RX AVIATION — Another Panicked Phone Call…

Stan Musick | stan@agairupdate.com

Frequently, my phone rings…and the voice on the other end is a pilot who has justbeen at an AME office and has been deferred/denied a medical. “Doc, I’m healthy as ahorse. But he/she said they can’t issue a medical!”

As we start to dissect the situation, frequently it’s an issue of being on a medication that is on the “not allowed” list. (https://www.faa.gov/about/ office_org/headquarters_offices/avs/offices/aam/ ame/guide/pharm/dni_dnf/)

My latest caller had been given Neurontin for his back pain, and as a result of taking it, he became dizzy, and fell off a ladder. Fortunately, he had no head trauma, and as soon as he had been off the medication for a few days he had complete resolution of his symptoms. He does have to report the incident, but he cannot fly while taking the medication! (Naturally, he has sworn off the medication completely).

Many medications are simply not allowed… either due to the disease they are treating (think coronary artery disease), or because of the side effects (as the Neurontin discussed above has). Many medications leave the individual feeling completely normal, but their reaction time and alertness are impaired. Muscle relaxants are especially important in this regard. Even a small change in your reaction time can be dangerous going down the field at 150 mph!

Ag pilots need to especially be aware of two forbidden classes…weight loss medications, and smoking cessation medications. Both are “do not issue” drug categories!

Two categories of medications are mentioned… ”do not issue”, which are medications that imply a condition in which the airman may be impaired

(angina drugs, cancer drugs) from the disease, and “do not fly” medications. The medications in the “do not fly” list can be taken, but you are not “okay to fly” until five “half-lives” of the medication have elapsed.

What is a “half-life”? That is the period of time required for half of the medication to disappear from your system, either by excretion (bile, urine, bowel) or by metabolism (often in the liver). Some medications have a very long half-life… Benadryl, for example has a half-life of 12 hours… so “five half-lives” would be 60 hours after the last dose before you can safely fly. Half-lives of drugs are easily obtainable by an internet search.

Sleep aids are especially tricky, as they have a widely differing half-life depending on the particular drug. (Restoril has a 72 hour waiting period!) Underlying medical disorders must be treated, despite some drugs short half-life (Flying is allowed 6 hours after use of Sonata, for example). The FAA specifically prohibits daily or frequent use, but does allow occasional use, as long as the required waiting period has been met. (see https://www.faa.gov/about/office_org/ headquarters_offices/avs/offices/aam/ame/guide/ pharm/sleepaids/)

Should your physician prescribe a drug, consult the links above, or call your AME! It is far easier to not take a drug, or find an alternate, than it is to deal with the “medical certificate consequences”!