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Making a List

Source: FAA Safety Briefing Jan/Feb 2019
By: Michael Berry, M.D. Federal Air Surgeon

“Doc, just give me a list of what medications I can take and still fly.” I get this request on a regular basis. However, addressing this request is more complicated than it might seem. The first question must always be: “Is it safe to fly with the medical condition for which I am taking the medication?” Next, we must consider that there is not a single medication that is safe for everyone in all situations. The good news is that we have made progress toward answering this request where it makes sense.

In November 2017, we updated the FAA information brochure, “Medications and Flying,” which is available in print and online at www.faa.gov/pilots/safety/pilotsafetybrochures. This is a good starting point for pilots.

Do Not Issue — Do Not Fly

We also added a chapter in the Guide for Aviation Medical Examiners (AME Guide) entitled, “Do Not Issue — Do Not Fly,” which lists some types of medications that should never be taken while flying. Although written for AMEs, anyone can access the AME Guide online. In the chapter, we included guidelines for a wide array of commonly used drug categories such as diabetes and high blood pressure medications, allergy medications, antacids, anticoagulants (blood thinners), antidepressants, and sleep aids. This information may help guide your treating physician toward a more aeromedically-acceptable treatment when several equally effective options exist. This information should not be used as justification to select an inferior treatment. In other words, “Don’t treat the flying status.”

From a practical standpoint, airmen usually make personal decisions about over-the-counter medications rather than prescription medications. We are currently working with the General Aviation Joint Steering Committee (GAJSC) on a more pilot-friendly version of the information in the AME Guide. No matter what the list looks like, you must always read the product label. Diphenhydramine (Benadryl) is a good example of a drug included in many combinations of cold and allergy medications, as well as sleep aids, which has prolonged, performance-impairing effects. Printed warnings against use of the drug when driving or operating dangerous machinery should always be a red flag.

Combinations and Complexity

Another reason producing a “pocket guide” for airmen is so difficult is because of the constant influx of so many new medications entering the market. Many combination medications are also available, and one cannot always assume that just because each individual drug may be acceptable, that the combination of these drugs would be. It is difficult to keep up with changes, and nearly impossible to assure outdated lists are consistently discarded. In an effort to stay current, we have recently added a doctoral level pharmacist to our headquarters staff.

In addition, we are often asked to consider a large number of new drugs for their aeromedical suitability. Usually we require the drug to be FDA approved and on the market for at least a year. We eventually approve most of these; however, the underlying disease will often preclude the special issuance of a medical certificate.

When in doubt about medication use, your AME is a good source for advice. If you have a question, ask. That’s what AMEs are for. If the AME can’t answer your question, your Regional Flight Surgeon should be able to provide more clarity. Ultimately, if you feel like you shouldn’t be flying, then you probably shouldn’t fly. We’ll give you as many tools as we can, but safety is up to you as the pilot in command.

For More Information:

Do Not Issue — Do Not Fly: www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/pharm/dni_dnf

AME Guide: www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide