Pilots, OTC Drugs Can Be Interactively Bad

By Scott Spangler on January 13th, 2020

Over-the-counter-drug-abuseA recent New York Times story about the hidden drug epidemic rooted in the conflict between prescribed medications and over-the-counter (OTC) drugs and supplements focused on people in their 60s, but as I read, I could easily see that pilots taking prescribed medications could also be unknowing participants.

According to the article, people in their 60s take an average of 15 prescriptions a year. “And that’s in addition to the myriad of over-the-counter drugs, herbal remedies, vitamins and minerals they may take, any of which — alone or in combination — could cause more problems than they cure.”

Taking aspirin or another nonsteriodal anti-inflammatory drug (NSAID) such as ibuprofen, for example, could heighten the chances for bleeding for those taking a prescribed anticoagulant like Coumadin.

This combination of prescribed and OTC drugs—and their interactive side effects—is known as “polypharmacy.” It is the result, the article said, “of our fragmented health care system, rushed doctor visits, and direct promotion of drugs to patients who are ill equipped to make rational decisions about what to take, what not to take, and when.”

Contributing to it are the number of prescribing physicians, who may not know what the prescribed and OTC drugs the person is taking, and this is what made me think of pilots, especially if they fly for a living. Rare is the professional pilot I’ve known who will volunteer anything that might put a medical certificate in jeopardy.

pand mGiven the consequences to such pilots and those who fly with them, this is foolish and shortsighted. Everyone should compile a list of every prescribed and OTC drug and supplement they consume and use it as a checklist when any doctor asks what you’re taking. And if the doc doesn’t ask, be a proactive patient and present it before the appointment end, especially if there is another prescription in the offing.

Before any pilot swallows an OTC drug new to them, they should read the FAA Aviation Safety page, Pilots and Medication. Here’s the attention getter: “Impairment from medication, particularly over the counter (OTC) medication, has been cited in a number of accidents in general aviation. In a 2011 study from the FAA’s CAMI Toxicology Lab, drugs/medications were found in 570 pilots (42%) from 1,353 total fatal pilots tested. Most of the pilots with positive drug results, 511 (90%), were flying under CFR part 91.”

Then pilots should run the OTC checklist in What OTC Medications Can I Take and Still be Safe to Fly? An affirmative answer to questions such as “Am I having trouble clearing my ears at ground level?” and “If currently taking a medication only for symptom relief, would you be safe to fly without it?” yields this warning: “STOP. You might not be fit to fly!”

chose otcThis page includes a table that lists go/no-go medications and the rational for the rating. The table also lists the medication or active ingredient that determines the medication’s go or no-go rating. The table lists the frequently used OTC medications: Antihistamines; Nasal Steroids; Nasal Decongestants; and Cough remedies.

After reading the active ingredients in the go/no-go table, you’re ready for the three-step evaluation of choosing an OTC medication. 1. Identify the active ingredients. “Verify that you have taken this medication in the past with no side effects. 2. Read the label. If it warns of possible drowsiness or to “be careful when driving,” it is not safe for flying. 3. Read the directions carefully. “If this is the first time you are taking a new medication, wait at least (5) dosage intervals and ensure that you suffer no adverse effects from it before flying while on the medication.”

A pilot’s aviation medical examiner is the ultimate resource when it comes to avoiding interactive drug problems. If there is a conflict between the prescription and OTC medications, an AME, said the Pilots and Medication page, in many cases can recommend treatment options “that may allow you to fly.” –Scott Spangler, Editor


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