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

Abstract

In order to maintain crew health and performance during long-duration spaceflight outside of low-Earth orbit, NASA and its international partners must be capable of providing a safe and effective pharmacy. Given few directed studies of pharmaceuticals in the space environment, it is difficult to characterize pharmaceutical effectiveness or stability during spaceflight; this in turn makes it challenging to select an appropriate formulary for exploration. Here, we present the current state of literature regarding pharmaceutical stability, metabolism, and effectiveness during spaceflight. In particular, we have attempted to highlight the gaps in current knowledge and the difficulties in translating terrestrial-based drug studies to a meaningful interpretation of drug stability, safety, and effectiveness in space. We hope to identify high-yield opportunities for future research that might better define and mitigate pharmaceutical risk for exploration missions.

Drug discovery and development: the final frontier

“…In some animal studies, spaceflight seems to change the activity of cytochrome P450 enzymes. The results are, however, inconsistent, perhaps reflecting methodological differences …”

“…But some other organisms show increased susceptibility. Biofilms grown in space show a different structure and are more complex than those on Earth . Experiments in microgravity help identify the regulatory pathways and genes driving changes in virulence, potentially offering new targets for treatments and vaccines against, for example, Salmonella gastroenteritis, methicillin‐resistant Staphylococcus aureus (MRSA) and Streptococcus pneumonia…”

How do the pharmacokinetics of drugs change in astronauts in space?

“…Most recently, enoxaparin and apixaban were used for treating jugular venous thrombosis in an astronaut onboard the ISS [4]. The efficacy and safety of these treatments are largely unknown, and it has been suggested that some medications may be less effective than expected [5]. However, in addition to pharmacokinetics and pharmacodynamics, the nature of disease itself (e.g.…”

Ingen måneferd uten romfartsmedisin

“…I slike tilfeller bør spesialisten på bakken inneha romfartmedisinsk kompetanse, inkludert innsikt i de fysiologiske og anatomiske endringene som astronautene gjennomgår i vektløshet. Det er også bekreftet gjennom flere studier at farmakokinetiske og farmakodynamiske egenskaper til mange medikamenter er annerledes i rommet (11), og man kan ikke nødvendigvis benytte samme prinsipper og doser som på Jorden. Dersom hendelsen er svaert alvorlig, kan astronauten evakueres fra den internasjonale romfartstasjonen til Jorden med Sojus-fartøyet.…”