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  Medications  

Abnormal Procedures (Physiological)

 


 

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Cartoon: Boarding, from Chris Manno

Regulatory

[14 CFR 67, §67.113 First-Class Airman Medical Certificate / General Condition]

The general medical standards for a first-class airman medical certificate are:

(a) No established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control.

(b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—

(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

(c) No medication or other treatment that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the medication or other treatment involved, finds—

(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

[Aeronautical Information Manual, ¶8-1-1.c.]

  1. Pilot performance can be seriously degraded by both prescribed and over-the-counter medications, as well as by the medical conditions for which they are taken. Many medications, such as tranquilizers, sedatives, strong pain relievers, and cough-suppressant preparations, have primary effects that may impair judgment, memory, alertness, coordination, vision, and the ability to make calculations. Others, such as antihistamines, blood pressure drugs, muscle relaxants, and agents to control diarrhea and motion sickness, have side effects that may impair the same critical functions. Any medication that depresses the nervous system, such as a sedative, tranquilizer or antihistamine, can make a pilot much more susceptible to hypoxia.
  2. The CFRs prohibit pilots from performing crewmember duties while using any medication that affects the faculties in any way contrary to safety. The safest rule is not to fly as a crewmember while taking any medication, unless approved to do so by the FAA.

Advice from the Feds to Pilots

[Medications and Flying]

  • First, consider the underlying condition that you are treating. What will be the consequences if the medication doesn’t work or if it wears off before the flight is over? A good general rule to follow is not to fly if you must depend on the medication to keep the flight safe. In other words, if the untreated condition is one that would prevent safe flying, then you shouldn’t fly until the condition improves — whether you take the medication or not.
  • Second, you must consider your reaction to the medication. There are two broad categories of medication reactions. One is a unique reaction based on an individual’s biological make-up. Most people don’t have such reactions but anyone can, given the right medication. Because of this, you should NEVER fly after taking any medication that you have not taken before. It is not until after you have taken the medication that you will find out whether you have this uncommon and unexpected reaction to the medication.
  • Third, consider the potential for adverse reactions, or side effects — unwanted reactions to medications. This type of reaction is quite common, and the manufacturer of the medication lists these on the label. You MUST carefully read all labeling. If you don’t have access to the label, then don’t fly while using the medication.
  • If you must take over-the-counter medications:
    • Read and follow the label directions.
    • If the label warns of significant side effects, do not fly after taking the medication until at least five maximal dosing intervals have passed. For example, if the directions say to take the medication every 4-6 hours, wait until at least 30 hours after the last dose to fly.
    • Remember that you should not fly if the underlying condition that you are treating would make you unsafe if the medication fails to work.
    • Never fly after taking a new medication for the first time until at least five maximal dosing intervals have passed and no side effects are noted.
    • As with alcohol, medications may impair your ability to fly—even though you feel fine.
    • If you have questions about a medication, ask your aviation medical examiner.
    • When in doubt, safety first—don’t fly.
  • When your treating physician prescribes a medication for you, be sure to ask about possible side effects and the safety of using the medication while flying. Since most of their patients are not pilots, many physicians don’t think about the special needs of pilots when they prescribe medication. You must also discuss the medical condition that is being treated. You may want to ask your physician to contact your aviation medical examiner to discuss the implications of flying with the medical condition and the medication.

Common side effects of frequently used OTC medications:

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Advice from the Feds to AMEs

Finding a good AME can be a chore but it is worth the effort. Over a four year span I had an AME who was thrown in jail for pedophilia, another died flying his Sabreliner into a mountain, a third was thrown in jail for tax evasion. And then I found one who is also an airline pilot for a major carrier. Jackpot!

The process made we wonder about the first three AMEs and how they managed to do their jobs despite other problems. The answer, or at least part of it, is at FlightPhysical.com (AME Area). It gives them the advice they need to answer your questions.

An Approved List of Medications?

The U.S. Federal Aviation Administration does not publish a list of "approved" medications for pilots. However, FAR 61.53, 67.113, 67.213, 67.313 and 91.17 preclude flying while having a condition or taking a medication that might affect flight safety. The following link contains medication information specific for Air Traffic Control duty (note that even if allowed for ATCS duty, medication use must be reported to the Regional Flight Surgeon before return to controlling): ATCS Drugs 2009-05-13.

The Aviation Medicine Advisory Service offers a search engine which provides advice for specific medications: AMAS Medication List.

References

14 CFR 67, Title 14: Aeronautics and Space, Medical Standards and Certification, Federal Aviation Administration, Department of Transportation

Aeronautical Information Manual

FAA Publication OK 05-005, Medications and Flying, Rev 6/10

Revision: 20140504
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