Medications
Also: Pharm risk
Distance from EarthHostile/Closed EnvironmentPharmacologyIn-flightLEO long-durationLunar surfaceMars transit & surfacePublicClinicianResearcher
- Medicines flown for up to 2.4 years in low Earth orbit stayed within 10% of ground potency but degraded about 1.5 times faster. Repackaging seemed to be the main cause. ◆◆◇◇ Low · F
- NASA rates the risk as accepted for ISS missions (1×1) but requiring mitigation for Mars (5×3). ◆◆◆◆ High · E
Proposed certainty (◆ High → ◇ Very low) and evidence-type tags: F flight · A analog · M model/animal · C computational · E expert/operational/standards. AI-proposed, pending reviewer confirmation. How to read the grades.
NASA risk title (verbatim)
Risk of Ineffective or Toxic Medications During Long-Duration Exploration Spaceflight
NASA short title: Pharm · HRP element: Exploration Medical Capability (ExMC) · Status: Active [current research ongoing] [1]
What it is
This risk asks whether medicines on long missions will stay potent and non-toxic, and whether the space environment changes how the body absorbs and responds to them (pharmacokinetics and pharmacodynamics) [1].
Current evidence
- ISS operations follow FDA standards. These rely on frequent (roughly yearly) resupply, which won’t be possible on a Mars mission [1].
- How spaceflight conditions affect drug stability on long and deep-space missions is not fully characterized. How altered physiology changes drug action is unclear [1].
- A pooled analysis of six spaceflight drug-stability studies (36 drug products) found that potency stayed within 10% of ground controls, with about a 1.5-fold faster degradation rate. Non-protective repackaging appeared to be the biggest problem [4].
- On the ISS, the most used medications were for sleep, pain, congestion and allergy [5].
- Engineers are also concerned about whether medications are compatible with spacesuits, which limits what can be given during suited operations [1].
NASA’s risk posture
NASA scores each risk for each design reference mission (DRM) as likelihood × consequence (LxC). Both run from 1 (lowest) to 5 (highest) on the HSRB’s 5×5 matrix [1][3]. Each score comes with a disposition, such as “Accepted”, “Requires Characterization” or “Requires Mitigation”. These ratings were last approved by NASA’s Human System Risk Board (HSRB) in 12/2021 [1].
| Mission | Duration | In-mission (operations) | Long-term health |
|---|---|---|---|
| LEO | Short (under 30 d) | 1x1 · Accepted | 1x1 · Accepted |
| LEO | Long (30 d–1 yr) | 1x1 · Accepted | 1x1 · Accepted |
| Lunar orbit | Short | 2x1 · Accepted | 1x1 · Accepted |
| Lunar orbit | Long | 3x2 · Accepted with Optimization | 2x2 · Accepted with Monitoring |
| Lunar orbit + surface | Short | 3x1 · Accepted with Optimization | 2x1 · Accepted with Monitoring |
| Lunar orbit + surface | Long | 4x2 · Accepted with Optimization | 2x2 · Accepted with Monitoring |
| Mars preparatory | Under 1 yr | 4x3 · Requires Characterization | 3x2 · Accepted with Monitoring |
| Mars planetary | 730–1,224 d | 5x3 · Requires Mitigation | 5x3 · Requires Mitigation |
Copied from the Human Research Roadmap on 2026-10-14. Ratings change. Check the live record before citing.
Open knowledge gaps
NASA lists 6 knowledge gaps for this risk, 6 of them open as of 2026-10-14 [1]. Each gap ID links to its page on the Human Research Roadmap (HRR).
Show NASA’s gap list (verbatim)
| Gap | NASA gap statement | Status |
|---|---|---|
| Pharm-101 | We need to determine the optimal packaging/storage strategy for medications in space that balances the needs of mitigating toxicity, preserving effectiveness, and minimizing resource “costs” (mass, volume, power, etc.). | Open |
| Pharm-201 | We need to establish an exploration formulary that identifies medications with maximal clinical benefit and minimal resource “costs” (mass, volume, etc.). | Open |
| Pharm-301 | We need to categorize all medications that are included in the iterative Exploration Candidate Formulary based upon the current state of knowledge of their effectiveness and safety in the spaceflight environment. | Open |
| Pharm-401 | We need to perform further research to understand and characterize the active pharmaceutical ingredient and degradation profiles of medications for which we have low to moderate confidence in their safety and effectiveness for exploration missions. | Open |
| Pharm-501 | We need to accurately characterize when astronauts use medications in space, why they use them, how they use them, whether they work, and if they cause any problems. | Open |
| Pharm-601 | We need to characterize the extent to which spaceflight alters pharmacokinetics and pharmacodynamics. | Open |
See also Open questions.
Active countermeasure research
- An exploration formulary. ExMC is working toward a safe, effective set of medicines with a shelf life of 3 years or more [1].
- Packaging and validation. Research covers packaging and storage, chemical and physical stability, toxicity of degradation products, and drug effects in spaceflight [1].
Project-level detail, including status, investigators and results, is in the NASA Task Book and on each HRR gap page.
Clinical articles
For practical, clinic-facing guidance, see:
Evidence profile
- Overall certainty
- ◆◆◇◇ Low (proposed)
- Evidence types
- F · Flight dataE · Expert / operational / standards
- Literature through
- 2026-10-14
- NASA source
- Human Research Roadmap risk page (last published 05/13/25; read 2026-10-14)
Requirements referenced 2
| Requirement | Title | Plain-language meaning |
|---|---|---|
| [V1 3004] | In-Mission Medical Care | Training, capabilities and resources to diagnose and treat conditions, based on probabilistic risk assessment and mission constraints. |
| [V2 7043] | Medical Capability | Vehicle medical system meeting Volume 1 requirements. |
IDs as published in NASA-STD-3001 Vol. 1 Rev C (2023-09-15) and NASA-STD-3001 Vol. 2 Rev F (2026-07-14). NASA-STD-3001 binds NASA programs; it is not a regulation for commercial flights. Paraphrased. Standards quick reference.
References 5
- NASA Human Research Roadmap. Risk record: “Risk of Ineffective or Toxic Medications During Long-Duration Exploration Spaceflight”. Accessed 2026-10-14. humanresearchroadmap.nasa.gov/Risks/?i=177 NASA E
- NASA Human Research Program. Evidence report for the Pharmacology risk (approved December 20, 2023). humanresearchroadmap.nasa.gov/evidence/other/Pharm%20evidenc… NASA E
- Antonsen EL, et al. Updates to the NASA human system risk management process for space exploration. NPJ Microgravity. 2023;9:72. doi:10.1038/s41526-023-00305-z PMID:37679359 Peer-reviewed E
- Reichard JF, et al. The effect of long-term spaceflight on drug potency and the risk of medication failure. NPJ Microgravity. 2023;9:35. doi:10.1038/s41526-023-00271-6 PMID:37147378 Peer-reviewed F
- Wotring VE. Medication use by U.S. crewmembers on the International Space Station. FASEB J. 2015;29(11):4417–4423. doi:10.1096/fj.14-264838 PMID:26187345 Peer-reviewed F
Machine-checked on 2026-10-14: each URL resolved, each DOI's title/journal/year matched via Crossref, and claims were checked against the source text (abstract or full NASA page). Human verification against full text is still required before review. NASA documents are U.S. Government works (public domain) and are summarized with attribution; journal articles are summarized, not reproduced.
Article info
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- Pending (AI-assisted draft)
- Reviewer
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- Last reviewed
- Pending review
- Literature through
- 2026-10-14
- AI-assisted
- Yes (disclosed)
- COI
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- License
- CC BY-SA 4.0
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- Cite this version
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