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Know Before You Go: Traveling with AVONEX

Posted May 24 2010 8:00am

Travelling with your meds is pretty straightforward; however, keeping a few things in mind can make the experience run more smoothly and provide more time at your destination to do the things you’d rather be doing!

I’ve put tens of thousands of miles on the odometer every month with AVONEX and I’ve learned a few tricks when travelling with medicines that need special treatment. I hope some of this is useful to you on your next trip!

Knowing Your Temperature Requirements

First, let’s review the requirements that Biogen Idec Inc ., the manufacturer of Avonex, publishes on its website avonex.com:

“When refrigeration (36-46ºF) is unavailable, AVONEX prefilled syringes can be stored for up to 7 days at room temperature (up to 77ºF). AVONEX also comes in a powder form that can be stored even longer at room temperature—up to 30 days…Do not expose to high temperatures. Do not freeze.”

In general, these temperature requirements are not difficult to maintain. However, on occasion you might be exposed to unexpected high or low temperature spikes. According to the Biogen any exposure to a temperature greater than 77º F (25ºC), or less than 36ºF (2ºC), destroys the medicine.

I use the vials (powder form) as opposed to the prefilled syringes. The vials are more temperature tolerant in terms of the number of days they can stay at room temperature. My opinion is that this works when on the road. Naturally, your choice depends on what is most convenient for you.

Preparing for Your Trip

When making your travel arrangements, you can take care of many potential problems before you even leave the house. Here are some things to do before you walk out the front door:

  • Get a cold pack to carry your meds in. I use a small pack made for carrying insulin that I got years ago from my local chapter of the American Diabetes Association. The frozen gel packs slide in the sides of the pack and the vials are held in a small pouch in the center. You can try finding such equipment at a medical supply house in your neighborhood or online. I found a number for sale at Amazon.com. Note that AVONEX must be kept cooler than insulin, so some packs that use moisture evaporation for cooling may not keep your meds sufficiently cool. Something that uses frozen gel is probably the way to go.
  • Find a small container made of hard plastic to protect the non-temperature sensitive items. Such items don’t need to be kept cool and to save space in the cold pack I pack things like syringes, needles, swabs, and diluents in a separate plastic container. The container also provides some crush-protection. Your container can also double as a sharps collector on the road until you get home. However, use caution here. This is not an approved sharps collector, so dispose of your sharps properly when you get home and keep out of reach of children at all times!
  • The telephone is a beautiful thing. Call the hotel, explain your requirements, and see what they have to offer you. The best option is to have a small fridge (with ice compartment) in the room. This allows you to freeze your gel packs in the freezer compartment while keeping your medicine cool in the fridge. Other questions to ask before you arrive at the hotel are: Is there a mini bar in the room? Is there a restaurant in the hotel and will the restaurant accept storing the gel packs in their freezer? If you hit a roadblock with hotel policy, try elevating your issue to the hotel general manager. Only once in 12 years have I had to resort to this, but it solved the impasse immediately.
    Call ahead to the hotel to make arrangements to keep your medication at the proper temperature.
  • Ask your airline what their policy is for keeping medicines in their coolers in-flight. Many airlines won’t accept medicines for cooling in-flight, so you are probably on your own here. Sometimes you can prevail on the flight attendants when you get on the airplane, but you should be prepared to take care of your medicine yourself if the flight attendants demure. I’ve had better luck with this on non-US carriers.
  • Passing through security? No problem. At minimum you should carry the label from the AVONEX box, showing your physician’s name, address and phone number, your name and address, and the name of the medication. The security folks are required to allow your medication through, including the needles and syringes for administration and the gel packs to keep it cool. I’ve never had any hint of a problem. If you want to wade through all the details, check out the Transportation Security Agency .

Travelling on the Airplane

Here are some tips to keep in mind when you are travelling to and from the airport, as well as when you are riding on the airplane:

  • Keep all your medicine and supplies in your carry-on luggage. Do NOT check it in. If your bag is lost, you don’t want to be stuck in East Upper Separatist Slobovia without your medicine and supplies. Also, checked baggage can get very cold in the cargo hold or very warm sitting in a baggage cart waiting to be loaded in the airplane. Your meds are important and you loose control over them if they are anywhere but with you in the cabin.
  • The coolest location for your meds is probably under the seat in front of you. Storing in a cool place will extend the useful range of your gel packs. The overhead compartments are also an acceptable location, but in my judgment the overhead compartments might be a bit warmer because heat rises in the cabin. The overhead compartments might also be a bit warmer because the reading lamps can warm the compartments slightly (depending on the design of the airplane). The location is not so important, as long as your gel packs are not depleted (in other words, they need to stay at least partially frozen).
  • Do NOT use dry ice! Dry ice is frozen CO2 and is much too cold: about ‑110ºF (that’s below zero!). This will destroy your meds.
  • Consider the season of the year and the time of day you will arrive. If your destination is warm, you will need to have some gel pack life remaining when you arrive to allow for safe transfer to the hotel. My gel packs don’t usually last for more than 8 to12 hours. Wrapping them in a blanket (or similar) on the airplane can extend their useful life. The larger the gel pack, the longer it will last; however, larger gel packs are going to be heavier. It’s a tradeoff.

    Get a gel pack and a cold pack to carry your medication in.

Arriving at the Hotel

You generally have a few options when you get to the hotel. If you are going to be there until it’s time to travel home, then you may not need to refrigerate your meds. Just make sure that the room is never over 77ºF for any longer that 7 days or 30 days (prefilled syringes or vials, respectively). If you will use up your medicine before you travel again, then just keep your meds in a cool place in the room. Be careful not to store them where they will be in direct sunlight (solar heating!) or anyplace else that will get warm. For example, I once discovered that a counter top in my room was surprisingly warm, when I investigated I discovered that the cupboard below it enclosed a mini bar that was exhausting its heat under the counter—making the counter just like a hot plate!

If you have a number of stops in your journey, the most important task on arrival anywhere is to make sure you can refreeze the gel packs for the next destination. Here are some things to remember:

  • When I check in, I ask if I can get a small refrigerator in my room, one that has some kind of ice-compartment. This is for freezing the gel packs (not the meds!). Refrigerators are more commonly available in US hotels than in hotels abroad.
  • If you can’t get a small refrigerator-freezer in the room, the gel packs must be refrozen in the restaurant freezer. You called ahead to find out if they had a restaurant, right?
  • In larger hotels you might discover that there are a number of restaurants having several freezers and refrigerators. If possible, go with the hotel employee and see where he or she stores your gel packs. If there is a “shift change” later-on when you pick up your packs, you can show them exactly where your gel packs are. If language is a problem, ask the hotel employee to write down the location and give it to you, you can pass this written information on to the next employee when you want to pick up your supplies. In a big hotel, all this information is logged with the concierge, but sometimes they will drop the ball.
  • In some countries, I’ve had a problem making it clear that the gel packs must be frozen not refrigerated. Drawing a picture can help. On a message-sized piece of paper I draw a picture of a thermometer with the mercury below 0ºC (the world uses degrees Celsius) to show them the gel packs need to be frozen. China is where I’ve had the most problem with this sort of thing.

In addition to the gel packs, I used to hand over my meds as well with instructions to freeze the gel packs and keep the meds in the cooler. However, handing over both requires additional coordination and, in the end, seemed unnecessarily complicated. Also, anything you give away can get lost. Now, I keep the medicine in my room in a mini bar or in my suitcase. I refreeze the gel packs in my room if a freezer is available, or in the restaurant freezer, if an in‑room freezer is not available.

If you decide to put your AVONEX in a fridge or mini bar in the room, use some care. Make sure the fridge is not too cold. Is there bottled water in the fridge? Check to see if the bottle water is frozen, if not, you are good to go. If the fridge is empty, put a tiny bit of water in a glass and put the glass in the fridge—if it is not frozen in a few hours, it is probably OK.  I spoiled three doses of AVONEX once because I put the meds into a refrigerator that was turned down too cold (I didn’t notice the bottled water was frozen until it was too late).

It is really all much simpler than it sounds. With a little experience you will be a seasoned expert. If you have any comments, additions, questions, or good ideas, don’t hesitate to add them here!

About the Author:
John Steiner is a pilot and an MS patient who is constantly traveling around the world. He corresponds with us regularly about the trials he faces while on the go as a person diagnosed with multiple sclerosis.
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