Mind Your Meds!
By Dr. Susan Northrup, FAA Federal Air Surgeon
Pilots often ask which medications are permissible for flight and where they can find this information.
Let’s check out some of the top prescription medications in the United States (according to GoodRx.com) and review how we consider them for medical certification. Here’s a link to the Pharmaceuticals (Therapeutic Medications) section of the AME Guide for further guidance.
💊 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 download) which you’ll also find helpful 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, 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. 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. 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.
💊 Hydrocodone/Acetaminophen (Lortab®, Vicoden®, Norco®): these pain medications can cause sedation and/or dizziness and are unacceptable for flight. Besides, if you need a 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.
💊 Diphenhydramine (Benadryl®): this is a common component in over-the-counter (OTC) sleep medications, many cough 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 a medication for a cold, flying is not a good idea anyway. For acceptable allergy medications, check out the Allergy — Antihistamine fact sheet.
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?
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?