Pilots’ biggest fears are stalls and seeing their aviation medical examiner. When ready to get or renew their pilot certificate, they must go to MedXPress and complete FAA Form 8500-8. Calmly reviewing the form, our diligent pilot stares at Item 17.a. Do You Currently Use Any Medication (Prescription or NONprescription)? (And, incidentally, the same question is also found on the BasicMed CMEC, the Comprehensive Medical Examination Checklist.) If the pilot is taking, on a regular basis, an over-the-counter non-sedating antihistamine for allergies, the medication should be listed along with any other currently used prescription medications. Antihistamines often result in increased heart rate, rising blood pressure, and profuse sweating. Sounds like a medication side effect, does it not?
I have been practicing pharmacy for 37 years and flying for 33 years. I understand as a healthcare professional that a pilot’s first thought will often be, “Can I fly with this medication, because all I remember is what it is used for and all the published major side effects.” Pilots have been known to not be completely forthcoming with Item 17(a), fearing that the medication(s) are not allowed by the FAA because of the potential adverse side effects or because of the underlying medical condition being treated by the medication. Fear of harm seems to be a bigger concern than how a medication can increase a person’s lifespan and quality of life. This fear is very unnecessary. Let me share with you some valuable information that should allay this fear.
Prescribing medications is always about benefits versus risks. If the benefits outweigh the risks, the medication could be prescribed. If the risks outweigh the benefits, it’s a no-go decision. The physician will also evaluate if the medication meets standardized guidelines for the disease state that is being treated. My role as a pharmacist is to ensure the medication is guideline- and evidence-based. The thought I have when I check a prescription order for a patient is, if this was my mom or dad, would this medication be a good choice for her or him? Will it prolong life and hopefully quality of life?
Every medication since the Food, Drug and Cosmetic Act of 1938 has been monitored for safety, quality, and effectiveness. Before a medication gets prescribed it must be studied in a clinical trial. The pharmaceutical company that discovered the medication will conduct such trials. The medication must go through three phases of study. The last phase of the trial is studying the medication in the patient population it is to be prescribed for. This phase usually has thousands, or even tens of thousands, of patients being studied for how well they do on the study medication. The endpoints of these trials are commonly mortality, hospitalizations, and safety. Side effects of the medication are reported and documented during the trials. Once the trial has been completed and assuming the results are positive, the medication is submitted to the Food and Drug Administration (FDA) for evaluation of approval. The FDA will approve the medication for use by the public if it meets the standards for safety and efficacy, and defines the claims the company makes regarding the medication’s utility.
If you already know the benefits of taking your prescribed medications, then this is not news to you. If this concept is new to you, then adopt this new paradigm of medication knowledge and thinking. My goal and mission is to inform you of the huge benefits of your medications and not to think about the side effects as a reason to not take a medication. Most side effects happen very rarely. Every side effect, from feeling dizzy to causing mortality, must be reported to the FDA starting from the original trial to the present. It is not investigated to see if the side effect was due to other causes such as stomach flu, infection, or dehydration. It is just reported and may not be due to the medication. When taking your medications on a daily basis, think about the positive effects on your health. That mindset keeps you healthy and flying. It also keeps you flying longer to enjoy a journey that very few people get a chance to do. For me, every moment of flying is a joy and a privilege. If I require a prescribed medication for a malady or disease state, my immediate thought is how the medication will benefit me, my family, and my flying career. If you have any questions concerning safe medications allowed or disallowed by the FAA go to: https://www.aopa.org/go-fly/medical-resources/medications-database.