Drugs - the legal kind

July 31, 2012

pps
Warren Silberman

Warren Silberman

  • Former Manager, FAA Aerospace Medical Certification 
  • Doctor of Osteopathic Medicine 
  • Expert in Aerospace/Preventive Medicine 
  • Pilot since 1986

Pilots are often asking why a given drug their regular doctor has prescribed does not appear on our list of “approved” medications. Well, here is the truth of the matter: The FAA does not give its approval of an FDA-approved medication until the drug has been available for one year.

This is not an arbitrary and deliberately obstructive move on their part; the FAA wants to see how the medication reacts on the body when a large population is exposed, over and above what was established in the clinical trials mandated by that other federal giant, the Food and Drug Administration. Specifically, are there any side effects that could be germane to aviators?

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Sometimes side effects that were not seen when the drug is used during its test phase only become obvious after it has been used by the general population. One great example that comes to mind is the medication Varenicline (Chantix), a drug that physicians use to reduce the urge to smoke cigarettes and for other addictions.

After the medication had been in general use for quite some time, people using Chantix began to complain of behavior change, hostility, agitation, depression, and suicidal thoughts, as well as worsening pre-existing psychiatric illnesses. Even though the FAA had waited the one year, the agency had to backtrack and disallow the medication. Makes sense really: One does not want a pilot flying angry!

So please keep this in mind when you see your non-AME treating physicians and they suggest placing you on a new medication; first log on to the AOPA member site and check the medication list. Since your AOPA Pilot Protection Services program specialists deal with the FAA medical certification division on a regular basis, they are able to maintain an up-to-date list and are available to support you in dealing with all medication issues.

When considering a given drug, the FAA physician usually considers the disease state before the specific medication being used to treat the condition. However, both the medication and the condition can be a basis for having a denial of medical certification.

Some entire categories of drugs are unacceptable for use when flying, and this applies to those of you who hold and use an FAA medical certificate. Airmen may not take narcotic analgesics and then go out and fly. Specific examples of these medications are: codeine, Fiorinal (butalbital, aspirin, and caffeine), demerol (meperidine), lortab (hydrocodone/acetaminophen), percocet (oxycodone/acetaminophen), tylenol#3 (acetaminophen/codeine), Ultram (tramadol), and vicodin (hydrocodone/acetaminophen). Many of these medications come in different forms such as fioricet and percodan. The companies substitute acetaminophen for aspirin, but they still contain the narcotic that is unacceptable to the FAA.

These medications all cause a sedative effect (hence “narcotic” from the Greek meaning to be stiff or numb) and are also addictive. The FAA will allow very occasional use, but then the airman will be warned that they cannot fly for five dosing intervals, which would mean that if you were taking Fiorinal every four hours, you could not fly for 20 hours. I personally never liked this practice—either a medication is acceptable or not.If a pilot has a condition that requires one of these medications then he or she should not be flying. Again, think about it—strong painkillers likely mean you have serious pain or health issues, and that alone should be a reason to stay on the ground for the time being.

For more information on the AOPA Pilot Protection Services program, visit www.aopa.org/pps.