The short answer: All SA airlines allow prescription medication in hand luggage. Controlled substances (Schedule 5 and 6) need original packaging plus a prescription or doctor's letter. CPAP machines travel free as medical devices. Syringes for medical use are permitted — declare them at security. Here is the complete breakdown.
In this guide
General rules — all medication types
South African domestic airlines do not have specific airline-level medication policies separate from ACSA (Airports Company South Africa) security rules. What governs your experience is the airport security checkpoint, not check-in. The rules below apply across OR Tambo, Cape Town International, King Shaka and all ACSA-operated airports.
| Medication type | Hand luggage | Checked luggage | Letter required? |
|---|---|---|---|
| Standard prescription medication (tablets, capsules) | ✅ Yes | ✅ Yes | Recommended, not mandatory |
| Controlled substances (Schedule 5 & 6) | ✅ Yes — with prescription | ✅ Yes | Strongly recommended |
| Insulin (vials, pens) | ✅ Yes | ✅ Yes — not ideal (temperature) | Recommended |
| Syringes and needles | ✅ Yes — declare at security | ✅ Yes | Recommended |
| Liquid medication >100ml | ✅ Yes — declare as medically necessary | ✅ Yes | Strongly recommended |
| CPAP machine | ✅ Yes — free, not counted as carry-on | ✅ Yes | Not required domestically |
| EpiPen / auto-injector | ✅ Yes | ✅ Yes | Recommended |
| Nebuliser | ✅ Yes — medical device exemption | ✅ Yes | Not required domestically |
| Oxygen concentrator | Airline approval required in advance | Not permitted | Yes — mandatory |
Controlled substances — Schedule 5 and 6 drugs
South Africa's Medicines and Related Substances Act classifies drugs into schedules. Schedule 5 and 6 substances are controlled — these include strong opioids, certain ADHD medications, some sedatives and high-dependency benzodiazepines.
Common Schedule 5 and 6 medications SA travellers carry
- Methylphenidate (Ritalin, Concerta) — ADHD
- Strong opioid painkillers (oxycodone, hydromorphone, fentanyl patches)
- High-potency benzodiazepines (clonazepam at higher doses)
- Certain sleep medications at prescription strength
- Some anti-anxiety medications at Schedule 5/6 classification
SAPS permits for international travel
For international travel with Schedule 6 substances, you may need a permit from the South African Police Service (SAPS) Forensic Chemistry Laboratories. This is not required for domestic flights but applies when taking controlled substances across international borders. Your prescribing specialist or a travel clinic can advise on whether your specific medication requires a SAPS permit for your destination country.
Insulin and injectable medication
Diabetic travellers flying SA domestic routes face no specific airline restrictions on insulin. The practical rules are:
Insulin storage on the aircraft
Insulin should always travel in your hand luggage, not in checked baggage. The hold is unpressurised and temperatures can drop below freezing — insulin that freezes is permanently degraded and must not be used. Keep it in an insulated medication wallet in the cabin at all times.
How much insulin can you carry?
There is no specified limit for personal-use quantities. Security applies a reasonableness standard — if the quantity appears consistent with your trip duration and your prescription, it will not be questioned. For longer trips or if you carry significant reserve stock, a doctor's letter confirming your diagnosis and daily requirements removes any ambiguity.
Insulin vials and the 100ml rule
Standard insulin vials are 10ml — well within the 100ml limit. Insulin pump reservoirs are similarly small. The 100ml rule is unlikely to affect insulin directly, but if you carry saline for flushing lines or larger volumes of liquid medication, declare these as medically necessary liquids at security.
CPAP and medical devices
CPAP (Continuous Positive Airway Pressure) machines are the most commonly carried medical device by SA domestic travellers. The rules are clear and consistent across all carriers.
| Item | Cabin allowed? | Counts as carry-on? | Checked luggage? |
|---|---|---|---|
| CPAP machine | ✅ Yes | No — medical device exemption | ✅ Yes |
| CPAP mask and tubing | ✅ Yes (in CPAP bag) | No | ✅ Yes |
| Distilled water for humidifier (>100ml) | ⚠️ Declare as medical | — | ✅ Yes (easiest) |
| CPAP travel power adapter | ✅ Yes | Part of CPAP bag | ✅ Yes |
| Portable oxygen concentrator | ⚠️ Advance airline approval required | No | Not permitted |
| Nebuliser | ✅ Yes | No — medical device | ✅ Yes |
| Blood glucose monitor | ✅ Yes | No — medical device | ✅ Yes |
Oxygen concentrators — advance approval required
If you require supplemental oxygen, you must contact the airline's special assistance desk at least 48–72 hours before departure. All SA airlines can arrange supplemental oxygen for medical passengers, but they supply it — you cannot bring your own oxygen cylinder or concentrator without prior written approval. Contact the airline directly; the process is different for each carrier.
Liquid medication and the 100ml security rule
ACSA's security rules follow IATA standards: liquids, aerosols and gels (LAGs) must be 100ml or less per container in a sealed transparent bag — unless they are medically necessary.
Medically necessary liquids are exempt from the 100ml rule. This covers:
- Liquid oral medication (syrups, suspensions)
- Eye drops prescribed by a doctor
- Liquid nutrition for medical conditions
- Insulin and other injectable medications
- Saline for medical use
Getting through airport security without delays
The security checkpoint is where most medication-related delays happen — and almost all of them are avoidable.
At OR Tambo (JNB)
OR Tambo is the highest-volume checkpoint in SA and has the most experienced security staff with medical items. Queues at peak times (05:30–08:00 and 15:00–18:30) are long — arrive early enough that a brief medication inspection does not cost you your flight. Terminal A (domestic) and Terminal B (international) have separate security lanes.
At Cape Town International (CPT)
Cape Town security is generally efficient. During December peak season (mid-December to early January) and Easter, queues extend significantly. Allow 2 hours before departure in peak periods if you have medication to declare.
At smaller regional airports
Smaller airports (George, Hoedspruit, Kimberley, Richards Bay) have fewer security lanes and less experienced staff with unusual medical items. If you carry controlled substances or specialist equipment, a doctor's letter is more important at these airports than at the main hubs — it removes the need for escalation to a supervisor.
The golden rules for security
- Declare proactively — say "I have prescription medication including syringes" before the bag goes through the scanner
- Keep medication in the top of your bag for easy access
- Never put controlled substances in checked luggage and then carry duplicates in hand luggage — it raises flags
- Original packaging always beats a pill organiser at security
- A printed doctor's letter is faster than showing a phone screen
International travel with medication from South Africa
Domestic rules are simple. International travel adds layers — both SA export rules and destination import rules apply simultaneously.
| Medication category | What you need leaving SA | What destination may require |
|---|---|---|
| Standard prescription medication | Original packaging + prescription | Usually just original packaging + script |
| Schedule 5 controlled substances | Original script + doctor's letter | May require import permit or local prescription |
| Schedule 6 controlled substances | SAPS permit recommended + script | Often requires import permit — check embassy |
| Insulin and diabetic supplies | Doctor's letter confirming diagnosis | Generally accepted with SA prescription |
| Cannabis-based medication | SA prescription — legal in SA with script | Illegal in most countries — do not travel with it internationally |
Pre-flight medication checklist
- All medication in original pharmacy packaging with dispensing label
- Copy of prescription (photo on phone + printed copy)
- Doctor's letter for controlled substances, syringes, or liquid medication >100ml
- Sufficient supply for trip duration plus 3 days contingency
- Insulin and temperature-sensitive medication packed in insulated wallet in hand luggage
- Syringes capped and in a sharps pouch or original packaging
- CPAP machine in its own bag, ready to remove at security
- Liquid medication separated and ready to declare at security checkpoint
- For international travel: checked destination country import rules, SAPS permit if Schedule 6
- Travel insurance that covers medical conditions and medication loss
Frequently Asked Questions
Can I take prescription medication in my hand luggage on a SA flight?
Yes. All prescription medication is allowed in hand luggage on SA domestic flights. Keep it in original pharmacy packaging with your dispensing label. Declare liquid medication or controlled substances at the security checkpoint.
Can I fly with Ritalin or Concerta in South Africa?
Yes. Methylphenidate (Ritalin, Concerta) is a Schedule 5 controlled substance in SA. You can fly with it domestically with the original pharmacy packaging showing your name, and the original prescription or a doctor's letter. Do not carry it in an unmarked container.
Can I bring syringes and needles on a SA domestic flight?
Yes, for medical use. Insulin pens, EpiPens and syringes for prescribed medication are allowed in hand luggage. Declare them at security, keep needles capped, and carry the associated medication with a pharmacy label or doctor's letter.
Does my CPAP machine count as carry-on luggage?
No. CPAP machines are classified as medical devices and do not count toward your carry-on allowance on any SA airline. They travel in the cabin free of charge in addition to your standard baggage allowance.
Can I take more than 100ml of liquid medication through security?
Yes — medically necessary liquids are exempt from the 100ml ACSA rule. Declare the medication at the security checkpoint before your bag goes through the scanner, have it in an accessible part of your bag, and carry a doctor's letter for quantities that appear large.
Related guides
This guide is general travel information and does not constitute medical or legal advice. Airline and security policies are set by ACSA, individual carriers and SAPS — they can change without notice. Always confirm current requirements directly with your airline and prescribing doctor before travel. For controlled substance import rules at international destinations, consult the destination country's embassy or a registered travel clinic.