reported as 

"not efficacious" (see below). Non-effectiveness can also occur when medications are used for the wrong 

purpose – e.g., fluid shifts to the head can appear as nasal congestion but will not be relieved by 

decongestants.

Pharmaceutical Use by U.S. Astronauts on Space Shuttle 

Missions 1999

Pharmaceutical Use by U.S. Astronauts on Space Shuttle Missions 1999

Background

11/21/2023

Rev A 9
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

11/21/2023

Rev A 10

Drug Expiration and Shelf Life

Medication expiration poses a big challenge to providers of health care for long duration spaceflight. Many 

medications expire within 1-5 years and without resupply, medication availability and usability is in question.

Expiration date: The final date at which the manufacturer can still guarantee the full potency and safety of 

the drug when stored under proper conditions. 

Shelf-life: Date determined by drug manufacturers expressed as an expiration date after which time the 

manufacturer cannot guarantee the stability or potency of the medication.

**Neither shelf-life nor expiration date state that medications are harmful if used beyond the identified date, and 

currently there is very little information regarding this topic. One medication, Tetracycline, is associated, but not 

strongly proven, with potential harm of increased risk of kidney damage (Fanconi Syndrome) when used 

beyond expiration (see Wegienka et al., 1964).

History of Expiration Dating

In 1979 the U.S. Food and Drug Administration (FDA) passed the law “Current Good Manufacturing practice 

for finished pharmaceuticals, expiration dating” to ensure people would only use medications that were safe 

and guaranteed to work as intended under proper storage conditions.

This protection also caused some difficulty. The Department of Health and Human Services (HHS), which 

stockpiles certain medications for emergency or in the interest of national health, found that they were 

often needing to replace stockpiles of unused medications at significant expense based on expiration dates.

Drug name Extension 

(avg months)

Morphine Sulfate 

injectable

89 (35-119)

Naproxen Tablets 52 (46-62)

Ciprofloxacin Tabs 55 (12-142)

Doxycycline Caps 50 (37-66)

Sample of SLEP medication extensions

1986 Federal Shelf-Life Extension Program (SLEP) 

This program was Developed by the Department of Defense 

in conjunction with the FDA to defer cost of drug waste by 

studying if drugs can be safely used beyond expiration (Lyon 

et al., 2006). The study demonstrated that many medications, 

when maintained in original and unbroken packaging, may 

last significantly longer than labeled expiration dates. Testing 

showed 88% of medication lots could be extended beyond 

their stated expiration (stability varied between samples of 

the same drug, manufacturer, and lot). As a result, some 

government stockpiled medications can be stored beyond the 

original expirations for emergency use only.

eMC - A similar study occurred in the UK with the electronic 

Medicines Compendium (eMC), which contained drug 

information from UK pharmacy companies. 

Many eMC medication shelf lives were changed by 

manufactures and extended for public use up to 3-6 years 

(practice is not yet adopted by FDA).

Other Concerns

Some medications may be more susceptible to bacterial growth or loss of stability including nitroglycerin, 

eye drops, liquid antibiotics, and insulin, and are less likely to qualify for extended shelf-life program.

Source: Lyon et al. 2006

Background
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

[V2 7043] Medical Capability A medical system shall be provided to the crew to meet the medical 

requirements of NASA-STD-3001, Volume 1. From NASA-STD-3001 Vol 2, Rev D.

Outline for the Use 

of PRA Data to Aid 

in the Generation of 

a Medical 

Conditions List

Application

Choosing Pharmaceuticals for Spaceflight

In addition to considering crewmember physiological aspects, information obtained from probabilistic risk 

assessment (PRA) aids in determining optimal formulary. The PRA tool helps predict medication needs and 

limitations for each specific vehicle and mission. PRA is a comprehensive, structured, and logical analysis 

method used as a decision support tool aiding clinical stakeholders and mission planners in providing 

probability of occurrence of medical conditions based on past spaceflight experience coupled with 

terrestrial occurrences of medical conditions. Disease states and medical conditions are identified through 

individual needs, clinical practice guidelines, flight surgeon recommendations, and flight surgeon 

knowledge. These disease states are fed into an analysis program (PRA/ Integrated Medical Model (IMM))

which considers many simulations ultimately identifying cases that will be at a higher risk for occurring in 

spaceflight. Once the most likely medical needs are identified, the needed pharmaceuticals or treatment 

options can be considered, including evidence-based effectiveness, storage requirements, size and weight, 

and expiration date optimization. 

11/21/2023

Rev A 11
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Integrated medical model (IMM) - A type of PRA developed by the Human Research Program; a stochastic 

decision support tool that is available for use by clinical stakeholders, spaceflight mission planners, and 

medical system designers to aid in assessing risks and optimizing medical systems. 

Musculoskeletal 

conditions

Acute arthritis

Acute compartment syndrome

Back injury (sprain/strain)

Dislocation (finger, elbow, shoulder)

Fingernail delamination (EVA related)

Fracture (finger, hand, wrist/arm, distal leg, hip/proximal femur, 

thoracolumbar spine, cervical spine)

Hand injury (EVA related)

Joint sprain/strain (shoulder, elbow, wrist, hip, knee, ankle)

Lower extremity stress fracture

Muscular sprain/strain

Neck injury (sprain/strain)

Overuse injury – Upper or lower extremity

Paresthesia

Subungual hematoma

Suit contact injury (EVA related)

Vertebral disc injury

Dermatological 

conditions

Burn – Chemical, skin

Cellulitis – Bacterial skin infection *

Herpes zoster (Shingles)

Skin abrasion *

Skin laceration *

Skin rash *

Toxic dermal exposure

Viral/fungal skin infection 

Sample of medical conditions identified during spaceflight 

Application

11/21/2023

Rev A 12

Conditions noted with an asterisk (*) should be addressed on every mission regardless of the DRM parameters.
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

11/21/2023

Rev A 13

Medication Storage and Packaging

NASA must consider logistical factors such as stowage and inventory, as well as formulary needs, when packing 

medication kits.

Considerations for Medical Kit Content

• Volume

• Mass

• Waste (excess packaging)

• Stability and sterility

• Storage conditions

• Pharmaceutical issues - PK/PD toxic metabolites

• Drug delivery systems ability in space

• Drug availability -shortages

• Packaging/repackaging effect on stability

• Astronaut personal medications

• Vehicle and suit environmental impacts

Onboard Personal Medical Kit Crewmembers are allowed to bring a personal supply of medications or 

medical supplies. These are currently referred to as ISS Medical Accessory Kits (IMAKs). This name will vary 

depending on the program, for example, future medical kits for Orion are referred to as Orion Medical Accessory 

Kits (OMAKs). The medical team needs to consider this content ahead of time to evaluate any potential 

medication interactions.

In-flight Medication Considerations

• Shelf life is a driver of medication as expiration is a limiting factor when flying medications. We can only legally 

pack medications that have manufacturer expiration data.

• Need to consider the time it takes to pack and transport to launch site.

• Toxicology considers all medications for active and inactive ingredients as possible toxic exposure.

• Shipping happens during prelaunch timeframe, need to ensure storage chain requirements are followed.

• Predict any side effects and interactions, including personal medications.

• Provide education regarding all medications.

• Consider administration, absorption, metabolism, elimination, clinical response, toxicity, and effectiveness.

• Consider any physiological change that can cause medications to work differently. 

• International medications – may need additional information such as education and storage if not familiar.

• Inventory management—ensure medications are packed to be accessible and designed to best manage 

expiration parameters.

• May have multiple medication packs depending on mission design.

A medical technician surrounded by medical kits 

for the ISS Crew. Source: NASA

[V2 7050] Stowage Provisions The system shall provide for the stowage of hardware and supplies, to include 

location, restraint, and protection for these items.

[V2 7055] Priority of Stowage Accessibility Stowage items shall be accessible in accordance with their use, with 

the easiest accessibility for mission-critical and most frequently used items.

From: NASA-STD-3001 Vol 2, Rev D

Background
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Radiation

The uncertainty of the effect radiation exposure has on pharmaceuticals during spaceflight is a subject of 

concern and study. During spaceflight, radiation can potentially cause direct or indirect damage to biological 

cells by disrupting genetics and biochemistry. Ionizing radiation exposure in LEO as well as the Earth’s 

protective magnetic field creates an environment that thus far has not been found to significantly 

interfere with the usability of medications. Long duration flights in deep space, however, will experience 

more dangerous galactic cosmic rays (GCR) and without the Earth’s magnetic field protection, it is unknown 

whether this will affect drug stability or produce potentially toxic byproducts in medicines.

Supplying a pharmacy for NASA exploration spaceflight: challenges and current understanding Blue et al. (2019) 

Uncertainty regarding radiation exposure during long duration spaceflight

Background

11/21/2023

Rev A 14
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

11/21/2023

Rev A 15

Pharmacogenomics The study of how a person's genes affect their response to medications.

Medication effectiveness can vary among patients, some will attain the desired effects with no problems 

while others may have an adverse drug reaction or receive no benefit from taking the medication. One 

cause of medication reaction variability is the fact that patients can have differences in enzymes which help 

to metabolize medications into usable products. Patients with enzymes which are more active have 

increased metabolism and may break down the medication too quickly to be able to work in the manner 

designed. If the patient enzymes are less active, medication is not broken down quickly enough and patient 

may be exposed to unexpected chemicals for longer periods of time which can cause adverse or toxic 

effects. Studies have also found particularly strong variances among specific cultural populations.

Pharmacogenomics and Spaceflight Pharmacogenomics information is not currently being used to choose 

spaceflight medications but is being studied as it could be helpful when choosing the optimal effective 

medications to include in each mission medication kit.

Pharmacogenomics Study Stengl et al. (2014) study explored 78 drugs permanently available on the ISS to 

determine variability the elimination of medications among crewmembers, and if this variability would require 

individual dose changes in order to prevent therapy failure or exposure to toxic adverse effects.

Results: 24 drugs showed metabolism is affected by polymorphic metabolizing enzymes, but not enough evidence 

was present on how polymorphisms affects drug exposure to predict therapeutic recommendations or dose 

adjustments to make genetic testing a requirement at this time.

Pharmacogenomics Examples Although we do not have enough information at present to base medical kit 

formulary choices on pharmacogenomics, we can still be aware of possible impacts. For example, enzyme CYP2D6 

has been studied and found to have significant variability with patients ranging from poor metabolizers, through 

ultrarapid metabolizers. CYP2D6 is involved in the metabolism of 11 medications currently on the ISS medical 

formulary including metoprolol, a heart medication, which when taken by poor metabolizers (PM) can lead to 

symptoms of bradycardia and by ultrarapid metabolizers cause twofold higher clearances, not treating patient's 

symptoms or disease properly. Pharmacogenomics is new in its use and not standard practice in spaceflight crews 

at this time but is something being studied for effectiveness for future long-distance spaceflight.

Example of Pharmacogenomics

Source: Journal of Solid 

Tumors, 2012

Background
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

11/21/2023

Rev A 16

History of Medication Kits

Mercury Medications were available for emergency auto injectors:

• Cyclizine for motion sickness, epinephrine for injury or shock, meperidine for pain, 

dextroamphetamine sulfate for alertness and response time.

Gemini Higher quantities of medications for longer missions, included a first-aid kit:

• Medications added included pseudoephedrine for congestion, as well as tetracycline for infection or 

diarrhea and eye drop medication.

Apollo Continued to adjust and add medications per needs assessed after each flight: 

• Included lunar module kit to accommodate crew split and medication for sleep disruption, cardiac 

dysrhythmias, eye, ear, multivitamins, decongestant/antihistamine, antibiotics, analgesics, GI, sedative, 

and stimulant medications.

Skylab Longer missions required larger and more comprehensive medical packs:

• Medications similar to Apollo, introduced additional medical kits including dental kit, diagnostic kit 

including hematology, urinalysis, and therapeutic kit including laryngoscope and airway equipment. 

Astronauts received 80 hours of paramedic training prior to launch. 

Space Shuttle Program Crew Medical Officer on each flight:

• Three kits including medication kit, medication and bandage kit (MBK), and emergency medical kit 

(EMK); kits contained subpacks to further organize and make medications accessible.

International Space Station Two medical kits, one for the Russian segment and one for the US segment:

• Contains 190 medications to treat anticipated medical conditions, medical officer trained in first aid 

and emergency medical and include personal medication kits for crew (IMAK).

Sample Medication Kit Lists

Mercury-4 Gemini-10 Apollo-30

Cyclizine Cyclizine Acetaminophen

Dextroamphetamine Dextroamphetamine Ampicillin

Epinephrine Diphenoxylate Aspirin

Meperidine Pseudoephedrine Atropine

ASA/phen/caffeine Bacitracin

Meperidine Cyclizine

Methyl Cellulose Dextroamphetamine

Simethicone

Tetracycline

Tetrahydralazine

Background

See next page for additional medication lists

Medication list from Principles of Clinical Medicine for Spaceflight, Michael Barratt Chapter 6 Spaceflight Medical 

Systems Pg 201-231.
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Proparacaine eye drops Meperdine Immodium Nitrostat SL Acetaminophen 

with Codeine

Zolpidem Eugenol Verapamil Pepto Bismal Diazepam

Amikacin Marcaine/bup

ivacaine

Triamcinolone Phazyme 125 Vidarabine

Amoxicillin Dextroamphet

amine

Lidocaine Promethazine Vosol HC otic

Anusol HC Acetazolamide clotrimazoe Polysporin xylocaine

Ascriptin Bisacodyl Lubricant Povidine iodine Azithromycin

Atropine Cefadroxil Morphine Sulfate Albuterol inhaler

Sulfamethoxazole/trimethoprim Ibuprofen Phenazopyridine

diphenhydramine Entex LA Clotrimazole Refresh eye 

drops

Ciloxan eye drops Epinephrine Mylanta Temazepam

Ciprofloxacin Metronidazole Naloxone Rimantadine

Loratadine Gentamicin Neosporin Plus Silvadene

Cyclogyl/cyclopentolate Haloperidol Nitroglycerin 

parch

Acetaminophen

Medication list from Principles of Clinical Medicine for Spaceflight, Michael Barratt Chapter 6 Spaceflight 

Medical Systems Pg 201-231.

Background

Space Shuttle Medication List

11/21/2023

Rev A 17
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

National Aeronautics and Space Administration (NASA) Emergency Medical Procedures Manual for the International Space Station (ISS) [partial], 2016 

The ISS medication kit includes nine individual packs with medications and supplies: Emergency Medical, 

Convenience Med, Oral Med, Topical and Injectable Med, Diagnostic, Minor Treatment, Medical Supply, IV 

Supply, and Physician Equipment Pack. Shown below are the medications:

Background

11/21/2023

Rev A 18
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

11/21/2023

Rev A 19

Medication Challenges

In-Suit Medication Use

Historically, a crewmember would plan to spend no more than 6 hours in a pressurized spacesuit for an EVA 

and would not need to take medications while in-suit. In future missions, situations may arise that require 

crewmembers to stay suited for longer periods and take medications while suited. For example:

• Long duration missions have longer transit times (i.e., return from the Moon can take 144 hours or 

more). Crewmembers must have the capability to stay suited for long periods of time in the event of 

unplanned cabin depressurization and ability to take medication if needed.

• Crewmembers may have much longer EVA capacity or be traveling in an unpressurized rover, requiring 

them to be suited for long periods of time and need the capability to access medications.

[V2 11027] Suited Medication Administration The system shall provide a means for administration of 

medication to a suited, pressurized crewmember for pressurized suited exposures greater than 12 hours. 

From: NASA-STD-3001 Vol 2, Rev D

Medication Delivery Options

NASA is studying many options to find the best way to provide medications to suited crewmembers. 

Injections and oral medications are both options being considered but each have their own challenges.

Toxic off gassing Another challenge 

is to ensure medications do not 

introduce off gassing or toxicity that 

may be damaging to the crew or 

vehicle. 

[V2 7115] Medical Treatment, Personal Supplies, and Impacts to 

Environmental Systems Medical treatment, including 

pharmaceuticals, non-pharmaceutical crew care items, and related 

supplies, shall be evaluated for impacts on vehicle systems. 

From: NASA-STD-3001 Vol 2, Rev D

Injectable Medication Challenges

• The ability to physically use the medical 

delivery device at the desired location 

while the astronaut is gloved and 

possibly seated is challenging.

• Not all medications are available as 

injectables so this method can decrease 

treatment options.

• Behavior of the fluid in a off nominal 

pressure/temperature environment can 

make injections difficult, for example, 

when giving an injectable medication 

the bubble within a syringe will expand 

as pressure decreases, including 

complete vaporization at very low 

pressures/vacuum.

• Require additional suit opening that can 

disrupt suit integrity, posing safety risks. 

Oral Medication Challenges

• The capability to provide an easily 

accessible, and administrable 

delivery of oral medication 

compatible with a pressurized suit is 

challenging. 

• Programs are currently considering 

using hand-held tools to assist with 

oral pill port type medication 

delivery which can pose a challenge 

when the astronaut has a gloved 

hand. 

• The oral delivery device limits what 

size of tablets/capsules can be 

administered, limiting medication 

options.

• Oral medication can potentially 

introduce residue contamination. 

Air Force U-2 suits have 

a port for food and pills 

in the hard shell. 

Application
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

11/21/2023

Rev A

History Apollo In-Suit Medication

When Apollo spacesuits were designed, the needs differed from the Mercury and Gemini programs 

because the transit time lengthened from hours to days. The suit needed to address additional risks 

imposed by the longer duration including if a contingency situation required the crew to remain in 

pressurized suits, they must be able to administer an injection while suited in the event of illness or injury. 

The Apollo Program identified a requirement (see below) for the Apollo EMU to have a biomedical 

injection patch to facilitate the injection while in a pressurized suit. This patch is no longer in use, however 

in-suit medication administration options are currently being studied. 

X-ray image of David Clark Apollo 

A-IC suit. Source: Smithsonian 

Institute Image

Right: Apollo 

Suit Injection 

Requirement. 

Apollo space 

Suit Assembly 

Design and 

Performance 

Specification, 

October 12, 

1964.

The Apollo medical kits 

housed pre-filled medical 

syringes inside a 

pressurized aluminum 

tube. Injections were 

activated by pressing a 

button at the top of the 

device, which caused the 

syringe and needle to 

displace, driving the needle 

through the seal on the 

device and the injection 

patch on the EVA suit into 

the muscle. 

Apollo suit medication injection 

patch. Source: NASA Source: NASA

Application

20
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Back-Up

11/21/2023

Rev A 21
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Original  Rev A • Updated information and standards to be consistent with NASA-STD-3001 Volume 1 

Rev C and Volume 2 Rev D.

• Added introduction with additional content, updated standards, added images of 

more current med kits.

• Deleted back risk and inflight medical risk for accuracy, added “other environmental 

factors” to space radiation bubble.

• New page with image “effects of space on the human body”, added wording 

regarding physiological, environmental, and immunologic changes information.

• Added additional information and graph regarding In-Mission Medication 

Effectiveness. 

• Added additional detailed information regarding medication selection. 

• Added Information and graph regarding Dose Tracker Study. 

• Added additional information regarding Medication storage, packaging, shelf life, 

Onboard medical kit, Federal Shelf-Life Extension Program. 

• Removed inflight medical kit image.

• Removed Apollo application information.

• New slide regarding radiation effects on medication.

• Added new slide analog and spaceflight to study medication use information.

• Added new slide history of medication kits.

• Added new slide information regarding pharmacogenomics.

• Added new slide regarding medication delivery and suited medication challenges.

• Added new slide with images regarding in suited medication administration. 

11/21/2023

Rev A

Major Changes Between Revisions

22
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

NASA-STD-3001 Volume 1 Revision C

[V1 3004] In-Mission Medical Care All programs shall provide training, in-mission medical capabilities,

and resources to diagnose and treat potential medical conditions based on epidemiological evidence-based 

PRA, individual crewmember needs, clinical practice guidelines, flight surgeon expertise, historical

review, mission parameters, and vehicle-derived limitations. These analyses consider the needs and 

limitations of each specific vehicle and design reference mission (DRM) with particular attention to 

parameters such as mission duration, expected return time to Earth, mission route and destination, 

expected radiation profile, concept of operations, and more. In-mission capabilities (including hardware and 

software), resources (including consumables), and training to enable in-mission medical care, and 

behavioral care, are to include, but are not limited to: (see NASA-STD-3001 Volume 1 Rev C for full technical 

requirement).

[V1 4009] Sensorimotor Countermeasures Countermeasures shall maintain sensorimotor function within

performance limits.

[V1 4016] In-Mission Hematological/Immunological Countermeasures In-mission countermeasures shall 

be in place to sustain hematological/immunological parameters within the normal range as determined by 

direct or indirect means.

[V1 4027] In-Mission Bone Countermeasures Countermeasures shall maintain bone mineral density of the 

hip and spine at or above 95% of pre-mission values and at or above 90% for the femoral neck.

[V1 5001] Medical Training Medical training shall be provided to crewmembers, flight surgeons (FSs), 

mission control support staff, and other ground support personnel (GSP).

[V1 5007] Support Personnel Training Supervised training programs shall be implemented for individuals

including but not limited to NASA personnel, international partners, and commercial/private space 

programs, who require knowledge of space medicine or flight medical procedures, such as flight directors, 

medical consultants, and/or other personnel deemed appropriate as part of the Medical and Crew Health 

Technical Requirements Document.

[V1 6001] Circadian Shifting Operations and Fatigue Management Crew schedule planning and operations 

shall be provided to include circadian entrainment, work/rest schedule assessment, task loading 

assessment, countermeasures, and special activities.

[V1 7001] Crew Health Results The results of all crew health monitoring shall be kept in a permanent

retrievable format for evaluation including trend analysis.

[V1 7002] Crew Records Transmission The method of transmission of crewmembers’ medical health data 

shall meet the medical operational needs of the program.

[V1 7003] Crew Records Security The method for handling, storing, and transmission of crewmembers’

medical health records shall be secured.

NASA-STD-3001 Volume 2 Revision D

[V2 7038] Physiological Countermeasures Capability The system shall provide countermeasures to meet 

crew bone, muscle, sensorimotor, thermoregulation, and aerobic/cardiovascular requirements defined in 

NASA-STD-3001, Volume 1.

Referenced Technical Requirements

11/21/2023

Rev A 23

View the current versions of NASA-STD3001 Volume 1 & Volume 2 on the 

OCHMO Standards website
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

NASA-STD-3001 Volume 2, Revision D

[V2 7042] Orthostatic Intolerance Countermeasures The system shall provide countermeasures to mitigate 

the effects of orthostatic intolerance when transitioning from weightlessness to gravity environments and 

during Az (head-to-foot) vehicle accelerations defined in the sustained acceleration limits.

[V2 7043] Medical Capability A medical system shall be provided to the crew to meet the medical 

requirements of NASA-STD-3001, Volume 1.

[V2 7045] Medical Equipment Usability Medical equipment shall be usable by non-physician crewmembers 

in the event that a physician crewmember is not present or is the one who requires medical treatment.

[V2 7115] Medical Treatment, Personal Supplies, and Impacts to Environmental Systems Medical 

treatment, including pharmaceuticals, nonpharmaceutical crew care items, and related supplies, shall be 

evaluated for impacts on vehicle systems.

[V2 7050] Stowage Provisions The system shall provide for the stowage of hardware and supplies, to 

include location, restraint, and protection for these items.

[V2 7051] Personal Stowage The system shall provide a stowage location for personal items and clothing.

[V2 7052] Stowage Location All relocatable items, e.g., food, EVA suits, and spare parts, shall have a 

dedicated stowage location.

[V2 7055] Priority of Stowage Accessibility Stowage items shall be accessible in accordance with their

use, with the easiest accessibility for mission-critical and most frequently used items.

[V2 7059] Inventory Tracking The system shall provide an inventory management system to track the 

locations and quantities of items (including hazardous trash) throughout the mission.

[V2 11027] Suited Medication Administration The system shall provide a means for administration of 

medication to a suited, pressurized crewmember for pressurized suited exposures greater than 12 hours.

[V2 11125] Suit Materials Compatibility Pharmaceuticals, topical treatments and cleaning materials shall 

be compatible with suit materials (internally and externally).

Referenced Technical Requirements

11/21/2023

Rev A 24

View the current versions of NASA-STD3001 Volume 1 & Volume 2 on the 

OCHMO Standards website
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Reference List

1. Du, B., Daniels, V.R., Vaksman, Z., Boyd, J.L., Crady, C., and Putcha, L. (2011). Evaluation of Physical and 

Chemical Changes in Pharmaceuticals Flown on Space Missions. The AAPS Journal, 13(2): 299-308

2. Wotring, V.E. (2014). Stability Analysis of Medications from the International Space Station.. JSC 

Pharmacology. 

3. Wotring, V.E. (2015). Medication use by U.S. crewmembers on the International Space Station. The FASEB 

Journal, 29(11): 4417-4423

4. Blue, R.S., Bayuse, T.M., Daniels, V.R., Wotring, V.E., Suresh, R., Mulcahy, R.A., and Antonsen, E.L. (2019). 

Supplying a pharmacy for NASA exploration spaceflight: challenges and current understanding. npj

Microgravity, 5(15)

5. Roberts, M. & Denton, M. Effect of posture and sleep on pharmacokinetics: amoxycillin. Eur. J. Clin. Pharm. 

18, 175–183 (1980).

6. Wotring, V.E. and Smith, L.K. (2020). Dose Tracker Application for Collecting Medication Use Data from 

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7. Putcha, L., Cintron, N.M., Tsui, J., Vanderploeg, J.M., and Kramer, W.G. (1989). Pharmacokinetics and Oral 

Bioavailability of Scopolamine in Normal Subjects. Pharmaceutical Research, 6: 481-485

8. Daniels, V.R., Bayuse, T.M., McGuire, K.M., Antonsen, E.L., and Putcha, L. (2017). Radiation Impact on 

Pharmaceutical Stability: Retrospective Data Review. Tech. Report No. 09940. Proceedings of the NASA 

Human Research Program Investigator Workshop (2018). https://ntrs.nasa.gov/citations/20170009940

9. Schuck, E.L., Grant, M., and Derendorf, H. (2005). Effect of Simulated Microgravity on the Disposition and 

Tissue Penetration of Ciprofloxacin in Healthy Volunteers. Journal of Clinical Pharmacology, 45(77): 822-831

10. Putcha, L., and Cintron, N.M. (1991). Pharmacokinetic consequences of spaceflight. Ann N Y Acad Sci, 28(618): 

615-618

11. Rumble, R.H., Roberts, M.S., and Scott, A.R. (1988). The effects of posture on the pharmacokinetics of 

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13. Juergensmeyer, M.A., Juergensmeyer, E.A., and Guikema, J.A. (1999). Long-term exposure to spaceflight 

conditions affects bacterial response to antibiotics. Microgravity Sci Technol, 12(1): 41-47

14. Emanuelli, M. (2014). Evolution of NASA Medical Kits: From Mercury to ISS. Space Safety Magazine. Retrieved 

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14. Stingl, J.C., Welker, S., Hartmann, G., Damann, V., and Gerzer, R. (2015). Where Failure Is Not an Option -

Personalized Medicine in Astronauts. PLoS One, 10(10): e0140764

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18. Gandia P., Bareille M.P., Saivin S. et al. Influence of simulated weightlessness on the oral pharmacokinetics 

of acetaminophen as a gastric emptying probe in man: a plasma and a saliva study. J. Clin. Pharmacol. (2003) 

43 1235–1243.

11/21/2023

Rev A 25
NASA-STD-3001 Technical Brief

OCHMO-TB-006

Pharmaceutical Care

NASA Office of the Chief Health & Medical Officer (OCHMO)

This Technical Brief is derived from NASA-STD-3001 and is for reference only.

It does not supersede or waive existing Agency, Program, or Contract requirements.

Reference List

11/21/2023

Rev A

19. Rumble R.H., Roberts M.S., Scott A.R. The effect of posture on the pharmacokinetics of intravenous 

benzylpenicillin. Eur. J. Clin. Pharmacol. (1986) 30 731–734. 

20. Levy G. Effect of bed rest on distribution and elimination of drugs. J. Pharm. Sci. (1967) 56 928–

21. Gandia P., Bareille M.P., Saivin S. et al. Influence of simulated weightlessness on the oral pharmacokinetics.

22. Stingl JC, Welker S, Hartmann G, Damann V, Gerzer R (2015) Where Failure Is Not an Option –Personalized 

Medicine in Astronauts. PLoS ONE 10(10): e0140764. https://doi.org/10.1371/journal.pone.0140764

23. https://lsda.jsc.nasa.gov/Experiment/exper/12376, Spaceflight Injectable Delivery System (ISIS)

24. https://pharmaceutical-journal.com/article/feature/drugs-in-space-the-pharmacy-orbiting-the-earth

25. Shane M. McFarland Jsc and Aaron S. Weaver Breaking the Pressure Barrier: A History of the Spacesuit 

Injection Patch. Conference Paper International Conference on Environmental Systems January 1,2013

26. U.S. Food and Drug Administration. Don’t Be Tempted to Use Expired Medicines. Feb 8,2021.

27. Lyon,R et al. Stability profiles fo drug products extended beyond labeled expiration dates. Journal of 

Pharmaceutical Sciences, Volume 97 issue 7 July 2006.

28. Gikonyo,D, Gikonyo,A, Luvayo,D, Ponoth<p. Drug expiry debate: the myth and the reality. African Health 

Sciences Sept 19.2019.

29. U.S.Food and Drug Administration. Expiration Dating Extension updated 111/8/2022

30. DoD Manual 4140.27 Volume 1 DoD Shelf-Life Management Program: Program Administration 7/6/2016, 

Change 2 12/11/2019.

31. Tull,K. 2018. Drug expiry standards in developing countries. University of Leeds Nuffield Centre for 

International Health and development June 11,2018.

32. Code of Federal Regulations , Title 21,Volume 4. Title 21- Food and Drugs, FDA of Health and Human 

Services, Drugs, Current Good Manufacturing Practice For Finished Pharmaceuticals.

33. Drug Expiration Dates- Do They Mean Anything? 2020. Harvard Health Publishing, Harvard Medical School 

Aug 29,2020.

34. Wegienka,L et al. 1964. Renal Tubular Acidosis Caused by Degraded Tetracycline. Journal of the American 

Medical Association August 1964.

35. Lyon et al. 2006. Stability profiles of drug products extended beyond labeled expiration dates. Journal of 

Pharmaceutical Sciences July 2006.

36. USA Today “After a year in space, Scott Kelly returns 2 inches taller”. Mary Bowerman 3- 3, 2016

Wotring VE. Chemical Potency and Degradation Products of Medications Stored Over 550 Earth Days at the 

International Space Station. AAPS J. 2016 Jan;18(1):210-6. doi: 10.1208/s12248-015-9834-5. Epub 2015 

Nov 6. PMID: 26546565; PMCID: PMC4706284.

37. Emanuelli, Matteo 2014Space Safety Magazine, Evolution of Nasa Medical Kits : From Mercury to ISS. ISSF

38. https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policyframework/expiration-dating-extension

26