Trail Run Spain.

Medications / Medical Kits for Ultra Running



Medical Kits
Each race will specify certain things that are mandatory. They may also recommend other items as recommended. This list will be different for different races, but will contain many of the same things. General principals are discussed, as well as a bit about specific medications. Of note if you are going somewhere exotic it’s a good idea to check with your doctor whether you need any vaccinations, or anti-malaria tablets etc.  Carry your med kit in your hand luggage except sharp objects which need to go in the hold.

General Principles
Make sure you have everything on the mandatory list, each item will be there for a reason, recommended by experienced doctors and racers. If you don’t carry them you might get a time penalty, or be unable to sort out medical problems as they arise.   Definitely carry all your own prescribed medication as well, and make sure you have a sufficient supply for the duration of your trip before you leave.  Consider carrying the recommended stuff as well, you can discuss this with other runners or your doctor. Don’t separate the tablets from the wrapping. This may seem obvious but it has been known for competitors to think they have been taking painkillers when they have actually taken sleeping pills.

Saying that it’s usually possible to have a fairly light personal med kit. Mine is usually about 70 grams, as I’ll take mandatory stuff, things I think I’ll need, and if something unexpected happens then the race medical staff are usually happy to help.  Some guys carry a huge kit, for every eventuality which will slow you down and possibly contribute to backache and blisters. I’ve seen people carrying their own intravenous fluids, which is madness.

Tailor your kit for the race you are doing. Single day ultras are different to multi days, and for example you won’t need salt tablets in the arctic, or frostbite treatments in the desert. If in doubt, check with the doctors/ medical staff. They are there to help you, and won’t pull you out for no reason. You’re more likely to finish by discussing medical problems and appropriate treatment of them with the team, it’s their job to help everyone achieve their potential, safely. The same medication may have more than one name. Often they have the actual drug name, and a brand name. Sometimes the name can be different in different countries for example paracetamol is known as acetoaminophen in the USA.

Painkillers
There are a number of different painkillers that people commonly use that are broadly in 4 different groups:

PARACETAMOL/ ACETOAMINOPHEN: Definitely take paracetamol with you. It’s a reasonably good painkiller that can be used itself or in combination with other painkillers. It does not have any anti-inflammatory properties. It has very few side effects, and is relatively safe to take anywhere. The maximum dose is 1 gram 4 x per day which is usually 2 tablets 4 x per day for an adult. Consider taking some ½ hour before the start. It’s effects last about 6-8 hours. Don’t take more than the prescribed dose as overdoses can cause significant problems.

NON STEROIDAL ANTIINFLAMMATORY DRUGS (N.S.A.I.D.S)Examples include ibuprofen/neurofen, diclofenac, naproxen and many others. Use of these drugs during prolonged exercise must be with extreme caution. They are attractive as they are effective as painkillers and anti-inflammatory. They can be helpful if used carefully during training but should not be used during prolonged exercise unless you know what you’re doing. The reasons for these vary with the environment. In the desert dehydration is a common problem and NSAID’s can cause the kidneys to fail in conjunction with dehydration, and muscle breakdown (rhabdomyolysis). If salts are lost during sweating and not replaced, a low sodium level results, and this can be made worse with anti-inflammatories. Runners are already at a slightly higher risk of stomach ulcers, and these are made worse by NSAIDS. All of these are potentially life threatening problems. Many race doctors will not issue this type of painkiller during a race, due to these risks but may allow competitors to use their own supply. Don’t use them if you have had previous ulcers/ kidney problems, and don’t use them if you are asthmatic and haven’t used them before.

CODEINE based medications. Are stronger painkillers, and have no anti-inflammatory properties. They can be useful last thing at night. They can cause drowsiness, constipation and nausea, so only take them if you have used them previously with no problems. TRAMADOL is similar, in that it’s a good painkiller. It doesn’t cause as much drowsiness but often makes runners feel sick, so is probably best avoided.

COMBINATION PAINKILLERS. These are usually combinations of the above painkillers. These include co-codamol, co-dydramol. You’re better taking the individual drugs, or individual drugs in combination if necessary.

Other medications / med kit stuff
LOPERAMIDE/ IMMODIUM.  These are anti-diarrhea medications. This doesn’t cure the cause for diarrhea, but will slow the diarrhea down. The dose is 2 mg after each loose bowel movement. This is a definite drug to take with you, don’t take any more than the dose on the pack.

ANTISICKNESS MEDS. There are loads of these. Examples include Metoclopramide/ Maxalon, and Cyclizine. It’s worth taking one of these options with you. They occasionally have side effects but are very useful to have. Cyclizine (dose 50 mg) is probably better, as metoclopramide can speed your bowels up a little.

SLEEPING PILLS. Some runners take these as sleeping can be difficult. They can make you feel tired the next day. Take earplugs instead.

ANTIHISTAMINES. Examples include CETIRIZINE, loratidine and chlorpheniramine/piriton. They are used for itch/ allergy. Some of these can cause sleepiness.  Cetirizine (10 mg once a day) doesn’t have this problem, it’s possibly the best choice.

ANTIBIOTICS. Some race organisers like racers to carry their own antibiotics. These can be used for a variety of bacterial infections. Usually race doctors will carry antibiotics if they are required. If you are asked take your own, consider FLUCLOXACILLIN for skin infections,

CO-AMOXYCLAV for chest or urine infections, and CIPROFLOXACIN for travellers diarrhea. Ensure you are not allergic to any antibiotic given to you.

ACICLOVIR/ ZOVIRAX (cream). If you are prone to cold sores, and are running in either a hot/ cold/ sunny environment then take some, as cold sores are much commoner in these environments.

VASELINE. Vaseline is much cheaper than fancy anti-chafing creams/ sprays and is probably just as good.

ALCOHOL HAND GEL. I think this should be on every mandatory list. Using this every time after going to the toilet, and every time before preparing food, especially in poor sanitary conditions will stop you getting diarrhea/ vomiting. A small bottle goes a long way. It’s incredible how many competitors get diarrhea during races, and it’s almost entirely preventable.

ANTISEPTIC CREAM. Like FUCIDIN treats minor skin/ foot infections. Use on any infected looking areas.

BLISTER KIT. Everyone has their own thoughts on this. Sterile swabs and needles, and plasters or tape are a must. Some people like second skin type dressings. The key is keeping blisters clean and dry. This is better discussed on separate articles on the subject.

BANDAGES. Don’t go overboard on this. One bandage in case of a sprain is sufficient, in semi supported races that have medics around.

CAFFEINE/PROPLUS. Check regulations as races may allow only a certain caffeine intake per day. Caffeine is a diuretic, so dehydrates you a bit.

CONTRACEPTIVES. Don’t forget these as it’s usually a pretty big post event party.

FEMALE SANITARY ITEMS. These can be hard to acquire in some locations, so safest to bring with you. Consider timing of your period as well, and plan accordingly.

SPECIFIC RACES :

Desert
Take electrolytes, or salt tablets. Ask in your running shop for advice re electrolyte drinks, or ask those that have been there before. Elete, and Science In Sport (SIS) both have palatable, well balanced drinks. If you drink these consistently rather than water, you probably don’t need to use salt tablets. If you drink water only, you will probably become unwell. You’ll probably be asked to carry an anti-venom pump in case of snake bite. These are of limited use. If you get bitten sit down and summon help immediately. Sun cream is important. P20 is great.

Cold Environments
Depending how cold it is, consider taking anti-inflammatories which can help with frostbite. Handwarmers can keep your hands warm as the name suggests.

Jungle
Check what vaccinations you need, and consider choice of antimalarial months prior to leaving.  Don’t leave this until the last minute. Choose antimalarials carefully, malarone may be a good choice, as Doxycycline causes the skin to burn more easily, and Larium can cause nightmares. Take plenty sunscreen. If there are snakes, take an antivenom pump. Definitely take anti-histamines with you for itchy insect bites, and also mosquito repellant.

WHERE TO GET MEDICAL KITS/ MEDICATION
Most of what you need, depending where you are going can be sourced from the chemist/supermarket. PARACETAMOL, IMMODIUM, CETIRIZINE (ANTIHISTAMINE), BLISTER KIT, NSAIDS, ZOVIRAX, VASELINE, ALCOHOL HAND GELS, and ANTISEPTICS can all be bought over the counter at the chemist. Speak to other competitors and only take realistic quantities.

Premade kits can be bought from Likeys, Sandbaggers, Across the Divide, Racing the Planet, and many others.  If you are going to see your GP/ doctor about your health, medication, antibiotics, vaccinations etc, TAKE SOME INFORMATION ABOUT THE EVENT WITH YOU.

There are often doctors / medics present at seminars or on forums. Questions can always be asked via these. Race organizers are usually extremely helpful and knowledgeable, or can point you in the right direction.

Dr Andrew Murray
( Co-founder Marathon Medical services, and ultrarunner. )


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