Extreme heat and flooding can threaten medicine integrity, interrupt medicine supply and access, and increase the difficulty of reaching communities already affected by geographic, socioeconomic, or health-related vulnerability. This rapid review examined evidence relevant to community-pharmacy protection of medicines, continuity of supply and access, communication with vulnerable communities, operational preparedness, and coordination with other services during extreme heat and flooding. A rapid-review design was used with transparent methodological streamlining and domain-based narrative synthesis. Four targeted PubMed-indexed search streams and supplementary targeted searches were executed on 14 September 2026. Evidence from 2017–2026 was screened using two analytically distinct strata: direct evidence concerning heat, flooding, extreme weather, medicine integrity, access, or community-pharmacy operations; and transfer evidence from other emergencies where it informed preparedness or cross-service coordination. Study design, setting, hazard, population, operational domain, methodological limitations, contradictory findings, and applicability boundaries were extracted. Design-appropriate critical appraisal informed interpretation without being used as an automatic exclusion threshold. Fifty-six records were captured, 10 duplicate occurrences were removed, and 46 unique records entered screening. Thirteen were excluded during initial screening, leaving 33 for detailed eligibility assessment; 19 were subsequently excluded and 14 evidence units were included. Direct evidence was limited and geographically concentrated. Temperature-excursion evidence showed that medicine-integrity risk is product- and exposure-specific rather than uniformly determined by ambient heat. Flood and hurricane evidence documented disruption to premises, logistics, medicine access, and service continuity. Preparedness and coordination findings were supported partly by transfer evidence from other emergencies and were heterogeneous rather than uniformly favorable. Community pharmacies can function as important continuity points during climate-related disruption, but the evidence does not support universal preparedness standards or simple assumptions about heat-related medicine damage. Heat-related medicine-integrity mechanisms and flood-related supply/access disruption should be managed as related but analytically distinct problems, with preparedness and coordination measures interpreted according to local infrastructure, population vulnerability, medicine characteristics, and evidence quality.
