AircraftOwner Online

I frequently get calls from pilots who want to know if a new drug that has been recommended is OK with the FAA. The problem is that there really is not an approved drug “list” by the FAA. There are many good reasons for this which I will attempt
to explain.

    First, the FAA Civil Aviation Medical Institute (CAMI) in Oklahoma City is concerned about a pilot’s ability to fly and the risk of sudden incapacitation. All medications have side effects. Many are predictable and many are not. Since there are thousands of medications and they are changing frequently, there is no way the FAA can monitor and maintain a list of “approved” medications which have “acceptable” side effects and do not cause incapacitation.

    The FAA is also concerned about what condition the medication is being taken for. Some medications, like bupropion are OK for smoking cessation as long as it is not taken in proximity to flying where bupropion taken for depression is not OK. The logic from the FAA is they are concerned about depressed pilots and not about people trying to quit tobacco products. (I do not agree with this logic since I would much rather be flying with a pilot whose depression is being treated versus one whose depression is not being treated.)

    The FAA does have some general rules about medications which do not necessarily prohibit or allow their use in toto. In general, the FAA prohibits sedating, psychoactive medications such as narcotics, sleeping or other sedating medications. They do not allow seizure medications because they do not allow anyone with seizures to fly. The FAA does not allow any antidepressants or stimulants like amphetamines. They do not allow motion sickness medication since they do not want pilots flying who get motion sick plus these medications cause sedation and blurred vision. Just for kickers, they do not allow Viagra to be taken in proximity to flying because it can affect color vision so guys with ED who want to join the Mile High Club just cannot get lucky!

    So how does an organization like the AOPA have a list of “approved” medications? What the AOPA has done is to collect information on pilots who have been approved on various medications and added medications which the FAA has specifically said were OK (not a list, mind you, but a few standard OKs). What is actually frustrating as an Aviation Medical Examiner is some drugs which were always denied by CAMI are suddenly OK and the only way AMEs hear about it is through the grapevine. Believe it or not, the FAA does not send blast Emails to AMEs due to some type of government regulation.

    Even medications that are always forbidden can be given
special OKs for use. I have had a patient on Beclofen, a sedating drug, receive a Special Issuance for use via an indwelling spinal catheter. In rare cases, some pilots have been approved for Ritalin (a stimulant) use for ADD but they had to prove they could operate an aircraft by taking lots of expensive medical tests.

    The issue of antidepressant medication has been a thorn in the FAA side for some time. They have always denied these medications and have been concerned about the underlying condition for which they are taken. The Aerospace Medical Association has encouraged the FAA to license pilots on third class medicals on antidepressant medications as a test group since AsMA did not feel these medications would adversely affect piloting skills. Even in a recent AME satisfaction survey for the FAA, AMEs urged reconsideration of the government’s position on antidepressant medication.

    The bottom line is the FAA moves slowly but they do move. When I first became an AME, very few blood pressure medications were approved for use by pilots. Now, too many years to count later, very few medications for blood pressure are not approved. The same goes for many cardiac medications.

    My sense of the FAA at this point is under Dr. Fred Tilton, who has been Federal Air Surgeon for about two years, and Dr. Warren Silberman, who is head of CAMI, major advances in approval of medications are forthcoming due to their progressive thinking. They have reduced the backlog of Special Issuance cases from over 100,000 to less than 1,000 during the past few years, so who know what is in store for medication approval in the next few!