Pharmacology Risk Report
It seems very likely that the actions of administered drugs on crewmembers during spaceflight are different than they are on Earth, but even after more than 40 years of spaceflight experience, the answers to most questions about medication use during missions remain unanswered. Use of medications with insufficient knowledge about their actual activities may result in inadequate treatment and may even reduce performance and well-being in particular circumstances. There is evidence that this has already occurred during and immediately after spaceflights. The spaceflight pharmaceutical activity knowledge base must be improved to enable flight surgeons and crewmembers to make better decisions about using pharmaceuticals inflight. The spaceflight environment induces changes in human physiology, and these changes have been the subject of much study over the past few decades. These studies are confounded by the small number of potential subjects, as well by the inability to separate the different stressors of spaceflight (radiation exposure from microgravity, for example). In every physiological system, the details of spaceflight-induced physiological changes are not well understood. Despite this fact, crewmembers are treated with pharmaceuticals to reduce or prevent medical problems, with insufficient information as to drug function on their altered physiological systems. There are two major concerns about pharmaceutical use in the unusual environment of spaceflight. The actions of pharmaceuticals on physiology altered by a spaceflight environment are currently assumed to be the same as the actions in terrestrial use. This has yet to be established. The wide range of physiological systems altered by spaceflight and the degree of change experienced in some of them make it very likely that alterations in pharmaceutical action will be seen. As the duration of missions lengthens to include more distant exploration, it becomes more likely that problems will be encountered. Secondly, the integrity of stored pharmaceuticals must be established to ensure that adequate amounts of active compounds are available in each dose and that degradation to toxic compounds is minimized. This risk is also dependent on mission duration, since longer missions will require that drugs be stored much longer than their usual terrestrial shelf-lives.