WHAT ABOUT MY MEDICATIONS? - DR. STEVE WAHLS - JULY 25, 2011
One of the fears we have as pilots, when considering the need to take a medication for a chronic problem, is “what will this do to my medical certification?” From antibiotics to cholesterol medication, antidepressants to vaccinations, many substances do have a remarkable benefit on disease conditions.
The good news is that many health problems and medications used to treat them do not compromise aviation safety and are permissible for those of us who fly aircraft. It is, however, our responsibility to monitor our readiness to serve as pilots and appropriately defer flying during acute illnesses as per 14 CFR part 61.53.
Medications have a variety of effects on our bodies. The desired effect of a medication or treatment is only one of the effects, and everything else of significance we call either “side effects” or “adverse reactions”.
Either the desired or side effects of a medication may cause that substance to be unallowable for pilots in the aviation environment. Diphenhydramine and cetirizine reduce allergy misery, but also are sedating. After one of these antihistamines is taken, guidelines state that a minimum of 5 dosage intervals should elapse after the last dose of these medications before we fly. Loratidine and fexofenadine are not sedating, and may be used if, after an adequate trial period, symptoms are controlled and no adverse effects appear.
Medications like pramipexole, used for restless leg syndrome and Parkinson’s disease, may cause sudden sleep attacks and hallucinations, and are prohibited in the aviation environment.
As aviation medical examiners, we are required to consider not only the medications themselves, but also the underlying diseases for which a product is used. When the medication itself is not a problem, sometimes the disease for which it is taken is an issue. It is also our responsibility to inform pilots of potential adverse effects and provide counsel on medication use.
Anticoagulants require very careful monitoring, and the FAA requires documentation of this. In addition, conditions that require anticoagulation like heart rhythm disorders or blood clots can pose a safety risk. Insulin use in diabetics also requires detailed medical information. In a future article, I will discuss the special issuance process that allows pilots using such medications to fly.
Some antidepressant medications have limited side effects, but the underlying problems associated with depression, such as poor focus and lack of energy require FAA involvement- and an adequate time off the medicine in the absence of ongoing depression- before a pilot may be cleared to fly.
The FAA does not publish lists of acceptable medications due to the potential for misuse and neglect of other factors that may impact flight safety, such as drug interactions or underlying diseases. In addition, drug and disease information change frequently. For questions about mediations and flying, your AME and/ or your Family Physician are your best options for information specific to your condition.
Steve Wahls is a Senior Aviation Medical Examiner and Family Physician who practices at OHSU Family Medicine in Scappoose. He holds a private pilot certificate and is available for aviation medical consultation or pilot medical exams.