The Federal Aviation Regulations include no specific references to medication usage. Two regulations, though, are important to keep in mind. FAR 61.53 prohibits acting as pilot-in-command or in any other capacity as a required pilot flight crewmember, while that person:
Further, FAR 91.17 prohibits the use of "any drug that affects the persons faculties in any way contrary to safety."
In 1994 an important court case, Bullwinkel v. FAA & NTSB, challenged the FAA's policy authority to disqualify medications in the absence of a disqualifying medical condition. As a result of that decision, an emergency rule was invoked giving the Federal Air Surgeon authority to deny any "medications or other treatment that (a) makes the applicant unable to safely perform the duties or exercise the privileges of the airman certificate that the applicant holds or for which the applicant is applying; or (b) may reasonably be expected, within 2 years after the finding, to make the applicant unable to safely perform those duties or exercise those privileges."
The FAA generally disallows certain types of drugs that are continuously used for treatment. These include, but aren't limited to, antiviral agents, anxiolytics (anti-anxiety), barbiturates, chemotherapeutic agents, experimental, hypoglycemic, investigational, mood altering, motion sickness, narcotic, sedating, antihistaminic, steroids, or tranquilizers.
However, there is no official published FAA "list" of medications that are allowed for aviation use. AOPA has developed an extensive database of drugs that is based on the most current information provided by the FAA. Medication usage policy is continually reviewed and as new data on potential side effects becomes known, the FAA can alter the status of a drug. Although we make every effort to maintain the accuracy of our medication database, changes in FAA policy can affect the accuracy of the information.
There are several thousand medications currently approved by the U.S. Food and Drug Administration, not including OTC (over the counter) drugs. Virtually all medications have the potential for adverse side effects in some people. While some individuals experience no side effects with a particular drug, others may be noticeably affected. The FAA regularly reviews FDA and other data to assure that medications found acceptable for aviation duties do not pose an adverse safety risk. Drugs that cause no apparent side effects on the ground can create serious problems at even relatively low altitudes. Even at typical general aviation altitudes, the changes in concentrations of atmospheric gases in the blood can enhance the effects of seemingly innocuous drugs that can result in impaired judgment, decision-making, and performance.
Another important consideration is the condition for which a medication is prescribed that may itself be disqualifying. Medications are prescribed to treat a medical condition and the condition itself may be considered disqualifying, with or without medication usage.
Some of the most commonly used OTC drugs, antihistamines and decongestants, have the potential to cause some of the most noticeable adverse side effects, sedation and drowsiness. The symptoms associated with common upper respiratory infections, including the common cold, will often suppress a pilot's desire to fly, and treating symptoms with a drug that causes side effects only compounds the problem. FAR 61.53 places the burden on the pilot to determine fitness to flying.
Any drug that produces drowsiness or other central nervous system effects should not be taken prior to or during flight. Experimental or Investigational drugs, those that are in clinical trials or that have limited approval by the U.S. Food and Drug Administration (FDA) are prohibited. Additionally, narcotic analgesics, stimulants, sedatives, hypnotics, amphetamines, barbiturates, anti-anxiety drugs, muscle relaxants, tranquilizers, and antipsychotics (neuroleptics) are included on the “no fly” list. Among the drugs classified as stimulants are methylphenidate (Ritalin, Concerta), and amphetamine (Adderall), all of which are used to treat attention deficit disorder (ADD); however the FAA does not currently allow any of these medications for any condition.
Among the antidepressants, the FAA now considers Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa) and Escitalopram (Lexapro) under a policy adopted in April 2010. All other antidepressants are currently disqualifying, regardless of the reason for their use. These medications are often prescribed for "off label" use, that is, they are treating symptoms other than those for which the Food and Drug Administration approved the medication. Again, the underlying symptoms and diagnosis may be disqualifying, and the use of an antidepressant medication compounds the situation.
Anticonvulsants are disqualifying because of the specific medical history that may include a prior seizure, seizure-like event, or risk of seizure. Although these drugs minimize the possibility of a seizure recurrence, their usage does not absolutely preclude an event.
The current FAA guideline for use of an otherwise acceptable medication is to observe the dosing interval and wait 5 times that interval after the last dose before flying. For example, if the dosing instructions indicate, “take every four hours for pain,” wait 20 hours after the last dose before flying. This allows adequate time for the drug to reach the expected half-life, the time after ingestion when a medication’s effectiveness is reduced by 50%..
If you have any questions about medication usage, you can also view a list of medications online. If you need additional information, call the Pilot Information Center and speak with a medical certification specialist at 800/872-2672.
Updated March 20, 2014
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