1. Do I need it?
In the United States, a perfect storm is driving the potential for inappropriate use of medications. Doctors are horribly overworked and pressured to see more and more patients in less and less time. Pharmaceutical advertising drives awareness of medications, and a culture that there must be a cure for everything demands a pill be popped. But that is not always a good idea.
For example, in this age of superbugs that have arisen due to antibiotic overuse, doctor and patient alike should be cautious about prescribing them. If you truly have Strep throat, then yes, antibiotics are not only indicated, they are necessary to prevent undue consequences. But most sore throats are caused by viruses that are totally immune to antibiotics. If you present with sandpaper in your throat, ask for a Strep test—they are fast and reliable and, if negative, you can go home, suck lozenges and recuperate while watching AOPA Live! Unnecessary antibiotics also can cause everything from minor irritants to potentially life-threatening problems, so they should be used responsibly. There are many other examples—sometimes one will be on a medicine whose use is no longer necessary because lifestyle changes, such as losing weight to address high blood pressure, has had their effect. Aim to review medications with your physician regularly and, additionally, discuss whether you could take a less expensive generic version. These are developed when patents expire and companies that did not invest billions of dollars developing a new drug can enter the market with a medicine that has the same active ingredients as the original, patented medicine but at a lower price.
2. Is it allowable by the FAA?
It continues to baffle me why this is even something we need to discuss as I, and my colleagues at AOPA, continue to receive questions about taking medications that are not safely compatible with flight. Simply put, because a given medicine has been cleared by the Food and Drug Administration does not mean that the FAA agrees it can or should be used by pilots. In fact, they routinely like to wait for the drug to be on the market for at least a year before considering it for use while flying. Sometimes, a drug is only allowed under certain circumstances. For example, Cialis can be used “as needed” at the normal dosage to address erectile dysfunction (but one should wait 36 hours after taking it before flying!), but the daily use low dosage formulation is not allowed if prescribed for benign prostatic hypertrophy (BPH), a condition where the prostate enlarges and impedes urination. There are several medications lists you can consult, including AOPA’s Medications Database
and the FAA Guide for Aviation Medical Examiners
to provide you with information, and ask your aviation medical examiner or call AOPA Pilot Protection Services.
3. Does it interact with anything else I take?
In a world where some people accumulate medical specialists like others collect stamps, the possibility exists for one doctor to prescribe a medication that interacts with something else one is taking and he or she is not aware of it. Never fail to provide a complete medical history to any healthcare provider you see, otherwise dire consequences may follow. This also includes divulging any allergies one has—if penicillin makes you burst out with a rash and swollen face, be aware that other non-penicillin antibiotics may do the same thing. For example, taking Coumadin, a blood thinning drug, can be problematic, with over 800 known drug interactions! If you take some pain medicines, this can lead to increased risk of bleeding. And as vitamin K and Coumadin work against each other, changing the amount of vitamin K-rich foods can upset the balance. Therefore, one should not change the amount of leafy green vegetables in one’s diet such as kale, collard greens, or broccoli if taking this type of medicine. Antidepressants belonging to the monoamine oxidase inhibitor class (MAO Inhibitors) prevent an amino acid called tyramine from being broken down and if you eat tyramine-rich foods (strong cheeses, cured meats, soy sauce, soybeans, and others) levels can get dangerously high causing blood pressure to spike with potentially bad consequences.
4. Where is it?
My mother maintains she is not deaf, just “hard of hearing,” and astonishingly her hearing aid does not work. I think if she placed it in her ear, rather than leaving it in the bedside table, it might work better. Not having your medication with you is a recipe for disaster, especially if taken for something like asthma or angina. Ensure you have an established supply and take it as prescribed by the doctor. The number of patients who fail to adhere to medical guidance on medications is astounding and has serious consequences.
If you travel overseas, not only make sure the medicines are physically with you and not in the aircraft hold, but keep them in their original bottles or packaging. Check on regulations, as some countries demand verification the medicine is yours, and beware of bringing medicines purchased abroad back into the United States without a valid prescription, or you may run afoul of U.S. Customs and Border Protection.
5. How do I pronounce it?
In the Superman comics, there was a villain named Mr. Mxyzptlk, and sometimes drug names remind me of that! Unpronounceable and decidedly odd! Basically, medicines have two names, the trade name that is a neologism, and which references the company or the mode of action of the drug, and the chemical name, which refers to the class of drug with a modifier, and these are developed by national or international consensus. For example, drugs that treat high blood pressure by blocking a specific receptor have similar chemical names like “propranolol” or “labetalol,” and a certain type of antibiotic also sounds similar like “erythromycin” or “streptomycin.” Drugs also fall into two main groups, small molecules like those referenced above and the newer, “biologics” that are developed within living organisms such as plant or animal cells often with recombinant DNA technology. Examples are etanercept or rituximab for rheumatoid arthritis or certolizumab for psoriasis. Names might perplex the Man of Steel and his everyday alter ego, Clark Kent. And me. But don’t you be perplexed!