Medications on the Mind: Flying (or not) with Drugs:111

Over the last two months we’ve been talking about the many problems that can pop up when using medicines while flying.

Side effects to watch for in the labeling of over-the-counter medications include light-headedness, drowsiness, dizziness and visual disturbance.

Allergy, cold and sinus medicines are some of the most common culprits. Be very careful if you are thinking about taking any of those.

Prescription medications usually don’t come with a list of side effects so it’s important to ask your doctor or pharmacist if the drug might cause anything that would impair your ability to fly.

We also pointed out that there are a lot of medications that will absolutely ground you either because of their side effects or because of the medical condition that they are used to treat.

Here are a few tips from the FAA on how to sort out these issues:

• Consult with your AME before flying while using prescription and/or OTC drugs. When you come in for your flight physical be sure to list all the medicines you are taking be they prescription or over-the-counter. If you are inhaling something or squirting it up your nose or any other orifice, it’s a drug. List it on the 8500-8 form you fill out on MedExpress. If you have an accident or incident and the NSTB finds out that you were taking a medication you did not report to your AME, there may be trouble a-brewin’!

• Make sure your AME knows about all the drugs you take and the medical conditions requiring their use. As we just said, tell all to your AME. It is important to list all your medications and to note any and all medical conditions you might have. Just last month I was copied on a very ominous letter the FAA sent out to an airman to whom we issued a Second Class Medical Certificate. It turns out that he has Attention Deficit Hyperactivity Disorder and is on psychoactive drugs to try to control it. He never said anything to me or to the FAA about it, but they did find out. The Med in Black might well be showing up at his door!

• Let your prescribing doctor know that you are a pilot. You can’t expect your primary care provider to be a Flight Surgeon but she darn well knows the potential for reactions to the medicines she gives you. If she knows you are going to plow through the air at 200 mph she will probably not treat you the same as if you were a couch potato flying video games.

• Ask about adverse effects associated with drug combinations. This is a tough question. There are hundreds upon hundreds of commonly used drugs out there with hundreds of thousands of possible interactions. Fortunately health care providers do generally have access to databases that can list potential interactions among the medicines you are taking. Ask them to check this. Your pharmacist probably will be the most knowledgeable and have access to the best data.

• In between doctor visits you are self-assessing your condition before each flight. Ground yourself when you are not fit to fly. So let’s say you’re all stuffed up and at bedtime you take a cold pill that has a sedating antihistamine. You wake up the next morning and feel good. Can you hop into the cockpit? Probably not. As a general rule of thumb when you take a potentially impairing medication you should wait for five times the maximum hour dose interval before flying. So let’s say the cold pill bottle says “take one every four to six hours as needed.” You should wait 30 hours (5 x 6 hrs.) at a minimum before flying. Notice I said “at a minimum.” Some of the antihistamines in cold and sleep aids can have a “hang-over” effect that lasts longer than the 5-times-the-dosing-interval period. Listen to your body. If it hints that it’s not at par, wait before flying.

• Never fly after taking a new medication for the first time until at least 48 hours have passed and no side effects are noted. Remember that everyone is different. Everyone has a different degree of susceptibility to side effects and that varies from drug type to drug type. In other words, there is no way to predict. So sit tight for a while before you “kick the tires and light the fires!”

Fly wisely. See you next month.

As always, comments, questions and suggestions are welcome:

jdlakin@mnallergyclinic.com