As a general rule drugs and flying should not be mixed. Unfortunately there will be times when an exception to this rule will have to be considered. A pilot may find that they are in the circumstance where long term medication is necessary, or where a short term ailment that can be safely and effectively treated which would otherwise disable the pilot. This short article is intended to give some advice in this regard.

GENERAL PRINCIPALS

As a first principal it should be stated there are no absolutely "safe" drugs. Aspirin can probably be taken by the majority of the population with little risk of side effects, but in a few individuals it can cause problems with hearing, balance, nausea or a severe allergic reaction. It is imperative then that even a "safe" drug be trialed for a few days; at least a minimum of twenty four hours, before using it while flying for the first time. A retrial is also indicated if the individual's general circumstances have changed such as while dieting or following a significant illness.

When considering the potential effects of a medication on flying abilities the following factors need to be considered:

• Is the illness for which the medication is being taken compatible with flying. Because the risks of sudden disablement are too high, the individual with established epilepsy cannot pilot an aircraft, it does not matter how free of side effects their anticonvulsant medication is.

• Will the primary effect for which the medication be taken interfere with the pilots abilities. A relaxant, eg. diazepam or "Valium", is designed to slow reaction times and diminish the individual's alertness, an unacceptable state while flying.

• Can the medication's side effects interfere with the pilots abilities. This requires that the medications are predictable in their effects. Unacceptable medications will usually have effects on the nervous system; sedation, depression, or balance or vision disorders, or cardiovascular system; eg. low blood pressure.

In many cases the medication will carry a warning to the possible side effects; sedation and interference with driving or operating machinery, blurring of vision or dizziness and these warnings should be heeded. If you have any doubts then discuss the medication with your pharmacist or doctor. If you have been prescribed a medication, especially for long term use, then discuss its possible effects on flying with your doctor, there are often more acceptable alternatives. Cessation of a medication, taken over a period of time, can also be associated with side effects. As such do not cease a medication immediately prior to flying.

The following notes are provided as guide to some of the more common medications.

 ANALGESICS

The safest analgesic is paracetamol, the other nonnarcotic analgesics such as aspirin and ibuprofen being acceptable in those individuals not exhibiting side effects (usually nausea). The stronger pain killers containing codeine and dextropropoxephene (eg; Digesic) should not be used while flying due to increased risk of sedation.

The main concern with analgesics is for the condition for which the medication is being taken. Obviously if the pain is severe enough to be distracting then you shouldn't be flying.

ANTIBIOTICS

Generally the antibiotics themselves don't preclude flying, though the condition for which they are taken often does. Gastrointestinal side effects are a common problem hence the course must have been started at least a day prior to flying.

Tetracyclines can be associated with a skin reaction following prolonged exposure to sunlight, a potential problem with longer glider flights.

HAY FEVER MEDICATIONS 

The earlier antihistamines are contraindicated for flying due to potential sedation. These (and narcotic analgesics) are a common ingredient in many over the counter cough and cold remedies. The more recent non-sedating antihistamines (eg; Telfast, Teldane, Hisminal) appear not to have any significant side effects and can be safely used while flying.

Nasal sprays, either decongestants or nasal steroids are also considered safe for use.

Again the main limitation in this condition is it's effect on the sinus's and ears and the ability to adequately equalise with pressure changes.

ANTIHYPERTENSIVES 

Most modern antihypertensive agents are acceptable, once the pilot is established on the treatment and no adverse side effects have been demonstrated. Agents in this group include diuretics, ACE inhibitors, calcium channel blockers, prazosin and betablockers. Earlier antihypertensives can be associated with unacceptable risk of sedation or low blood pressure and dizziness.

Because of their interference on blood pressure regulation and G tolerance betablockers and prazosin are not acceptable for pilots indulging in aerobatics.

GASTROINTESTINAL MEDICATIONS

Antacids are generally regarded as a safe medication. H2 antagonists, eg; Tagamet, Zantac, used in the treatment of non-ulcer (an active ulcer would preclude flying) disease are also regarded as safe.

Many of the antidiarrhoeal medications contain either narcotics or anti-cholinergics (a class of drug often associated with blurring of vision as a side effect) and are contraindicated. Diarrhoea and vomiting is the commonest cause of sudden in flight incapacitation (at least in the GA scene) and is hence a contraindication anyway.

ASTHMATIC MEDICATIONS 

Inhaled steroids (eg; Becotide, Aldecin, Pulmicort), cromglycate (eg; Intal), or occasional bronchodilators (eg; Ventolin, Bricanyl, Respolin) for the control of asthma where there is no history of severe or disabling attacks is acceptable. The use of oral medications such as steroids would imply a more severe degree of asthma which would possibly preclude flying.

SLEEPERS

The newer shorter acting hypnotics such as temazepam (eg; Euhypnos, Normison, Temaze) are acceptable if taken at least ten hours before flying. Note that these medications should only be used for short periods. The older hypnotics such as nitrazepam (eg; Mogodon) persist in the body for an unacceptable period and are contraindicated.

SUMMARY

Again it is important to emphasise that even the "safe" drugs listed above require a trial on the ground before using them while flying. Also the guide above is only for the medications used individually, used in combination the potential for side effects increases further and unpredictably and must be avoided.