Federal Aviation Administration Office of Aerospace Medicine

Federal Aviation Administration

Office of Aerospace Medicine

Acceptable and Non-Acceptable

Medications/Drugs in Aviation

Medicine

Melchor J. Antuñano, M.D.

Director, Civil Aerospace Medical Institute

SUBSTANCE

MEDICATION: Substance use in diagnosis,

prevention, or treatment of illnesses or symptoms

DRUG: Narcotic of other substance with potential

for abuse

FAR 91.17

NO PERSON MAY OPERATE OR ATTEMPT

TO OPERATE AN AIRCRAFT:

• Within 8 hrs of having consumed alcohol

• While under the influence of alcohol

• With a blood alcohol content of 0.04% or greater

• While using any drug that adversely affects

safety

ACCIDENTS: 1989 - 2002

SCHEDULE 1 - 2:Marijuana 103

Cocaine 36

Codeine/morphine 46

Amphetamines 24

Barbiturates 30

Synthetic opiates 30

Methaqualone 1

ACCIDENTS: 1989 - 2002

SCHEDULE 3 - 5:Benzodiacepine 73

Phentermine 13

Phendimetrazine 1

OTHERS:Fluoxetine 38

Sertaline 19

Imipramine 7

Amitryptiline 10

Verapamil 35

ACCIDENTS: 1989 - 2002

OTHERS (CONT):

Phentoin 14

Diphenhidramine 140

Clorpheniramine 91

Pseudoephedrine 195

Phenylpropanolamine 168

Doxilamine 34

Quinine 66

PERCENT OF PILOT FATALITIES WITH

MEDICATIONS, ALCOHOL, OR OTHER DRUGS

U. S. 1989–2002 (4,786 fatalities)

0

5

10

15

20

25

30

89 90 91 92 93 94 95 96 97 98 99 0 1 2

SCH 1-2

SCH 3-5

RX

OTC

ALCOHOL

USE OF MEDICATIONS

FAIRLY COMMON AND VARIED PROBLEM IN

AVIATION:

Prescribed medications

Over-the-counter medications

Prescribed narcotics

Alcohol, nicotine, caffeine

Natural remedies (herbs)

WIDE DIFFERENCE OF OPINION AS TO WHICH

OF THESE LEGAL SUBSTANCES REPRESENT

A SAFETY PROBLEM

VARIATION IN EFFECT

INDIVIDUAL’S KNOWLEDGE OF THEMEDICATION’S EFFECT

Pilot’s past experience with medication maynot be predictive

INDIVIDUAL FACTORS Illnesses, fatigue, tolerance

ENVIRONMENTAL FACTORS VFR/IFR, day/night, type of aircraft, type of

flight

WHAT MUST BE CONSIDERED

INDICATIONS FOR USE: medication may beOK, but underlying medical condition maycompromise safety

SECONDARY EFFECTS: Predictable: antihistamines and drowsiness

Unpredictable: antihypertensives and potentialdecrease in G-tolerance

Idiosyncratic: heat intolerance

Synergistic: alcohol and antidepressants

GENERAL FAA ADVICE

Avoid medications that list drowsiness, impaired vision,

or impaired judgment as side-effects

If you must use medications wait at least twice the

recommended dosing interval before considering

returning to flight duties

Don’t fly for 24 hours after taking a medication for the

first time

FAA CRITERIA FOR NEW

DRUGS/MEDICATIONS

Rule of thumb: In general the FAA does

not grant medical certification for ANY

medication in a NEW DRUG CATEGORY

until one year has passed from FDA

approval

Usually Disqualifying Medications

Any routinely used psychotropic

Muscle relaxants (skeletal or smooth)

Experimental medications

Anti-Motion sickness medications

“Sedating” antihistamines

Reserpine, guanethidine, methyldopa

Tricyclic Antidepressants for ANY

medical condition

Selective Serotonin Reuptake Inhibitors

(SSRIs) for ANY medical condition

Specific Unacceptable Medications

Usually OK Acute Medications(If underlying medical condition OK)

Aspirin, acetaminophen, ibuprofen, topicals

Decongestants like pseudoephedrine

“Newer” antihistamines

GI meds (H2-blockers, antacids, Pepto)

Low-dose steroids

Antibiotics

OK If Not Intended for Use

During Flight

Viagra

Usually OK Chronic Medications

Antihypertensives

Non-steroidal anti-inflammatories

H2-blockers

Allergy shots

Prostate medications

Usually OK Chronic Medications

Xanthines, -agonists, cromolyn

Cholesterol-lowering agents

Hormones

Hypoglycemic agents

Glaucoma drops

Specific Acceptable Medications

ANTIHISTAMINES:

Non-Sedating are acceptable: Allegra

(Fexofenadine), Claritin (Loratidine), and

Clarinex (desloratadine)

Sedating not acceptable: Cetirazine (Zyrtec);

Dipenhydramine (Benadryl); Astelin

(Azelastine) Nasal Inhaler

ANTIHYPERTENSIVES:

ALL are allowed except: Reserpine,Methyldopa, Guanadrel, Guanabenz, &Guanethidine (because of potentialsedation)

Specific Acceptable Medications

ASTHMA MEDICATIONS:

ALL acceptable EXCEPT doses of steroids > 20 mg Prednisone

Xolair new (Omalizumab) for moderate to severe asthma is acceptable

Specific Acceptable Medications

LIPID LOWERING AGENTS:

ALL acceptable – Pilot is required to

notify FAA at time of exam

Specific Acceptable Medications

Gastrointestinal Medications:

Limited use of Loperamide (Imodium)

Unacceptable: Diphenoxylate (Lomotil),

Anticholinergics (Bentyl), Opiates (Paregoric)

Specific Acceptable Medications

Special Cases

The AME must defer a pilot who is taking continuous treatment with:

Anticoagulants

Antivirals

Anxiolytics

Barbiturates

FAA does not grant medicalcertification to a pilot who isreceiving:

Radiation therapy or chemotherapy for cancertreatment

Investigational therapy or unapproved use of

FDA approved medication

Special Cases

A pilot who has donated 200 cc ormore blood for plasmapheresis orwhole blood should not fly for at least24 hours

Special Cases

CASE SCENARIO

41 y/o airline transport pilot with

Colitis who has exacerbation and is

placed on high-dose steroids

What would you do?

CASE SCENARIO

50 y/o private pilot takes his son’sMethylphenidate, (Ritalin) because hefeels he has ADHD and the medicationmakes him more alert

Psychology testing including the TrailMaking Test (TMT), Wisconsin CardSorting Test (WCST), Pace AuditorySerial Addition Test (PASAT)

CASE SCENARIO

50 y/o airline transport pilot developsType II Diabetes Mellitus and is treatedwith Glyburide (sulfonylurea). He alsohappens to be on Atenolol for HTN

The AME issues – Was he right?

No, because beta bloquers maskhypoglicemic signs

CASE SCENARIO

45 y/o airman is given BupropionHCL (Zyban) for a trial of SmokingCessation.

The AME issues – Was he right?

No, because bupropion can causesedation

CASE SCENARIO

71 y/o pilot elects to receive External

Beam Radiation and insertion of

radioactive seeds (Brachytherapy) for

Prostate cancer

Can he get a commercial pilot medical

certificate?

During he active radiation therapy NO. But

after implanting radioactive seeds YES

Herbal (or Alternative) Medications

In general, the FAA accepts the use of these

medications

Do not accept those containing Ephedrine

due to cardiac toxicity

Remember: It is the medical condition, not

the medication that is the concern!

Diet Pills

The ONLY medication approved is Xenical

– Xenical (Orlistat) can cause diarrhea and thus a

30 day period of non-flying is required.

Websites with Aeromedical

Information

AOPA.org

EAA.org

leftseat.com

www.aviationmedicine.com

www.cami.jccbi.gov

Part 61.53

Prohibition on operations during a medical

deficiency

(a) . . . A person who holds a current

medical certificate issued under part 67 of

this chapter shall not act as pilot in

command, or in any other capacity as a

required pilot flight crewmember, while that

person:

Part 61.53

– (1) Knows or has reason to know of any

medical condition that would make the

person unable to meet the requirements

for the medical certificate necessary for

the pilot operation; or

Part 61.53

– (2) is taking medication or receiving

other treatment for a medical condition

that results in the person being unable

to meet the requirements necessary for

the pilot operation.