A List at Long Last

By Michael Berry, M.D., Federal Air Surgeon

Source: FAA Safety Briefing, Jan/Feb 2020

Probably the most consistent question I get when talking to airmen is, “Why isn’t there a list of approved medications from the FAA?” The answer was always that the request was actually far more difficult than most people understood. Having an approved list means having one not only for you, but also for every other pilot across all classes of medical certification as well as alternative qualifications. But that has changed.

The Challenges

Several major issues have always made this holy grail of aerospace medicine a herculean task. First, every medication can have different effects on different people. Any list of approved medications would have to cover any potential impairment for any airman. In many cases, medications that seem innocuous (e.g., Diphenhydramine/Benadryl^®) can have dangerous side effects. Next is the fact that no two illnesses/diseases are identical. That leads to point three: the underlying condition for which you are taking the medication could be disqualifying. These issues only scratch the surface of our required considerations.

But we understand that there is a challenge for airmen as well. Ultimately, an airman is responsible for determining whether they are fit for flight under Title 14 Code of Federal Regulations (14 CFR) section 61.53. We understand that such a list is a valuable resource in making that determination.

The Long Awaited Prize

The General Aviation Joint Steering Committee (GAJSC) requested a list as part of an effort to educate pilots on the dangers of certain medication use while flying. Working with the GAJSC, the Office of Aerospace Medicine has produced a document to help guide pilots in making that fitness decision.

The guide opens with a preamble that discusses factors you should know and consider when using it. First, evaluate your condition, then examine the medication for obvious warnings such as “Do not operate machinery.” Next you need to be able to determine what exactly you are taking. The document provides a guide to over the counter (OTC) drug labels that should help because you can often find the same active ingredient in many different brand names and sometimes for treating different symptoms. Prescription drugs won’t feature the standardized label, but do indicate what they are and usually a common trade name.

Multiple Choice

When evaluating a possible medication, keep in mind the two primary concerns for aeromedical fitness are subtle and sudden incapacitation. Will this medication degrade your performance in a way that you will be unable to detect? Will this medication cause you to lose consciousness with little or no warning? When you have a choice, this guide can help you pick an option that should be safe to use.

For example, let’s take a look at some common cough/cold medications. Most medications not labeled “PM” are usually safe for flight, but there are some exceptions. It’s important to look at all the active ingredients. Anything that contains dextro-methorphan (that includes Dayquil^®) is not allowed. Another common ailment is gastrointestinal illness. Medications containing bismuth subsalicylate like Pepto-Bismol^® or Kaopectate^® are fine, but those containing Loperamide, like Imodium^®, are not. It’s a good idea to test out a medication prior to using it while flying in case you have an adverse reaction.

It would be easy to view all of those medications as roughly equivalent, but from an aerospace medicine point of view, they are not. This is why this guide has such great potential to help airmen treat illness while staying safe. The guide is a reference, but ultimately, you are still the final authority.

Learn More

What OTC Medications Can I Take and Still Be Safe To Fly? - www.faa.gov/go/pilotmeds

Dr. Michael Berry received an M.D. from the University of Texas Southwestern Medical School, and a master’s in preventive medicine from Ohio State University. He is certified by the American Board of Preventive Medicine in aerospace medicine. He served as an FAA senior aviation medical examiner and vice-president of Preventive and Aerospace Medicine Consultants for 25 years before joining the FAA. He also served as both a U.S. Air Force and NASA flight surgeon.