Medicine and Aviation

Australia runs on alcohol and drugs – both medically prescribed and “over-the-counter”. Not without justification we have been described as a race of drugged-up, obese, insightless alcoholics.

It is one of the astonishing paradoxes that we live in the greatest country on earth, we enjoy high living standards, a superb environment, excellent climate, abundant food and sunshine, fantastic beaches, yet we are the greatest collection of pill-popping hypochondriacs and grizzlers on earth. This may be because our whole medical structure is based on illness and not health.

Much medication is hazardous for persons engaged in aviation duties and you have to be very careful about what you take – especially ‘herbal’ and ‘natural’ substances.

Set out here is a guide to the relevance to aviation of the five groups of medications to which the population generally is exposed.


1. Medications that are considered safe when flying or controlling.

  • Simple analgesics such as aspirin, paracetamol and (Schedule 3) ibuprofen. Medications containing codeine must be avoided. Codeine is methylmorphine and in the body is metabolised to morphine and other related substances.

  • Simple antacids, but not those containing anticholinergics or antispasmodics (dicyclomine, atropine and hyoscine.)

  • Avoid H2 receptor antagonists such as cimetidine, famotidine and ranitidine.

  • Simple antidiarrhoeals such as kaomagma and kaopectate are acceptable, but not kaolin and opium mixture, diphenoxylate or loperamide.

  • Nasal sprays such as oxymetazoline and phenylephrine are OK for immediate use in flight.

  • Most non-prescription suppositories and creams for haemorrhoids are harmless.

  • Topical antiseptics, topical acyclovir, antifungals, weak steroid creams and most vaginal creams and pessaries are unlikely to cause harm.

  • Oral, injectable and implantable contraceptives are OK.

  • Nicotine gum, patches or sprays may be used.

  • Steroid nasal sprays for hay fever are fine, but you should not use them for more than a week as they then start to have the opposite effect to what is intended. They will simply block your nasal passages completely off and dry them up.

  • Moistening or simple astringent eye drops are OK.

  • Be aware that liquid medicines (especially for coughs) may contain alcohol – often in surprising amounts.


2. Medications which require you to have a ground trial and/or consultation with CASA before you can fly or control.
  • Anaesthetics. You need a clearance from a medical practitioner after the administration of any anaesthetic.

    Local, regional or dental anaesthetic – no flying or controlling for 12 hours.

    General, spinal, epidural or neuroleptanalgesia anaesthetics – no flying or controlling for 48 hours.

  • Hypnotics. Do not fly or control for 12 hours after taking temazepam (although it is pretty harmless.)

  • Don’t even think of taking zolpidem or melatonin.

  • Antibiotics. Generally you can continue to fly or control when taking antibiotics. Each situation will be considered on its merits.

  • Immunisations. Do not undertake aviation related duties for 24 hours after receiving a primary or booster immunisation. Class 3 licence holders might be allowed to continue their duties.

    Some vaccines have particularly noxious side effects and you should not fly or control for 72 hours. One such is Japanese Encephalitis.
  • Non-sedating antihistamines. Some doctors would need convincing there was such a substance.


3. Medications which need to be individually and specifically assessed by CASA.
  • Sedating antihistamines. The principal one is the phenothiazine derivative promethazine (phenergan.) It is an excellent antihistamine but should only be taken at bedtime. If you wake up it will generally be found to have worked OK.

  • Antihypertensives. At the last count there were about 270 different classes and brands.

  • Antiarrhythmic drugs. These include quinidine derivatives, disopyramide, amiodarone, flecanide and sotalol. Digoxin is also on the black list although having been around for more than 300 years most doctors feel it is pretty safe.

  • Gout medication. (But would any clean living decent young pilot or controller ever get gout?) Drugs include colchicine, probenecid and allopurinol.

    Colchicine is also good at removing bowel linings so you had better have a cockpit toilet if you take it.
  • Lipid lowering drugs. These include the statins, fibrates and bile acid sequestrants. CASA has a particular dislike of colestipol.

    Unpleasant side effects of some of these medications continue to be reported, including muscle destruction. Combinations of them seem to be particularly deadly.
  • Eye drops for glaucoma. These include timolol and betaxolol, but there are about 27 different brands.
  • Thyroid disease. Thyroxine requires a fourteen day ground trial. Carbimazole and propylthiouracil, which are far more toxic, seem to have escaped the net.

  • Miscellaneous medication. CASA has a particular interest in acyclovir, famcyclovir, griseofulvin, terbinafine, omeprazole, clomiphene, sucralfate, tetracycline, sulfasalazine and certain urinary antibiotics.


4. Medications that you cannot take if you want to fly or control.
  • Narcotics. Includes codeine, hydromorphone, morphine, oxycodone, fentanyl, pethidine and methadone.

    They are consumed in enormous quantities in Australia and a significant percentage of the population is hopelessly addicted to them.

    Codeine + paracetamol = panadeine forte, which is gobbled by the tonne because this is a country where it is seems mandatory for everyone to have pain somewhere and to take something for it. It is loved by addicts and doctor-shoppers who enjoy taking it with the benzodiazepines. They are then able to rot their brain cells and livers without worrying about the consequences.
  • Insulin.
  • Amphetamines: includes dexamphetamine and methylphenidate.
  • Cytotoxics: doxorubicin, epirubicin, mitozantrone and bleomycin.

  • Psychotropics. There are many because mental illness is very common. They include the antipsychotics, diazepines, benzamides, lithium, benzodiazepines and assorted miscellaneous others.

  • Anticoagulants. Warfarin, dalteparin, enoxaparin, heparin, abciximab, clopidogrel and others also with wonderful names, seen more rarely.

  • Nitrates. Glyceryl trinitrate and isosorbide are the most common.

  • Complex antidiarrhoeals. These have been mentioned above.


5. Vitamins, minerals and herbal preparation.

If you have a healthy lifestyle and eat sensibly there is no need whatever to waste your money on vitamin and mineral preparations.

Herbal preparations are certainly the flavour of the 21st Century and are purchased and consumed in enormous quantities. Most of them are harmless or useless but they are certainly good for the bank accounts of the manufacturers, as the most cursory glance at some Gold Coast properties will show.

Many quite sensible and normal people are attracted to herbal remedies because they are seen as a ‘natural’ alternative to conventional medicine. It is an irrefutable fact of modern life that orthodox medicine has inflicted a good deal of harm on patients, particularly from side effects which vary from a simple rash to total organ failure and death. All modern medicine comes at a price and each new drug is marketed aggressively to doctors by the pharmaceutical industry, and there is a great deal of indiscriminate and irrational prescribing.

However a lot of herbal medicine is also dangerous, not only in its own right but because of interactions with prescribed drugs, and CASA does not permit persons taking herbal preparations to fly or control.

A main reason for this stand is that some herbals are hallucinogenic and/or sedating. Some can precipitate heart attacks and others have caused acute liver failure.

Keep away from them.

 

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