What adjustments should be made to the patient's current medication regimen for overseas travel, considering their multiple medical conditions and recent blood test results?

Medication Adjustments for Overseas Travel in a Patient with Multiple Comorbidities

This patient requires careful adjustment of diuretics and RAAS inhibitors during travel to prevent volume depletion-related complications, while maintaining all other medications unchanged with adequate supply in carry-on luggage.

Critical Medication Adjustments for Travel

Diuretic Management (Furosemide 20mg)

• Temporarily reduce or hold furosemide during long-haul flights and in hot climates to prevent dangerous volume depletion 1
• The patient's current BP of 105/69 mmHg is already lower than usual, indicating potential volume depletion risk 1
• Signs requiring immediate furosemide cessation include: postural dizziness, increased heart rate, muscle cramps, low urine volume, or further BP drops 1
• Resume normal dosing only after symptoms resolve and body weight returns to baseline 1

RAAS Inhibitor Precautions (Losartan 50mg)

• Reduce or temporarily discontinue losartan if postural or symptomatic hypotension develops during travel 1
• Given the patient's already low BP (105/69), monitor closely for orthostatic symptoms 1
• Any postural hypotension requires medical evaluation before resuming full dose 1

SGLT2 Inhibitor Considerations (Empagliflozin 25mg)

• Stop or reduce empagliflozin if signs of volume depletion occur, as SGLT2 inhibitors promote diuresis and increase dehydration risk 1
• This is particularly important given the patient's elevated HbA1c and potential for osmotic diuresis 1

Medications to Continue Unchanged

Cardiovascular Medications

• Continue atorvastatin 20mg nocte without modification 2
• Continue felodipine 5mg daily - maintain calcium channel blocker for BP control 1
• All cardiovascular medications should be packed in carry-on luggage in original labeled containers 1

Diabetes Medications

• Continue Galvumet (metformin/vildagliptin) BD and glipizide 5mg 2 tabs BD without interruption 3
• Abrupt discontinuation of diabetes medications can cause dangerous glycemic excursions 4

Other Medications

• Continue allopurinol 300mg daily for gout prophylaxis 3

Fluid Management Strategy

During Flight

• Increase fluid intake by 0.5-1.0 L per day above baseline with non-alcoholic beverages 1, 5
• Cabin humidity causes approximately 200 mL/hour water loss through respiration 1
• Avoid alcohol and excessive caffeine as both promote diuresis 1, 6

At Destination

• Add an additional 0.5-1.0 L per day if traveling to hot/dry climate 1, 5
• Hot environments can cause up to 1.2 L/day fluid loss independent of physical activity 1

Self-Monitoring Protocol

• Weigh daily and adjust diuretics/fluid intake if weight changes >2 kg in 3 days 5
• Monitor for volume depletion signs: fatigue, exercise intolerance, postural dizziness, low urine output 1

Traveler's Diarrhea Preparedness

High-Risk Considerations

• 10-40% of travelers to Asia, Africa, and South/Central America develop diarrhea within 4-14 days of arrival 1
• This patient's multiple medications (diuretics, RAAS inhibitors, SGLT2 inhibitors) dramatically increase complication risk during diarrheal illness 1

Prophylactic Prescriptions Needed

• Prescribe loperamide (antimotility agent) for self-treatment 1
• Prescribe azithromycin or rifaximin for self-treatment of bacterial diarrhea 1
• If diarrhea occurs: increase oral rehydration solutions, monitor weight/urine output, and temporarily stop diuretics and SGLT2 inhibitors 1

Pre-Travel Documentation Requirements

Essential Documents (Carry-On)

• Photocopy of all current prescriptions 1
• List of diagnosed conditions and all medications 1
• Insurance card and patient identification 1
• Recent discharge summaries or specialist letters 1
• Physician letter explaining medication necessity for customs 1

Medication Supply

• Pack 3+ months supply (entire trip duration plus extra for delays) 1
• All medications must remain in original labeled containers 1
• Store exclusively in carry-on luggage to prevent loss 1

Special Considerations for This Patient

Polycythemia and Dehydration Risk

• The elevated Hb (162) may be dehydration-related, making volume management even more critical 1
• Dehydration can worsen polycythemia and increase thrombotic risk during prolonged immobility 1

Venous Thromboembolism Prevention

• Encourage movement every 2 hours during flight to reduce DVT risk 1
• Patients with multiple cardiovascular risk factors have substantially elevated VTE risk during travel >4 hours 1

Poor Glycemic Control

• The patient's hypertriglyceridemia secondary to poor diabetes control requires continued adherence to all diabetes medications 3
• Travel disruption increases non-adherence risk; emphasize importance of maintaining medication schedule 3

Common Pitfalls to Avoid

• Never abruptly stop beta-blockers, corticosteroids, or psychotropic medications without tapering, as this causes severe withdrawal symptoms 4
• Do not implement rigid fluid restriction during travel - this patient needs liberalized fluids, not restriction 5
• Avoid assuming all medications are available abroad - counterfeit drugs are common in low/middle-income countries 1
• Do not ignore the low baseline BP (105/69) - this patient is already at risk for symptomatic hypotension with current regimen 1