Usually Acceptable Medicine
Atorvastatin (Lipitor®): this medication is used for high cholesterol and is allowed if the user experiences no significant side effects. Like any acceptable medication, wait at least 48 hours (some need a longer ground trial) after the first dose to make sure you have no problems with the medication. Lisinopril (Prinivil, Zestril): an angiotensin-converting enzyme inhibitor (ACE-I) used for high blood pressure or heart failure. Most high blood pressure medications are allowed after a seven-day ground trial. Review the disposition tables here (bit.ly/HeartHypertension) to see what information you need from your personal physician for your AME to issue a medical certificate under Conditions an AME Can Issue (CACI). Another resource is this FAQ page (bit.ly/HeartHypertensionFAQs) (PDF) where you’ll also find help for these next two medications. Amlodipine (Norvasc®): a calcium channel blocker (CCB) used for high blood pressure. If you take it for any other reason, let your AME know why. Losartan (Cozaar): an angiotensin II receptor blocker (ARB) used for high blood pressure. It also reduces the likelihood of stroke and protects against kidney disease in individuals with diabetes. It can be acceptable for all of these conditions. Albuterol (Accuneb®, Ventolin, Proair®, Proventil®): this medication is used to treat wheezing and shortness of breath from asthma or COPD. Review the CACI Asthma worksheet (bit.ly/CACIAsthma) (PDF), and bring a copy to your personal doctor, so they know which medications are acceptable for flight. Be sure to tell your AME what you use, how often you use it, and why. Levothyroxine (Synthroid®, Unithroid®, Levoxyl®): this medication is used for hypothyroidism. Review the CACI Hypothyroidism Worksheet (bit.ly/CACIHypothyroidism) (PDF). Provide a copy to your personal doctor to help ensure that their clinical note includes the information we need for medical certification. Metformin (Glucophage) for Diabetes: check out the Acceptable Combinations of Diabetes Medications (bit.ly/ComboDiabetesMeds) (PDF). This two-page chart lets you, your AME, and (if you bring them a copy) your personal physician know what medications the FAA allows for pilots and how long you must wait to return to active flying after starting, adding, or changing diabetes medication.
Unacceptable for Flight
Gabapentin (Neurontin®): used for seizures, nerve pain, or shingles pain, this medication can make you drowsy or dizzy, may slow your thinking, and cause loss of coordination. In fact, the prescription insert warns you not to drive a car or operate heavy machinery. Neurontin and similar sedating medications are referenced on the Do Not Issue — Do Not Fly list in the AME Guide (bit.ly/NoIssueOrFly). Hydrocodone/Acetaminophen (Lortab®, Vicoden®, Norco®): these pain medications can cause sedation and/or dizziness and are unacceptable for flight. Besides, if you need narcotic pain medication, you shouldn’t be flying. These medications are also found on the DNI-DNF list and in the Medications and Flying brochure (bit.ly/MedsFlying) (PDF). Diphenhydramine (Benadryl®): this is a common component in over-the-counter (OTC) sleep medications, many coughs and cold combination medications, and some allergy medications. It is the most common medication seen in fatal aircraft accidents. If you take it, you should not fly for 60 hours after the last dose. If you need medication for a cold, flying is not a good idea anyway. For acceptable allergy medications, check out the Allergy — Antihistamine page (bit.ly/AllergyAntihistamine) (PDF).
OTC Medication Example
Omeprazole (Prilosec): this is an OTC medication used to reduce stomach acid in many underlying conditions like heartburn, GERD, or ulcers. It is also available as a prescription medication in a higher dose. If you need an OTC medication, start here: What OTC medications can I take and still be safe to fly? (bit.ly/OTCMedstoFly) When in doubt about medications, ask your AME. Your personal physician might not understand the implications of many medications and/or conditions for flight safety. Ask them a simple question — Would they feel safe on an airplane if THEIR pilot was using this medication? 6 FAA Safety Briefing CONDITION INSPECTION CHRIS M. FRONT, PSY.D. AND RANDY J. GEORGEMILLER, PH.D. PILOTS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) Safety experts agree that at least 70% of aviation accidents are attributable to the pilot. NASA scientists report that most accidents result from some failure in the pilot’s cognitive performance, with distractions and errors in aeronautical decision making (ADM) most prominent. For example, when a pilot decides to launch into marginal VFR conditions, continues as conditions deteriorate, enters IMC, and loses control of the aircraft, the fatal crash may be categorized as a “loss of control” event, but it was rooted in poor ADM. Even experienced pilots with no impairing conditions occasionally make errors in ADM or get distracted. That fact led to the emphasis on CFIs creating realistic distractions in flight to teach effective distraction management, as well as scenario-based training and formal risk assessment tools to improve ADM. The likelihood of an accident rooted in distraction or poor ADM is heightened when the pilot has a condition that negatively affects such skills. Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with symptoms of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. ADHD occurs in approximately 5% of children and frequently persists into adulthood, affecting about 2.5% of adults. Three subtypes of ADHD are based on the symptoms exhibited: a “predominantly inattentive” presentation, a “predominantly hyperactive/impulsive” presentation, and a “combined” presentation. All three include symptoms that pose a hazard to flight safety. Inattention manifests behaviorally in ADHD as being disorganized, easily distracted, wandering off task, and having difficulty sustaining focus. Hyperactivity refers to an excessive motor activity or excessive restlessness, or talkativeness. Impulsivity refers to hasty actions without adequate consideration of possible consequences, despite the high potential for harm. NTSB investigations of fatal accidents attributed to ADHD have documented that pilots with ADHD: failed to adequately prepare for flight (e.g., did not check the weather), continued flight when it was ill-advised (e.g., due to deteriorating weather), engaged in hazardous actions (e.g., low-level maneuvering to show off), and became distracted and made critical errors (e.g., failed to maintain airspeed, stalled, and spun while circling a friend’s home at low altitude). Due to the risks to flight safety posed by ADHD, regulatory authorities worldwide consider ADHD a disqualifying condition for pilots. Unfortunately, pilots sometimes fail to disclose ADHD to their Aviation Medical Examiner (AME). The result is that the FAA learns about the condition after a fatal accident when the toxicology results reveal the presence of medication used to treat ADHD. Notably, pharmacological treatments for ADHD are not approved for flying because they can cause harmful effects on perceptual, motor, and cognitive functions and impair the recognition of fatigue. Additionally, their effectiveness is time-limited, a particular concern if a dose is missed or flight time exceeds the therapeutic impact of the drug. Complicating the picture is the fact that an inaccurate diagnosis of ADHD is not uncommon. Proper diagnosis of ADHD is a complex and time-consuming process. Medical providers, acting under time pressure and attempting to respond to the concerns of patients (or their parents), sometimes prescribe medication to treat ADHD or assign a diagnosis without adequate evidence of the disorder. The result is a subset of the adult population with a documented history of treatment for ADHD — some of whom truly had the condition and others who probably did not. To determine if the adverse impact of ADHD is present or not, the FAA requires a thorough evaluation by a licensed psychologist. It is most beneficial to see a psychologist familiar with the FAA’s specific protocols and standards. AMEs have access to a list of FAA-eligible providers to assist with referrals. The FAA’s evaluation requirements for a history of ADHD are available at the following link: bit.ly/AMEGuide. Upon review, the FAA will either deny the pilot’s application or grant an unrestricted or Special Issuance (SI) medical certificate. If the pilot receives a time-limited SI, further monitoring and assessment may be required. While time-consuming and costly, based on the safety risks posed by the symptoms of ADHD, the FAA has established this evidence-based risk assessment protocol to safeguard both the pilot and the national airspace system.