Space Medicines for Space Health

Expiration analysis of the International Space Station formulary for exploration mission planning

Effective medications will be required to maintain human health for long-duration space operations. Previous studies have explored the stability and potency of several of the medications used on the International Space Station (ISS). This study is a comprehensive analysis of the expected terrestrial shelf-lives of the entire 2023 ISS formulary using 4 international registries. Of the 106 medications in the ISS formulary, shelf-life data was found in at least 1 of the registries for 91 (86%) medications. Of these 91 medications, 54 have an estimated terrestrial shelf-life of ≤36 months when stored in their original packaging. 14 will expire in less than 24 months. The results of this study provide operational insight to supplying a pharmacy for an exploration mission, optimize therapeutic outcomes, and prevent diseases associated with extended spaceflight operations. Ultimately, those responsible for the health of spaceflight crews will have to find ways to extend the expiration of medications to the complete mission duration or accept the elevated risk associated with administration of an expired medication.

The Final Frontier: Palliative Care in Space is an Inevitability

As space exploration becomes increasingly common, palliative care for astronauts will require greater consideration. All aspects of palliative care need to be specifically adapted for astronauts. For example, addressing additional circumstances such as inability to see loved ones from Earth will be an important part of meeting their psychological and spiritual needs. A different approach to pharmacological management of end-of-life symptoms is also warranted due to changes in human physiology and pharmacokinetics in space.

The kidney, volume homeostasis and osmoregulation in space: current perspective and knowledge gaps

Although we have sent humans into space for more than 50 years crucial questions regarding kidney physiology, volume regulation and osmoregulation remain unanswered. The complex interactions between the renin-angiotensin-aldosterone system, the sympathetic nervous system, osmoregulatory responses, glomerular function, tubular function, and environmental factors such as sodium and water intake, motion sickness and ambient temperature make it difficult to establish the exact effect of microgravity and the subsequent fluid shifts and muscle mass loss on these parameters. Unfortunately, not all responses to actual microgravity can be reproduced with head-down tilt bed rest studies, which complicates research on Earth. Better understanding of the effects of microgravity on kidney function, volume regulation and osmoregulation are needed with the advent of long-term deep space missions and planetary surface explorations during which orthostatic intolerance complaints or kidney stone formation can be life-threatening for astronauts. Galactic cosmic radiation may be a new threat to kidney function. In this review, we summarise and highlight the current understandings of the effects of microgravity on kidney function, volume regulation and osmoregulation and discuss knowledge gaps that future studies should address.