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Sneezes and Zzzzs

Frederick E. Tilton, M.D; Federal Air Surgeon

Reprinted with permission from FAA Safety Briefing

As winter’s grip on most of the country slowly loosens, the countryside comes back to life. While most people regard the warming weather as nothing but good news, not everyone is so cheery. For those who suffer from seasonal allergies, the annual spring rejuvenation can be a very unpleasant time.

To cope with the sneezing and congestion, many allergy sufferers turn to over-the-counter (OTC) medications like Benadryl, Allergia-C, and other common allergy remedies. Though effective, these medications are not without side effects. In fact, the active ingredient in most of these medications is the same: Diphenhydramine. Diphenhydramine is a great medication that can be used not only for allergies, but also to treat cold, cough, and even motion sickness. It can even be used to treat allergies in your dog (but check first with your vet for dosing and instructions). But it also has a function that can be especially troubling for those of us in aviation: it acts as a sedative. More on that in a moment.

The Cure Can Be Worse?

In weighing the use of any medication, you always have to consider whether the cure is worse than the symptoms. Because many, if not all, medications have side effects, it is important to consider those side effects in your decision to take a medication, especially an OTC medication where a doctor and pharmacist are not involved in the decision. In the case of Diphenhydramine, side effects can include dry mouth, nose, and throat; drowsiness; dizziness; nausea; vomiting; loss of appetite; headache; muscle weakness; and nervousness.

While it’s unlikely you will experience all of these side effects, even one or two can have a negative effect on your ability to fly safely. So if you find yourself in a situation where you feel the need to take an allergy medication, you need to seriously consider whether you should be flying at all. Remember that it is your responsibility as pilot in command to ensure that you meet all applicable medical standards before any flight. No one expects you to be as skilled as an aviation medical examiner in determining your exact medical status, but you know your body. Just as with any flight, the FAA expects you to be honest with yourself when it comes to assessing whether you are fit to operate an aircraft as pilot in command.

Would You Fly on Sleeping Pills?

Now back to Diphenhydramine. The side effects are certainly a potential issue, but that’s not all. In addition to being used in OTC allergy medications, Diphenhydramine is an active ingredient in a number of sleep aid medications. These include Unisom, Sominex, and Nytol. It is also a key ingredient in most, if not all, labeled medications with the “PM” notation, such as Excedrin PM or Advil PM. Most people probably wouldn’t be aware that OTC medication taken for allergies is also widely used as a sedative. Another problem with Diphenhydramine is that some people are not aware of its side effects. Individuals who have taken Diphenhydramine often subjectively report that they feel “perfectly fine.” However, performance tests show that these same people were just as incapacitated as others who were legally intoxicated from alcohol. Needless to say, this knowledge should lead you to the conclusion that it is not a good idea for you to perform flight crew duties while taking these medications.

This discussion also highlights the larger issue for pilots: Our standards must be higher. We have to take a much greater interest in our medications, whether OTC or prescription, for how they could affect piloting ability. If you’re not sure, ask your AME. Better still, when in doubt, sit it out. Remember that flying is supposed to be fun … and you’ll have a much better, and much safer, flight when you are fit and free of potentially harmful medications.

Frederick E. Tilton, M.D., M.P.H., received both an M.S. and an M.D. degree from the University of New Mexico and an M.P.H. from the University of Texas. During a 26-year career with the U.S. Air Force, Dr. Tilton logged more than 4,000 hours as a command pilot and senior flight surgeon flying a variety of aircraft. He currently flies the Cessna Citation 560 XL.