FAA Provides Cold- and Flu-Season Medication Guidance
By ALPA Staff
With cold and flu season well under way, the FAA’s Office of Aerospace Medicine recently provided some additional direction to aviation medical examiners regarding airline pilot use of over-the-counter (OTC) medications to treat these conditions. Some of these drugs include decongestants and antihistamines, which may contain ingredients that produce little or no apparent side effects for pilots on the ground but can cause issues when they become airborne.
The August 28 edition of the Guide for Aviation Medical Examiners provides a quick reference table for medications that are safe to take as well as others that should be avoided before flying, and the agency’s rationale behind these decisions. Symptoms of these common fall and winter illnesses include fever, head and muscle aches, and congestion, which can divert pilot attention, impacting general awareness and decision-making abilities.
The recent guide recommends nonsedating medicines like fexofenadine (Allegra) and loratadine (Claritin) for seasonal coughs and colds. However, the FAA prohibits the use of brompeniramine (Dimetapp), cetirizine (Zyrtec), chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), and levocetirizine (Xyzal) when flying. These latter drugs are sedating antihistamines that cause drowsiness and can impair judgment.
Some sedating medications can increase the risk of hypoxia, a deficiency in the amount of oxygen reaching tissues. Consequently, these specific medicines have been prohibited by the FAA. As a general rule, make sure you understand the potential side effects of any medicine before taking it.
Other medications for conditions listed in the OTC Medications Reference Table that are generally safe to take while flying include acetaminophen, aspirin, ibuprofen, and naproxen (Naprosyn) for related aches and pains.
The August guide advises, “If you take any of the no-go medications listed in the OTC Medications Reference Table or if you have previously had side effects from the medication, wait at least five dosage intervals after the last dose before flying.” The guide notes that “sedating antihistamine medications have a long half-life so wait time is 60 hours for both diphenhydramine (Benadryl) and doxylamine (Unisom) and five days for both chlorpheniramine (Chlor-Trimeton) and Clemastine.”
Corresponding sinus problems affecting the inner ear and nasal passages can further affect pilot performance. Atmospheric pressure changes occur when the aircraft climbs and descends, causing severe pain in the nose, ears, and eyes for those affected. Nasal decongestants like oxymetazoline (Afrin), phenylephrine (Sudafed PE), are pseudoephedrine (Sudafed) are appropriate treatments, but be aware that Sudafed-like medicines can increase heart rate—an important consideration for anyone with an underlying heart condition.
Saline nasal sprays and neti pots (i.e., devices that force a stream of saline solution through the nasal passages, clearing out trapped mucus and allergens) are safer bets.
Cold and flu preventative measures include avoiding those who are sick, covering your mouth when you cough, and regularly washing your hands. These simple practices can help contain the spread of germs and limit respiratory illnesses.
In addition, the U.S. Centers for Disease Control and Prevention recommends that those six months and older get a flu vaccine every season (unless a special condition prevents those from heeding this advice). Flu shots reduce the risk of flu illnesses and hospitalizations.
Keep in mind that for your safety and the safety of your passengers, crewmembers, and others, 14 CFR 61.53 prohibits you from acting “as pilot in command, or in any other capacity as a required pilot flightcrew member, while…taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirements for the medical certificate necessary for the pilot operation.” And per Canadian aviation regulations Section 404.06, pilots are prohibited from exercising their privileges if they have an illness, injury, or disability; are taking medications or drugs; or are undergoing medical treatment that could impair their ability to function safely.
Have Questions?
U.S. ALPA pilots with general health and medical certification questions are encouraged to contact the Aviation Medicine Advisory Service, ALPA’s Aeromedical Office, Monday–Friday 8:30 a.m. to 4:00 p.m., mountain time. Additional information is available on the AMAS website at AviationMedicine.com, including related materials in its medical article database. ALPA members based in Canada should contact ALPA Canada’s aeromedical consultant at 800-561-9576 ext. 8312 or visit pilotmd.ca for assistance.
