Pharmaceutical and biomedical challenges for crew autonomy in health preservation during future exploration missions

Human space missions beyond Low Earth Orbit (LEO), such as to the Moon and Mars, will require increased crew autonomy in health management, due to communication delays and limited resupply. These missions pose unique biomedical challenges, including radiation exposure, altered gravity, and prolonged isolation, which can affect physiology and compromise available treatments. This review examines current efforts in pharmaceutical and biomedical strategies to support health preservation during long-duration missions. We discuss technologies needed to assure drug stability and storage, also considering potential modifications of pharmacokinetics in space, and the potential of nanotechnologies, physical therapies, and in-situ manufacturing. Non-pharmacological tools for diagnostics, trauma care, and tissue regeneration are highlighted for their promise in enhancing medical self-sufficiency. These advances are not only critical for ensuring mission success and crew safety beyond LEO, yet may also translate to healthcare solutions in remote or underserved Earth settings.