What every pilot needs to know about medication

The next time you have your pilot’s licence in hand, flip it over. If your Aviation Medical Examiner (AME) has printed your latest medical certificate on the official CAA paper, prepare to be amazed.

I’m being a tad facetious of course, but there is some really important information there that you may not have noticed before. Specifically, I want to draw your attention to the fact that you need to inform your AME when you are taking any chronic medication.

It continues to surprise me how many pilots will take medication prescribed by their GP without checking with their AME if it’s safe to do so. And at times, they don’t even understand exactly why they are taking it. When this happens, I invariably find out anyway and then it takes a lot of time and effort to resolve the situation − once I’ve separated my palm from my forehead, of course.

Mosts GPs have no aviation medicine training

GPs have a tough job. They often have no more than 15 minutes allocated per patient. During the consultation, the patient presents a main complaint and the GP takes a quick history, conducts a brief examination and offers a possible solution. Broadly speaking, they do not have any training in aviation medicine.

Although I am obviously generalising, the mainstay of patient care (or a “solution”) equates to a script for the pharmacy. Telling your GP that you’re a pilot won’t always guarantee a prescription for allowable medication. You must check with your AME.

Serious side-effects, serious consequences

I have seen GPs prescribe strong sedatives to airline pilots for work stress, anti-depressant medication for marital strife, potent analgaesia for back pain and even diabetic medication (usually Metformin) for insulin resistance. These are all drugs with potentially serious side-effects.

You may not realise that side-effects of medication on the ground will be magnified when you’re at altitude. This is due to a combination of decreased oxygen and atmospheric pressure, disequilibrium and stress to name just a few factors. The results can be very dangerous. So why are pilots prescribed drugs that have the potential to impact their ability to fly safely?

You may not realise that side-effects of medication on the ground will be magnified when you’re at altitude.

Pilots are not “normal” patients

I’m not saying that GPs don’t offer a valuable service or do an amazing job under difficult circumstances, but pilots need to be aware that they are not normal patients. The side-effects they experience from taking certain medications could have devastating consequences.

Let me use the diabetic medication scenario as an example, because I come across this more often than I would like to admit. Metformin certainly may be a good suggestion where the patient is struggling with obesity and insulin resistance, or pre-diabetes is evident. It helps to sensitise your cells to your own insulin. There are, however, some major aeromedical pitfalls that the GP (and evidently the pilot) don’t always consider.

The combination of poor diet and Metformin may result in low blood sugar. Diabetic patients are trained to monitor their blood glucose, but generally, people who’ve been prescribed this drug during a 15-minute consultation are not. Low blood sugar may result in fainting. Obviously this is not an ideal situation for your passengers or co-pilots!

A word of warning  

If you are taking undisclosed medication and have an accident, the insurance company will have a legal reason to not pay the claim. Furthermore, you or your estate may be criminally liable for damages caused.

All prescription medication is recorded, and that you’ve taken it will be easy to prove during a forensic investigation.  Also, if the CAA is tipped off that you’re using undisclosed medication, you’re in for a world of trouble. A common mechanism for this disclosure seems to be an angry spouse. I kid you not.

Mood-stabilising drugs

Anti-depressants are another dispensing favourite. I do sometimes question the wisdom of getting your pharmaceutical mental health care from your GP instead of a psychiatrist. But be that as it may,  these medications certainly work wonders. But like diabetes, suffering from a mood disorder, even if temporarily, needs careful monitoring.

You can definitely fly on most of these medications, but compliance and adherence to the published medical protocols as per the CATS and CARS is critical for your own flying longevity, as well as the safety of others.  

If in doubt…

Be particularly cautious if the medication makes you drowsy, or has an effect on your mental status. If in doubt, contact your AME. Very few problems in avmed are insurmountable and the truth will set you free − and keep you and others safe.