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Vaccinated Tourists May Be Able to Travel to Italy by Mid-May, Italian Prime Minister Says

Despite lockdown restrictions still in place, the prime minister says now is the time to book that Italian summer vacation.

Italy is ready to welcome vaccinated tourists — and it's aiming to do so before the rest of the European Union. Following Tuesday's Group of 20 (G20) meeting of tourism ministers, Italian prime minister Mario Draghi announced that the country will be introducing a pass to allow in visitors who meet the criteria in a few weeks.

"Let us not wait until mid-June for the EU pass," Draghi said, according to Skift . "In mid-May, tourists can have the Italian pass… so the time has come to book your holidays in Italy."

Last month, the European Commission announced plans to allow Americans inoculated with approved vaccines — including Moderna, Pfizer/BioNTech, and Johnson & Johnson — to visit its 27 member states this summer. Though specifics about Italy's pass have yet to be disclosed, Draghi's statement puts the nation ahead of that timeline by a month. He also added that those who have just tested negative or are able to show they recently recovered from COVID-19 can also travel.

The news is a dramatic shift in a nation where lockdown restrictions are still widely in place. In the regions of Lazio (where Rome is located) and Lombardy (where Milan is located), yellow zone restrictions mean there's still a curfew between 10 p.m. and 5 a.m. While movement between the yellow and white zones is permitted, several regions — including Puglia, Sicily, Aosta Valley, and Sardinia — are still in the orange and red zones, which doesn't allow people to travel outside of their areas.

Draghi, who served as the chair of the G20 meeting, also said that the EU needs to come up with simple and clear rules for its reopening. In a statement from the meeting, the leaders said that the pandemic had given the industry a chance to "rethink tourism" with "safe international mobility initiatives," and that "the resumption of travel and tourism was crucial for global economic recovery," Skift reported. Italy usually generates 13% of its economy from tourism, so with global tourism dropping 73% worldwide in 2020, the impact has been a gut punch.

The CDC currently has Italy at a Level 4 "Very High Level of COVID-19" advisory, stating that "because of the current situation in Italy, even fully vaccinated travelers may be at risk for getting and spreading COVID-19 variants and should avoid all travel to Italy." Since the beginning of the pandemic, Italy has had 4,059,821 COVID-19 cases and 121,738 deaths, making it the eighth-highest nation in the world for cases, according to data from the Johns Hopkins Coronavirus Resource Center .

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Covid-19: travel information

Considering the epidemiological situation, Italy has foreign travel restrictions in place depending on where you are travelling from/to. 

An interactive questionnaire is available from https://infocovid.viaggiaresicuri.it  to check the rules currently in force regarding travel to and from Italy.

Please find below a list of other useful web pages:

• Covid-19 Information for travellers  
• Information for Italian nationals returning to Italy and foreigners in Italy
• Information from Embassies and Consulates
• Useful information for travellers on the ‘Viaggiare sicuri’ website  

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Italy Travel Advisory

Travel advisory july 26, 2023, italy - level 2: exercise increased caution.

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Exercise increased caution due to terrorism .

Country Summary: Terrorist groups continue plotting possible attacks in Italy. Terrorists may attack with little or no warning, targeting tourist locations, transportation hubs, markets/shopping malls, local government facilities, hotels, clubs, restaurants, places of worship, parks, major sporting and cultural events, educational institutions, airports, and other public areas.

Read the  country information page for additional information on travel to Italy.

If you decide to travel to Italy:

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What you need to know about traveling to Italy right now

Aug 23, 2021 • 6 min read

Tourists return to the Teatro Antico in Taormina, Sicily as Italy relaxes border and domestic restrictions © Fabrizio Villa/Getty Images

Italy has gradually relaxed border controls and most restrictions as travelers return to one of the world's most popular destinations. And while there are plenty of new attractions to enjoy, from newly-opened secret tunnels in the Colosseum to recent discoveries in Pompeii , it isn't business as usual. Italy is still in a state of emergency and some pandemic-related restrictions apply, including the requirement of a green pass to enter indoor venues and large events.

With the ongoing threat of the Delta variant, travelers are warned that increased measures could be enforced with little notice. If you're planning a trip to Italy this year, here's what you can expect.

Can I travel to Italy from the EU?

Italy has adopted the EU digital COVID certificate which facilitates the return of free movement across the bloc. It's a digital or paper certificate that indicates the holder meets the conditions for travel: is fully vaccinated (the last dose administered at least 14 days before departure), or has recovered from COVID-19, or holds a negative COVID-19 result from a PCR or antigen test taken within 48 hours of travel.

Read more: Planning your perfect trip to Italy's Amalfi Coast

You will need to present this cert to enter Italy, regardless of where you are traveling from in the EU. That's because Italy does not classify risk areas in accordance with the EU's recommendations and currently no country is classified as low risk. So even if you are coming from an EU country that is classified green (low risk) in the European Center for Disease Prevention and Control’s traffic light system, you are still required to present a digital COVID cert to travel to Italy.

Can I travel to Italy from a non-EU country?

Italy applies border restrictions on travelers depending on the COVID situation in the country they are departing from. Most countries are on the C and D list and quarantine restrictions apply to all of them except for the US, Canada, Japan and Israel . People arriving from those countries are permitted to skip quarantine provided they present proof of vaccination, proof of recovery from COVID-19, or a negative result from a test taken no more than 72 hours before traveling to Italy, using official vaccination or medical documents issued in either of those countries.

Those arriving from the UK will have to undergo a five-day quarantine upon arrival with mandatory testing until at least August 30.

Entry restrictions for individual countries can be found here .

What vaccines does Italy accept?

Italy requires that travelers are fully vaccinated with both doses of an EMA-approved vaccine: Pfizer, Moderna, or AstraZeneca; or with the one-shot Johnson & Johnson vaccine.

Do children need to be vaccinated to enter Italy?

Children under six-years-old are exempt from all vaccine, testing or quarantine requirements in Italy. However, children between the age of six and 18 are required to present a negative COVID-19 test result before arrival.

What else is required?

All arrivals are required to fill in a passenger locator form before arrival, regardless of their COVID status or point of departure.

Do I need a green pass in Italy?

Yes, if you want to enjoy most of Italy's cultural attractions, you'll need a green pass. The pass proves that the holder has been vaccinated, has recovered from COVID-19 or has recently tested negative for the virus. People need to present it to enter indoor spaces such as museums, football stadiums, gyms, theme parks, spas, swimming pools and theaters. It's also required to sit indoors at bars and restaurants; and from September 1, it will be required to board public transport in Italy.

Anyone traveling from another EU country, can present their EU digital COVID cert wherever the green pass is required. People traveling from a Schengen Zone country can present their official health documents too.

The Italian government confirmed that it will accept official COVID documents that were issued in Canada, the US, the UK, Japan and Israel from tourists too in place of a green pass. This was later extended to cover all official vaccination certificates that are compliant with Italian or EU guidelines. In order for it to be accepted in lieu of the green pass, the certificate must be in Italian, English, Spanish or French and contain the following information: type of vaccine (Pfizer, Moderna, J&J or AstraZeneca), date of doses and lot number, as well as the person's name and the name of the medical authority issuing the certificate.However, despite the guidelines, some tourists have reported difficulty with having their certificates accepted at venues.

If you're not vaccinated, you'll need to be tested via a PCR or antigen test within the previous 48 hours.

Read more: Italy has expanded the use of it 'green pass' - here's what travelers need to know

Can I get tested in Italy?

Many countries, including the US, require passengers to present a negative COVID-19 test result before boarding their flight home from an international trip. Fortunately, tests are widely available across Italy in pharmacies, labs and testing centers. Antigen tests cost approximately €20, while PCR tests are generally around €65.

The Red Cross has pop-up testing sites in train stations across Italy , including Roma Termini, Milano Centrale, Venice Santa Lucia and Florence Santa Maria Novella for antigen tests. On-site testing is available at Italy's major airports too, and most offer both antigen and PCR tests but check the website of the airport you are traveling through in advance for details.

Read more: Italy visa requirements

What's open in Italy?

Italy is home to many of the world's greatest works of art, architecture and gastronomy, and has more Unesco World Heritage cultural sites than any other country. Among its popular attractions are Pompeii , where visitors can walk in the footsteps of ancient Romans, and Ravenna , home to glittering Byzantine treasures. The gondolas of Venice take in the famous Rialto Bridge , while Rome is home to St Peter's Basilica, the Vatican Museums and the Colosseum, as well as the iconic Trevi Fountain.

Thankfully, you can experience these sites with relative ease as all Italian regions are now classified as "white zones". Italy classifies its regions into colored areas based on the epidemiological risk; different restrictions apply, depending on the color. White zones are very low-risk zones. Most restrictions have been lifted but social distancing guidelines remain in place in public areas, as do mask requirements in crowded outdoor places, on public transport and in indoor public spaces.

Indoor dining has returned to Italy's restaurants, cafes, bars, ice-cream parlours and pastry shops. Some capacity limits apply but the general rule is no more than six people per table. Anyone who wishes to eat inside will need to show proof of vaccination, recovery from COVID-19 or a recent negative test. Hotels, spas and swimming pools are open, as well as beaches but visitors must keep at least one meter apart when setting up towels, deck chairs or umbrellas.

Museums and cultural attractions are open for walk-ins with capacity limits Monday to Friday and for those with pre-booked tickets on weekends. Cinemas, theaters and concert halls are generally open at 50% capacity. Again, remember to bring your vaccination card if you're planning to visit any museum or cultural attraction in Italy.

For a full breakdown of restrictions per region, see here .

This article was first published on May 5 and updated on August 23, 2021.

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Travel Vaccines and Advice for Italy

Of all the places to go in Europe, Italy is first on the list for many people. Italy’s charm is found in its ancient wonders, cuisine and unique landscapes.

The Coliseum, Florentine markets and volcanic ruins, there is no shortage of history waiting to be explored.

Travel can be done a multitude of ways including local flight options, by ferry for coastal towns and to islands or by train or bus. Some of the hidden treasures of Italy need extra planning. But, they are well worth the time.

On This Page: Do I Need Vaccines for Italy? Other Ways to Stay Healthy in Italy Do I Need a Visa or Passport for Italy? What Is the Climate Like in Italy? How Safe Is Italy? Is the Food Safe in Italy? See the Amazing Cinque Terre What Should I Take to Italy? U.S. Embassy in Italy

Do I Need Vaccines for Italy?

Yes, some vaccines are recommended or required for Italy. The CDC and WHO recommend the following vaccinations for Italy: hepatitis A , polio , chikungunya , tick-borne encephalitis , rabies , hepatitis B , influenza , COVID-19 , pneumonia , meningitis , chickenpox , shingles , Tdap (tetanus, diphtheria and pertussis) and measles, mumps and rubella (MMR) .

See the bullets below to learn more about some of these key immunizations:

• Hepatitis A – Food & Water – Recommended for most travelers.
• Polio – Food & Water – Due to an increase in cases globally, an additional adult booster is recommended for most travelers to any destination.
• Chikungunya – Mosquito – A chikungunya outbreak occurred in 2017. Local transmission is still possible in some regions.
• Tick-borne Encephalitis – Ticks – Typically found in alpine areas, especially in the northeast.
• Rabies – Saliva of Infected Animals – Vaccine recommended for long-term travelers and those who may come in contact with animals.
• Hepatitis B – Blood & Body Fluids – Recommended for travelers to most regions.
• Influenza – Airborne – Vaccine components change annually.
• COVID-19 – Airborne – Recommended for travel to all regions, both foreign and domestic.
• Pneumonia – Airborne – Two vaccines given separately. All 65+ or immunocompromised should receive both.
• Meningitis – Direct Contact & Airborne – Given to anyone unvaccinated or at an increased risk, especially students.
• Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
• Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
• Polio – Food & Water – Considered a routine vaccination for most travel itineraries. Single adult booster recommended.
• TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
• Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.

See the table below for more information:

Specific Vaccine Information

• Hepatitis A – Hepatitis A is an infectious liver disease caused by the hepatitis A virus, often spread through contaminated food or water, or via direct contact with someone infected. It leads to liver inflammation, potentially impairing its function, and manifests as symptoms like tiredness, stomach pain, nausea, and yellowing of the skin or eyes. The vaccine for hepatitis A offers robust protection against this virus. It is typically given in two doses over a six-month period and is advised for those traveling to regions with higher risk or for people more likely to come into contact with the virus.
• Chikungunya – Chikungunya is a viral disease transmitted by infected mosquitoes and can also spread through other means like blood transfusion. To prevent it, use mosquito repellents or wear protective clothing. Vaccination is available and considered the best form of protection.
• Tick-borne Encephalitis – Tick-borne encephalitis, transmitted by infected ticks, poses a risk to individuals in forested areas. Protect yourself by wearing appropriate clothing, using repellents, and getting vaccinated.
• Rabies – Preventing rabies involves avoiding contact with infected animals and ensuring timely vaccination. The rabies vaccine is a critical tool, offering protection through post-exposure prophylaxis (PEP) and preemptive vaccination for high-risk individuals like travelers.
• Hepatitis B – Hepatitis B, a liver infection spread through bodily fluids, poses a significant health risk. Safe practices help, but vaccination is the ultimate safeguard. It prompts the immune system to produce antibodies, ensuring strong and persistent protection.
• Measles, Mumps, Rubella (MMR) – Measles, mumps, and rubella are contagious viral infections, causing various symptoms and complications. To prevent them, vaccination is key. The MMR vaccine, given in two doses, safeguards against all three diseases and helps establish herd immunity, reducing the risk of outbreaks.

As a developed country, Italy does not have many communicable diseases. Make sure you are up-to-date on your routine vaccinations before traveling.

Visit our vaccinations page to learn more. Travel safely with Passport Health and schedule your appointment today by calling or book online now .

Other Ways to Stay Healthy in Italy

Prevent bug bites in italy.

When bitten by bugs, clean the area with soap and water, refrain from scratching, and use over-the-counter remedies. For severe reactions or tick bites, consult a healthcare professional promptly. Following CDC guidelines can help prevent and manage bug bites effectively.

Food and Water Safety in Italy

While dining abroad, prioritize food safety by avoiding street food, practicing hand hygiene, and selecting fully cooked dishes. Opt for sealed bottled or canned drinks. Prevent travelers’ diarrhea by adhering to hand hygiene, skipping raw foods, and dining at reputable establishments.

Altitude Sickness in Italy

Altitude sickness, characterized by symptoms like headache and nausea stemming from oxygen deprivation at high elevations, can be prevented through gradual ascent, hydration, and medication like acetazolamide. Should AMS symptoms arise, immediate descent to lower altitudes, rest and seek medical attention.

Infections To Be Aware of in Italy

• Leishmaniasis – Leishmaniasis is transmitted by sand flies’ bites. To prevent its spread, individuals should use insect repellents, wear long-sleeved clothing and limit outdoor activities during sand fly activity periods. Eliminating breeding sites and early diagnosis are crucial for effective prevention.

Do I Need a Visa or Passport for Italy?

A visa is not required for travel to Italy. But, your passport must have at least three months’ validity remaining.

Sources: Embassy of Italy and U.S. State Department

If you plan to stay for 90 days or more, a visa will be required. You must get this visa before starting your trip.

What Is the Climate Like in Italy?

The climate in Italy differs depending on location.

Winters can be brutal in northern areas near the Alps. Summers can be hot in this region as well. Central Italy remains somewhat constant with mild temperatures throughout the year. In southern Italy, temperatures are warm in winter and even warmer in the summer. Regardless of where in Italy, the climate is described as Mediterranean.

• Milan – Nestled in the northern Italy, Milan is bordered by the Alps. Winters are milder than other northern cities, but summers can be hot. The variety in temperature is typical in Northern cities.
• Rome – Sitting in central Italy, Rome experiences a range of seasons. Most of Rome’s rainfall occurs in the winter. Most other areas in Italy that receive the bulk of the rain in the spring and summer.
• Naples – Is one of the largest and most-traveled cities in Southern Italy. Even in the winter months, temperatures will remain mostly above 50 degrees Fahrenheit. In the summer months, Naples will catch cool breezes off the ocean.

How Safe Is Italy?

Italy is a beautiful place to visit, but it’s important to stay safe. Here are some tips to help you:

• Learn about the places you’ll go, including customs and safety tips.
• Keep your things safe from thieves by using special bags or pouches. Be careful in crowded places.
• Travel with friends or a group, and don’t walk alone at night in dark or empty areas.
• Use safe public transportation, and keep your luggage close on trains.
• Be careful when using ATMs, and don’t let anyone help you.
• Don’t show off expensive items like jewelry or watches.
• Pay attention to your surroundings and watch out for scams or distractions.
• Follow local rules and customs to avoid getting in trouble.
• Have emergency contact numbers and tell your family or friends about your travel plans.
• Get travel insurance to protect you in case something goes wrong.

By following these tips, you can have a fun and safe trip to Italy.

Is the Food Safe in Italy?

Italy is notorious for producing some of the most delectable cuisine in the world. Italian culture is centered around meal time. Most devote a lot of time and energy into the preparation and cooking of every meal. With the culinary bar set so high, it is rare that travelers will sit down to a meal is deemed unsafe for consumption. The only thing to remain wary towards is water. Most restaurants will serve water and sodas in the bottle to guarantee high and consistent quality.

See the Amazing Cinque Terre

Avoid an embarrassing stop, over 70% of travelers will have diarrhea., get protected with passport health’s travelers’ diarrhea kit .

Cinque Terre is a beautiful coastal region in Italy that is a UNESCO World Heritage Site. Its name refers to the five colorful fishing villages nestled along the Mediterranean coastline. The villages are connected by hiking trails that offer breathtaking views of the sea and the terraced vineyards on the hillsides.

Visitors can spend their days hiking the trails and evenings enjoying delicious seafood at one of the local restaurants.

Other popular activities include boat tours, wine tasting and shopping for local handicrafts. Tourists in Cinque Terre will be captivated by its beauty and charm.

What Should I Take to Italy?

Considering where and when you plan on traveling to Italy and for how long, there are a variety of items that should make it into your suitcase:

• Comfortable walking shoes with arch support
• A shawl or scarf to cover your shoulders. There are many churches and religious areas that require modest clothing before entry
• A purse with a latch of some kind. Theft from purses has been known to happen in large crowded cities
• Light and airy clothing for the humid summer months
• An umbrella or rain proof jacket for the occasional rainstorm
• A hat as the sun can be harsh
• If fine-dining is in your plans, pack “black-tie” attire as some restaurants have dress codes

U.S. Embassy in Italy

There is one embassy and three consulates located throughout Italy in major tourism cities. The embassy and consulates can assist in most matters of travel from lost passports to helping victims of crime. There are many issues that are not considered emergencies and these problems can be solved in a more efficient manner if an appointment is made ahead of time.

U.S. Embassy Rome Via Vittorio Veneto, 121 00187 Rome, Italy Telephone: +(39) 06-4674-1 Emergency After-Hours Telephone: +(39) 06-4674-1 Fax: +(39) 06-4674-2244 Email: [email protected]

Visit the Embassy to Italy website before departure to confirm correct contact details for the office.

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Everything you need to know about traveling to Italy

For Aldo Melpignano, co-founder of the luxury hotel Borgo Egnazia in Italy’s Puglia region, the country’s reopening is palpable in the piazza, where people dance while local musicians play.

His hotel had reimagined its operations during the pandemic, hosting dinner parties with spaced-out tables. But he recently saw guests get up and move to the music again at an event in late April — and even danced with them.

“It’s refreshing and makes you feel like we’re back, and sort of almost forgot about all that’s happened the last couple years,” he said.

Like destinations around the world, Italy has relaxed many of its covid restrictions , and Melpignano and other Italian travel experts are gearing up for a busy summer. “In terms of tourism here in Italy, it’s definitely back on,” Clio Morichini, head of travel and events for Italy Segreta , said in an email.

If you’re thinking about visiting this summer, here’s what you need to know before you go.

How to get there

As of June 1, Italy has lifted all its pandemic-era entry restrictions , no longer requiring international travelers to show proof of vaccination, proof of recovery from the coronavirus or a negative test.

Italy requires travelers to wear FFP2-grade masks on planes. Despite the European Union ending a mask mandate for air travel, Italy will keep its rule in place until June 15.

Elizabeth Minchilli, an author and food tour operator who lives in Rome and has a vacation home in Umbria, said your airline’s website is typically your best source of information regarding any remaining rules.

A local's guide to Rome

How to show your vaccination status

Italy discontinued the use of its Green Pass — which captured proof of vaccination, recovery from covid or a negative test result — for most indoor settings this month. The pass is no longer required for many places including restaurants, bars, museums, theaters, spas and gyms. However, it is still mandatory for others, like hospitals and nursing homes.

Some tour operators such as Minchilli, are also asking customers to be vaccinated before being allowed to join group excursions.

How to dine and explore

You may have competition finding a seat, room, ticket or beach chair this summer. Simone Amorico, CEO of the private tour operator Access Italy , estimates that his company’s bookings are up about 40 percent from 2019.

He advised travelers to plan ahead by booking hotels and activities two months in advance. “I mean, the sooner the better, but two months is a good bracket,” he said.

Even so, Amorico said, during a visit to Rome’s Colosseum last week, he noticed shorter lines now that guests do not need to present a Green Pass.

Minchilli said the Italian capital is already packed. “It’s hard to drive through the streets, there are so many people wandering around,” she said. “But that’s normal for May and June … For those of us who lived the last two years in Rome, it’s sort of shocking because we got kind of used to it being empty. But now, things are starting to get back to normal, which is a good thing.”

Her tours are fully booked through 2023, though she is adding more next year.

Annabella Cariello, general manager of Hotel Vilòn in Rome, also advised purchasing train and ferry tickets ahead of time and making reservations when going out to eat. She said the situation is much different from last fall or summer.

“I think that we have indeed switched gears and are ready to bring back our Italian-ness and celebratory approach. … The atmosphere is rather festive as the weather is getting better and we see summer just around the corner,” she said in an email.

In southeast Italy, this pastry is king

What to know about restrictions

Morichini said by email that while coronavirus case numbers are relatively high, many restrictive measures have been “removed or softened and life is slowly and gradually going back to normality.” Italy saw a 12 percent drop in daily cases over the past seven days, with 22.85 reported cases per 100,000 people reported Monday, according to tracking data compiled by The Washington Post.

That number is higher than this time last year but represents a dramatic decrease from counts during the omicron wave, which saw 378.33 reported cases per 100,000 people on Jan. 18. Daily deaths also dropped 10 percent over the past week.

While Italy dropped its indoor mask rule this month for most places, masks are still recommended indoors and at crowded outdoor events. In addition to airports and public transportation, FFP2 face coverings are also still required at indoor sporting events, cinemas and concert halls.

Minchilli gives her guests a pack of masks to wear out of consideration for staff at businesses such as stores and restaurants. “I suggest that if you walk in and somebody working in a place is wearing them, you might want to put them on just in respect of that person,” she said.

As the world battles the spread of coronavirus variants , too, remember that mandates and restrictions may change at any time.

Where to get a coronavirus test before returning home

While the testing requirement to return to the United States has dropped, you may still want to test before your flight home.

PCR tests cost about $70, and antigen tests run about $20, according to the U.S. Embassy and Consulates in Italy.

You should still test for travel, health experts say

Melpignano — who is also vice president of the Altagamma, a foundation that represents high-end Italian cultural and creative companies — says most upscale hotels will arrange tests for guests to make life easy.

Amorico said test-seeking travelers can find them at Italian pharmacies. Otherwise, instead of finding a test locally, travelers can pack an at-home test with a video option to test in front of a provider, such as the Abbott BinaxNOW kit, to take themselves within that one-day window.

In case you do test positive for the coronavirus while you’re in Italy, Melpignano, Minchilli and Amorico all recommend getting covid-specific travel insurance . You should check whether your health-insurance plan covers issues abroad, too.

Those who test positive will need to self-isolate for seven to 21 days, depending on the circumstances, and will be on the hook for the cost, per the U.S. Embassy and Consulates in Italy.

Otherwise, while you’re there, have fun. Minchilli said there is a positive energy right now, from locals and tourists alike: “Even when you’re in a crowded piazza in Rome, you can just feel how happy everybody is."

Natalie Compton contributed to this report.

More travel tips

Vacation planning: Start with a strategy to maximize days off by taking PTO around holidays. Experts recommend taking multiple short trips for peak happiness . Want to take an ambitious trip? Here are 12 destinations to try this year — without crowds.

Cheap flights: Follow our best advice for scoring low airfare , including setting flight price alerts and subscribing to deal newsletters. If you’re set on an expensive getaway, here’s a plan to save up without straining your credit limit.

Airport chaos: We’ve got advice for every scenario , from canceled flights to lost luggage . Stuck at the rental car counter? These tips can speed up the process. And following these 52 rules of flying should make the experience better for everyone.

Expert advice: Our By The Way Concierge solves readers’ dilemmas , including whether it’s okay to ditch a partner at security, or what happens if you get caught flying with weed . Submit your question here . Or you could look to the gurus: Lonely Planet and Rick Steves .

Updates On Italy Travel Restrictions For Us Citizens

• Last updated May 31, 2024
• Difficulty Beginner

• Category Travel

If you're a US citizen dreaming of a wanderlust-filled journey through the charming streets of Italy, it's important to stay updated on the ever-changing travel restrictions. Amidst the ongoing pandemic, Italy has been implementing various measures to ensure the safety of its citizens and visitors alike. In this article, we will dive into the latest updates on Italy travel restrictions, giving you a glimpse of what to expect and how to navigate these restrictions as a US citizen. So, pack your bags, grab your passport, and let's explore the world of Italian travel restrictions together!

What You'll Learn

Current travel restrictions for italy and the us, vaccination requirements and testing protocols for travel to italy, anticipated timeline for the resumption of travel to italy from the us, travel tips and safety guidelines for visiting italy post-pandemic.

Are you eagerly waiting to travel to Italy from the US? Due to the ongoing COVID-19 pandemic, there have been several travel restrictions in place. However, as the situation evolves, travel restrictions are constantly being updated. Here's a detailed overview of the current travel restrictions for Italy and the US.

Entry Restrictions for Italy:

• Italy has specific entry requirements for travelers arriving from the US. Currently, there is no requirement for a quarantine period upon arrival for travelers from the US.
• However, passengers must provide a negative COVID-19 test result, taken within 72 hours before arrival in Italy. The test must be either a molecular (PCR) or antigenic (rapid) test.
• Additionally, passengers must also complete a self-declaration form stating their purpose of travel and agreeing to abide by the Italian regulations.

Returning to the US:

• When returning to the US from Italy, travelers must follow the guidelines set by the Centers for Disease Control and Prevention (CDC). The CDC recommends getting tested with a viral test 1-3 days before departure.
• All air passengers age 2 and older must provide a negative COVID-19 test result taken within 3 days before their flight to the US departs. Alternatively, they can provide documentation of recovery from COVID-19 in the past 90 days.
• Upon arrival in the US, it is still advisable to self-quarantine for a period of 7 days, even if the test result is negative. However, if the test result is positive, isolation for a period of 10 days is necessary.

Additional Precautions:

• It is crucial to follow all the local regulations and guidelines in Italy, such as wearing masks, practicing social distancing, and frequently washing hands.
• Stay updated with the travel advisories issued by the government of the United States and the Italian authorities.
• Check with your airline for any specific requirements or restrictions before booking your flight.

Please note that these travel restrictions are subject to change based on the evolving situation. It is essential to stay informed and regularly check for updates from reliable sources such as the US Department of State and the Italian Ministry of Foreign Affairs.

In conclusion, currently, US citizens can travel to Italy with the necessary requirements in place, including a negative COVID-19 test result. However, it is crucial to follow all the guidelines and regulations to ensure a safe and smooth journey. Stay informed, stay prepared, and enjoy your trip to Italy!

Exploring the World of Travel in Management Consulting

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Italy is an incredibly popular travel destination, known for its rich history, beautiful landscapes, and delicious cuisine. However, due to the COVID-19 pandemic, travel to Italy has been heavily restricted. As vaccination rates increase and the situation begins to improve, many people are eager to know when they can travel to Italy again. In this blog post, we will discuss the current vaccination requirements and testing protocols for travel to Italy.

As of now, the Italian government has implemented a traffic light system to determine the entry requirements for travelers. This system classifies countries into different categories based on their COVID-19 risk level: green, orange, and red. The classification of each country can change frequently based on the current epidemiological situation.

For travelers coming from green countries, there are currently no vaccination or testing requirements to enter Italy. These countries are considered low-risk, and travelers are free to enter without any additional restrictions. However, it is important to note that even travelers from green countries may still be subject to random testing upon arrival in Italy.

For travelers coming from orange countries, vaccination and testing requirements are in place. It is mandatory for these travelers to present a negative molecular or antigenic test taken within 48 hours prior to their arrival in Italy. Additionally, travelers must also complete a self-declaration form stating that they have not been in close contact with any confirmed COVID-19 cases in the 14 days prior to their arrival.

For travelers coming from red countries, the entry requirements are more stringent. In addition to the negative test requirement and the self-declaration form, these travelers must also quarantine for 5 days upon arrival in Italy. After the 5-day quarantine period, a second test must be taken to be released from quarantine. It's important to note that these requirements may differ for vaccinated individuals, and it is recommended to check the latest updates from the Italian government before traveling.

Furthermore, it is crucial for all travelers to fill out the European Digital Passenger Locator Form (dPLF) before their arrival in Italy. This form collects important information such as contact details and travel itinerary and helps facilitate contact tracing if necessary.

It's important to keep in mind that these vaccination requirements and testing protocols are subject to change as the situation evolves. Therefore, it is essential to stay up to date with the latest guidelines and regulations provided by the Italian government and international health organizations.

In conclusion, while travel to Italy is beginning to open up, there are still vaccination requirements and testing protocols in place to ensure the safety of residents and visitors. Travelers from green countries are exempt from these requirements, while those coming from orange and red countries must present a negative test and complete a self-declaration form. For red countries, a quarantine period and additional testing are also mandatory. Remember to stay informed and follow the latest guidelines to ensure a smooth and safe trip to Italy.

The Never-Ending Journey: Experiencing a Lifetime of Travel

As the world continues to navigate the ongoing COVID-19 pandemic, many people are eagerly awaiting the resumption of international travel. With its rich history, vibrant culture, and stunning landscapes, Italy is a popular destination for travelers from all over the world, including the United States. However, due to the global health crisis, travel restrictions and entry requirements have been put in place to help prevent the spread of the virus. So, when can US travelers expect to be able to visit Italy again? Let's take a look at the anticipated timeline for the resumption of travel to Italy from the US.

As of now, US travelers are currently subject to restrictions when entering Italy. Persons who have stayed or transited through specific countries in the 14 days prior to their arrival are not allowed to enter Italy unless they have specific reasons, such as being an Italian resident or having urgent work or health reasons. The list of countries on this restricted list is subject to change based on the evolving situation. It is important for travelers to stay informed about the latest updates from the Italian government and Consulate.

Recently, Italy has implemented a "traffic light" system to categorize countries based on their COVID-19 risk level. Countries are assigned a color - either white, yellow, orange, or red - based on their epidemiological situation. Travel restrictions and entry requirements, including quarantine measures, may vary depending on the country's color. The United States is currently categorized as an "orange" country which means that non-essential travel from the US to Italy is not permitted. However, Italy has indicated that it plans to ease restrictions for travelers from the US in the near future.

The exact timeline for when US travelers can visit Italy again will largely depend on the progress of the vaccination campaigns, the control of new COVID-19 variants, and the overall global health situation. The Italian government has expressed its intention to gradually ease travel restrictions, especially for countries with a high vaccination rate and improving epidemiological situation. As vaccination rates increase and the number of COVID-19 cases decline, it is expected that Italy will open its borders to US travelers in the coming months.

To prepare for future travel, it is important for US travelers to stay updated on the latest entry requirements and restrictions. The Italian government has introduced the European Union Digital COVID Certificate, also known as the Green Pass. This certificate aims to facilitate safe travel within the EU by providing proof of vaccination, a negative test result, or recovery from COVID-19. US travelers should stay informed about the acceptance of this certificate and any additional requirements that may be in place upon entry.

In summary, while the exact date for the resumption of travel to Italy from the US is still uncertain, there is hope on the horizon. As vaccination rates increase and the global health situation improves, Italy is expected to gradually open its borders to US travelers. It is important for travelers to stay informed about the latest updates and requirements from the Italian government and Consulate. By staying prepared and following the necessary guidelines, we can look forward to the day when we can once again explore the beautiful sights and experience the rich culture that Italy has to offer.

Understanding Traveler's Medical Payments: Do I Have to Pay Back?

As the world slowly recovers from the impact of the COVID-19 pandemic, many travelers are eager to explore new destinations once again. Italy, with its rich history, stunning landscapes, and sumptuous cuisine, is a popular choice. However, it's important to stay informed about the latest travel regulations and safety guidelines. In this guide, we will provide you with valuable travel tips to help make your trip to Italy a safe and enjoyable experience.

Stay informed about entry requirements:

• Before planning your trip, check the official websites of the Italian government and the US Department of State for the latest travel restrictions and entry requirements. These may include COVID-19 testing, vaccination certificates, or quarantine measures.
• Keep in mind that the situation can change rapidly, so regularly check for updates leading up to your departure date.

Get travel insurance:

Make sure you have comprehensive travel insurance that covers COVID-19 related incidents. This will provide you with financial protection in case your trip gets disrupted due to illness or other unforeseen circumstances.

Plan ahead and make reservations:

Due to the lingering effects of the pandemic, many attractions and restaurants in Italy may have limited capacity or require advance reservations. Plan your itinerary in advance and secure reservations to avoid disappointment.

Follow hygiene practices:

• Maintain good hand hygiene by regularly washing your hands with soap and water for at least 20 seconds, or using hand sanitizer when soap and water are not available.
• Avoid touching your face, especially your eyes, nose, and mouth, as this can help prevent the transmission of the virus.
• Practice good respiratory etiquette by covering your mouth and nose with a tissue or your elbow when coughing or sneezing.

Wear a mask:

• Follow the mask-wearing guidelines set by the Italian government and local authorities. Masks may be required in public places, including shops, museums, and public transportation.
• Carry an adequate supply of masks with you and make sure to wear them properly, covering both your nose and mouth.

Practice social distancing:

Maintain a distance of at least 1 meter (3 feet) from others, particularly in crowded areas. Follow any specific social distancing guidelines provided by the local authorities.

Stay updated on local regulations:

Keep yourself informed about the COVID-19 situation in the regions you plan to visit. Local regulations may vary, so it's important to stay up to date to ensure compliance with the rules and regulations in each specific area.

Be respectful of local guidelines and customs:

• Respect the local culture and adhere to any additional guidelines or rules implemented by businesses, attractions, or accommodations you visit.
• Be patient and understanding of any limitations or changes you may encounter during your trip. Remember, these measures are in place to ensure the safety of both travelers and locals.

Remember, staying informed and following the recommended guidelines is crucial to ensure a safe and rewarding travel experience in Italy. By practicing personal hygiene, wearing masks, maintaining social distancing, and respecting local regulations, you can help protect yourself and others while enjoying the beauty and charm of this remarkable country.

Navigating from Hamburg Airport to the City Centre: A Traveler's Guide

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• Section 2 - Vaccination & Immunoprophylaxis— General Principles
• Section 2 - Yellow Fever Vaccine & Malaria Prevention Information, by Country

Interactions Between Travel Vaccines & Drugs

Cdc yellow book 2024.

Author(s): Ilan Youngster, Elizabeth Barnett

Vaccine–Vaccine Interactions

Travel vaccines & drugs, antimalarial drugs, drugs used for travel to high elevations, hiv medications, herbal & nutritional supplements.

During pretravel consultations, travel health providers must consider potential interactions between vaccines and medications, including those already taken by the traveler. A study by S. Steinlauf et al. identified potential drug–drug interactions with travel-related medications in 45% of travelers taking medications for chronic conditions; 3.5% of these interactions were potentially serious.

Most common vaccines can be given safely and effectively at the same visit, at separate injection sites, without impairing antibody response or increasing rates of adverse reactions. However, certain vaccines, including pneumococcal and meningococcal vaccines and live virus vaccines, require appropriate spacing; further information about vaccine–vaccine interactions is found in Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis—General Principles .

Live Attenuated Oral Typhoid & Cholera Vaccines

Live attenuated vaccines generally should be avoided in immunocompromised travelers, including those taking antimetabolites, calcineurin inhibitors, cytotoxic agents, immunomodulators, and high-dose steroids (see Table 3-04 ).

Chloroquine and atovaquone-proguanil at doses used for malaria chemoprophylaxis can be given concurrently with oral typhoid vaccine. Data from an older formulation of the CVD 103-HgR oral cholera vaccine suggest that the immune response to the vaccine might be diminished when given concomitantly with chloroquine. Administer live attenuated oral cholera vaccine ≥10 days before beginning antimalarial prophylaxis with chloroquine. A study in children using oral cholera vaccine suggested no decrease in immunogenicity when given with atovaquone-proguanil.

Antimicrobial Agents

Antimicrobial agents can be active against the vaccine strains in the oral typhoid and cholera vaccines and might prevent adequate immune response to these vaccines. Therefore, delay vaccination with oral typhoid vaccine by >72 hours and delay oral cholera vaccine by >14 days after administration of antimicrobial agents. Parenteral typhoid vaccine is an alternative to the oral typhoid vaccine for travelers who have recently received antibiotics.

Rabies Vaccine

Concomitant use of chloroquine can reduce the antibody response to intradermal rabies vaccine administered as a preexposure vaccination. Use the intramuscular route for people taking chloroquine concurrently. Intradermal administration of rabies vaccine is not currently approved for use in the United States (see Sec. 5, Part 2, Ch. 19, . . . perspectives: Rabies Immunization ).

Any time a new medication is prescribed, including antimalarial drugs, check for known or possible drug interactions (see Table 2-05 ) and inform the traveler of potential risks. Online clinical decision support tools (e.g., Micromedex) provide searchable databases of drug interactions.

Atovaquone-Proguanil

Antibiotics.

Rifabutin, rifampin, and tetracycline might reduce plasma concentrations of atovaquone and should not be used concurrently with atovaquone-proguanil.

• Anticoagulants

Patients on warfarin might need to reduce their anticoagulant dose or monitor their prothrombin time more closely while taking atovaquone-proguanil, although coadministration of these drugs is not contraindicated. The use of novel oral anticoagulants, including dabigatran, rivaroxaban, and apixaban, is not expected to cause significant interactions, and their use has been suggested as an alternative for patients in need of anticoagulation.

Antiemetics

Metoclopramide can reduce bioavailability of atovaquone; unless no other antiemetics are available, this antiemetic should not be used to treat vomiting associated with the use of atovaquone at treatment doses.

Antihistamines

Travelers taking atovaquone-proguanil for malaria prophylaxis should avoid using cimetidine (an H2 receptor antagonist) because this medication interferes with proguanil metabolism.

Atovaquone-proguanil might interact with the antiretroviral protease inhibitors atazanavir, darunavir, indinavir, lopinavir, and ritonavir, or the nonnucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz, etravirine, and nevirapine, resulting in decreased levels of atovaquone-proguanil. For travelers taking any of these medications, consider alternative malaria chemoprophylaxis .

Selective Serotonin Reuptake Inhibitors

Fluvoxamine interferes with the metabolism of proguanil; consider an alternative antimalarial prophylaxis to atovaquone-proguanil for travelers taking this selective serotonin reuptake inhibitor (SSRI).

Chloroquine

Antacids & Antidiarrheals

Chloroquine absorption might be reduced by antacids or kaolin; travelers should wait ≥4 hours between doses of these medications.

Chloroquine inhibits bioavailability of ampicillin, and travelers should wait ≥2 hours between doses of these medications. Chloroquine should not be coadministered with either clarithromycin or erythromycin; azithromycin is a suggested alternative . Chloroquine also reportedly decreases the bioavailability of ciprofloxacin.

Concomitant use of cimetidine and chloroquine should be avoided because cimetidine can inhibit the metabolism of chloroquine and increase drug levels.

CYP2D6 Enzyme Substrates

Chloroquine is a CYP2D6 enzyme inhibitor. Monitor patients taking chloroquine concomitantly with other substrates of this enzyme (e.g., flecainide, fluoxetine, metoprolol, paroxetine, propranolol) for side effects.

CYP3A4 Enzyme Inhibitors

CYP3A4 inhibitors (e.g., erythromycin, ketoconazole, ritonavir) can increase chloroquine levels; concomitant use should be avoided.

Chloroquine can increase digoxin levels; additional monitoring is warranted.

Immunosuppressants

Chloroquine decreases the bioavailability of methotrexate. Chloroquine also can cause increased levels of calcineurin inhibitors; use caution when prescribing chloroquine to travelers taking these agents.

QT-Prolonging Agents

Avoid prescribing chloroquine to anyone taking other QT-prolonging agents (e.g., amiodarone, lumefantrine, sotalol); when taken in combination, chloroquine might increase the risk for prolonged QTc interval. In addition, the antiretroviral rilpivirine has also been shown to prolong QTc, and clinicians should avoid coadministration with chloroquine.

Doxycycline

Antacids, Bismuth Subsalicylate, Iron

Absorption of tetracyclines might be impaired by aluminum-, calcium-, or magnesium-containing antacids, bismuth subsalicylate, and preparations containing iron; advise patients not to take these preparations within 3 hours of taking doxycycline.

Doxycycline can interfere with the bactericidal activity of penicillin; thus, in general, clinicians should not prescribe these drugs together. Coadministration of doxycycline with rifabutin or rifampin can lower doxycycline levels; monitor doxycycline efficacy closely or consider alternative therapy.

Patients on warfarin might need to reduce their anticoagulant dose while taking doxycycline because of its ability to depress plasma prothrombin activity.

Anticonvulsants

Barbiturates, carbamazepine, and phenytoin can decrease the half-life of doxycycline.

Antiretrovirals

Doxycycline has no known interaction with antiretroviral agents.

Concurrent use of doxycycline and calcineurin inhibitors or mTOR inhibitors (sirolimus) can cause increased levels of these immunosuppressant drugs.

Mefloquine can interact with several categories of drugs, including anticonvulsants, other antimalarial drugs, and drugs that alter cardiac conduction.

Mefloquine can lower plasma levels of several anticonvulsant medications, including carbamazepine, phenobarbital, phenytoin, and valproic acid; avoid concurrent use of mefloquine with these agents.

Mefloquine is associated with increased toxicities of the antimalarial drug lumefantrine, which is available in the United States in fixed combination to treat people with uncomplicated Plasmodium falciparum malaria. The combination of mefloquine and lumefantrine can cause potentially fatal QTc interval prolongation. Lumefantrine should therefore be avoided or used with caution in patients taking mefloquine prophylaxis.

CYP3A4 Enzyme Inducers

CYP3A4 inducers include medications used to treat HIV or HIV-associated infections (e.g., efavirenz, etravirine, nevirapine, rifabutin) and tuberculosis (rifampin). St. John’s wort and glucocorticoids are also CYP3A4 inducers. All these drugs (rifabutin and rifampin, in particular) can decrease plasma concentrations of mefloquine, thereby reducing its efficacy as an antimalarial drug.

Potent CYP3A4 inhibitors (e.g., antiretroviral protease inhibitors, atazanavir, cobicistat [available in combination with elvitegravir], darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (azithromycin, clarithromycin, erythromycin); and SSRIs (fluoxetine, fluvoxamine, sertraline), can increase levels of mefloquine and thus increase the risk for QT prolongation.

Although no conclusive data are available regarding coadministration of mefloquine and other drugs that can affect cardiac conduction, avoid mefloquine use, or use it with caution, in patients taking antiarrhythmic or β-blocking agents, antihistamines (H1 receptor antagonists), calcium channel receptor antagonists, phenothiazines, SSRIs, or tricyclic antidepressants.

Concomitant use of mefloquine can cause increased levels of calcineurin inhibitors and mTOR inhibitors (cyclosporine A, sirolimus, tacrolimus).

Anti-Hepatitis C Virus Protease Inhibitors

Avoid concurrent use of mefloquine and direct-acting protease inhibitors (boceprevir and telaprevir) used to treat hepatitis C. Newer direct-acting protease inhibitors (grazoprevir, paritaprevir, simeprevir) are believed to be associated with fewer drug–drug interactions, but safety data are lacking; consider alternatives to mefloquine pending additional data.

Psychiatric Medications

Avoid prescribing mefloquine to travelers with a history of mood disorders or psychiatric disease; this information is included in the US Food and Drug Administration boxed warning for mefloquine.

Table 2-05 Drugs & drug classes that can interact with selected antimalarials

ANTIMALARIALS

DRUGS & DRUG CLASSES THAT CAN INTERACT

Atovaquone- proguanil

• Fluvoxamine
• Metoclopromide
• Tetracycline
• Calcineurin inhibitors
• Ciprofloxacin
• CYP2D6 enzyme substrates 1
• CYP3A4 enzyme inhibitors 2
• Methotrexate
• QT- prolonging agents 3
• Bismuth subsalicylate
• Barbiturates
• Carbamazepine
• Iron- containing preparations
• mTOR inhibitors
• Antiarrhythmic agents
• Beta blockers
• Calcium channel receptor antagonists
• CYP3A4 enzyme inducers 4
• H1 receptor antagonists
• Lumefantrine
• Phenothiazines
• Protease inhibitors
• Tricyclic antidepressants

1 Examples include flecainide, fluoxetine, metoprolol, paroxetine, and propranolol.

2 Examples include antiretroviral protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (e.g., itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin); selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine, fluvoxamine, sertraline); and cobicistat.

3 Examples include amiodarone, lumefantrine, and sotalol.

4 Examples include efavirenz, etravirine, nevirapine, rifabutin, rifampin, and glucocorticoids.

Drugs Used to Treat Travelers’ Diarrhea

Antimicrobials commonly prescribed as treatment for travelers’ diarrhea have the potential for interacting with several different classes of drugs ( Table 2-06 ). As mentioned previously, online clinical decision support tools provide searchable databases that can help identify interactions with medications a person may already be taking.

Azithromycin

Increased anticoagulant effects have been noted when azithromycin is used with warfarin; monitor prothrombin time for people taking these drugs concomitantly.

Because additive QTc prolongation can occur when azithromycin is used with the antimalarial artemether, avoid concomitant therapy.

Drug interactions have been reported with the macrolide antibiotics, clarithromycin and erythromycin; antiretroviral protease inhibitors; and the NNRTIs, efavirenz and nevirapine. Concomitant use of azithromycin and these drugs can increase the risk of QTc prolongation, but a short treatment course is not contraindicated for those without an underlying cardiac abnormality. When azithromycin is used with the protease inhibitor nelfinavir, advise patients about possible drug interactions.

Concurrent use of macrolides with calcineurin inhibitors can cause increased levels of drugs belonging to this class of immunosuppressants.

Fluoroquinolones

Concurrent administration of ciprofloxacin and antacids that contain magnesium or aluminum hydroxide can reduce bioavailability of ciprofloxacin.

An increase in the international normalized ratio (INR) has been reported when levofloxacin and warfarin are used concurrently.

Asthma Medication

Ciprofloxacin decreases clearance of theophylline and caffeine; clinicians should monitor theophylline levels when ciprofloxacin is used concurrently.

Immunosuppresants

Fluoroquinolones can increase levels of calcineurin inhibitors, and doses should be adjusted for renal function.

Sildenafil should not be used by patients taking ciprofloxacin; concomitant use is associated with increased rates of adverse effects. Ciprofloxacin and other fluoroquinolones should not be used in patients taking tizanidine.

Rifamycin SV

No clinical drug interactions have been studied. Because of minimal systemic rifamycin concentrations observed after the recommended dose, clinically relevant drug interactions are not expected.

Rifaximin is not absorbed in appreciable amounts by intact bowel, and no clinically significant drug interactions have been reported to date with rifaximin except for minor changes in INR when used concurrently with warfarin.

Table 2-06 Drugs & drug classes that can interact with selected antibiotics

ANTIBIOTICS

• HIV medications
• Antacids containing magnesium or aluminum hydroxide
• Theophylline

No clinical drug interactions have been studied; none are expected

Before prescribing the carbonic anhydrase inhibitor, acetazolamide, to those planning high elevation travel, carefully review with them the complete list of medications they are already taking ( Table 2-07 ).

Acetazolamide

Acetaminophen & Diclofenac Sodium

Acetaminophen and diclofenac sodium form complex bonds with acetazolamide in the stomach’s acidic environment, impairing absorption. Neither agent should be taken within 30 minutes of acetazolamide. Patients taking acetazolamide also can experience decreased excretion of anticholinergics, dextroamphetamine, ephedrine, mecamylamine, mexiletine, and quinidine.

Acetazolamide should not be given to patients taking the anticonvulsant topiramate because concurrent use is associated with toxicity.

Barbiturates & Salicylates

Acetazolamide causes alkaline urine, which can increase the rate of excretion of barbiturates and salicylates and could cause salicylate toxicity, particularly in patients taking a high dose of aspirin.

• Corticosteroids

Hypokalemia caused by corticosteroids could occur when used concurrently with acetazolamide.

Diabetes Medications

Use caution when concurrently administering metformin and acetazolamide because of increased risk for lactic acidosis.

Monitor cyclosporine, sirolimus, and tacrolimus more closely when given with acetazolamide.

Dexamethasone

Using dexamethasone to treat altitude illness can be lifesaving. Dexamethasone interacts with several classes of drugs, however, including: anticholinesterases, anticoagulants, digitalis preparations, hypoglycemic agents, isoniazid, macrolide antibiotics, oral contraceptives, and phenytoin.

Table 2-07 Drugs & drug classes that can interact with selected altitude illness drugs

ALTITUDE ILLNESS DRUG

• Acetaminophen
• Anticholinergics
• Aspirin, high dose
• Dextroamphetamine
• Diclofenac sodium
• Mecamylamine
• Anticholinesterases
• Digitalis preparations
• Hypoglycemic agents
• Macrolide antibiotics
• Oral contraceptives

Patients with HIV require additional consideration in the pretravel consultation (see Sec. 3, Ch. 1, Immunocompromised Travelers ). A study from Europe showed that ≤29% of HIV-positive travelers disclose their disease and medication status when seeking pretravel advice. Antiretroviral medications have multiple drug interactions, especially through their activation or inhibition of the CYP3A4 and CYP2D6 enzymes.

Several instances of antimalarial prophylaxis and treatment failure in patients taking protease inhibitors and both nucleoside and NNRTIs have been reported. By contrast, entry and integrase inhibitors are not a common cause of drug–drug interactions with commonly administered travel-related medications. Several potential interactions are listed above, and 2 excellent resources for HIV medication interactions can be found at  HIV Drug Interactions and HIV.gov . HIV preexposure prophylaxis with emtricitabine/tenofovir is not a contraindication for any of the commonly used travel-related medications.

Up to 30% of travelers take herbal or nutritional supplements. Many travelers consider them to be of no clinical relevance and might not disclose their use unless specifically asked during the pretravel consultation. Clinicians should give special attention to supplements that activate or inhibit CYP2D6 or CYP3A4 enzymes (e.g., ginseng, grapefruit extract, hypericum, St. John’s wort). Advise patients against coadministration of herbal and nutritional supplements with medications that are substrates for CYP2D6 or 3A4 enzymes, including chloroquine, macrolides, and mefloquine.

The following authors contributed to the previous version of this chapter: Ilan Youngster, Elizabeth D. Barnett

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Jabeen E, Qureshi R, Shah A. Interaction of antihypertensive acetazolamide with nonsteroidal anti-inflammatory drugs. J Photochem Photobiol B. 2013;125:155–63.

Kollaritsch H, Que JU, Kunz C, Wiedermann G, Herzog C, Cryz SJ Jr. Safety and immunogenicity of live oral cholera and typhoid vaccines administered alone or in combination with antimalarial drugs, oral polio vaccine, or yellow fever vaccine. J Infect Dis. 1997;175(4):871–5.

Nascimento Silva JR, Camacho LA, Siqueira MM, Freire Mde S, Castro YP, Maia Mde L, et al. Mutual interference on the immune response to yellow fever vaccine and a combined vaccine against measles, mumps and rubella. Vaccine. 2011;29(37):6327–34.

Nielsen US, Jensen-Fangel S, Pedersen G, Lohse N, Pedersen C, Kronborg G, et al. Travelling with HIV: a cross sectional analysis of Danish HIV-infected patients. Travel Med Infect Dis. 2014;12(1):72–8.

Ridtitid W, Wongnawa M, Mahatthanatrakul W, Raungsri N, Sunbhanich M. Ketoconazole increases plasma concentrations of antimalarial mefloquine in healthy human volunteers. J Clin Pharm Ther. 2005;30(3):285–90.

Sbaih N, Buss B, Goyal D, Rao SR, Benefield R, Walker AT, et al. Potentially serious drug interactions resulting from the pre-travel health encounter. Open Forum Infect Dis. 2018;5(11):ofy266.

Stienlauf S, Meltzer E, Kurnik D, Leshem E, Kopel E, Streltsin B, et al. Potential drug interactions in travelers with chronic illnesses: a large retrospective cohort study. Travel Med Infect Dis. 2014;12(5):499–504.

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