Medications Pilots Must Avoid

FAA Medication List: Do Not Issue - Do Not Fly

Apr 2014

Guidance is compiled and interpreted by professional pilots and physicians at FlightPhysical.com from the 2014 AME Guide, FAA and FDA web data (www.FAA.gov & www.FDA.gov), instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).

The information in this section was provided by the FAA in 2014 to advise Aviation Medical Examiners (AMEs) about two medication issues:

Medications for which they should not issue applicants without clearance from the Federal Aviation Administration (FAA), AND
Medications for which for which they should advise airmen to not fly and provide additional safety information to the applicant.

FAA Disclaimer: The lists of medications in this section are not meant to be all-inclusive or comprehensive, but rather address the most common concerns.

Do Not Issue.

Banned Medication List for Pilots(Noninclusive list)

Pilots will not be authorized for Airman Medical Certification is on any of these medications

AMEs will not issue airmen medical certificates to applicants who are using these medications. If AMEs have any questions, they are requested to call the AMCD or Regional Flight Surgeon

Anticholinergics (oral)
Antiseizure medications, even if used for non-seizure conditions
Centrally acting antihypertensives, including but not limited to clonidine, reserpine, guanethidine, guanadrel, guanabenz, and methyldopa
Bromocriptine
Dopamine agonists used for Parkinson's disease or other medical indications: Pramipexole (Mirapex), ropinirole (Requip) and rotigotine (NeuPro). All carry warnings for suddenly falling asleep during activities of daily living
Mefloquine (Lariam)
Over-active bladder medications. Almost all of these medications are antimuscarinic. Antimuscarinic medications carry strong warnings about potential for sedation and impaired cognition
Varenicline (Chantix)
An open prescription for regular or intermittent use of any drug or substance classified under the Controlled Substances Act (Schedules I - V).
- This includes medical marijuana, even if legally allowed or prescribed under state law.
- Note: exceptions would be for documented temporary use of the drug solely for a medical procedure or for a medical condition, and the medication has been discontinued.
Most psychiatric or psychotropic medications, including but not limited to antipsychotics, most antidepressants (see SSRI policy), antianxiety drugs, mood stabilizers, attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) medications, sedative-hypnotics and tranquilizers
High doses of oral steriods (greater than 20 mg prednisone or prednisone-equivalent per day)
Agents for treating cancer, including chemotherapeutics, biologics, etc., whether used for induction, "maintenance", or suppressive therapy
Antiangina medications
Concurrent use of a beta-blocker plus a sulfonylurea or insulin or a meglitinide. Commonly used meglitinides include repaglinide (Prandin) and nateglinide (Starlix). Commonly used sulfonylureas include: acetohexamide (Dymelor); chloropropamide (Diabinese); tolazamide (Tolinase); tolbutamide (Orinase); glimepiride (Amaryl); glipizide (Glucotrol, Glucotrol XL); glyburide (DiaBeta, Micronase, Glynase); glyburide plus metformin (Glucovance); glipizide plus metformin (Metaglip)
Any medication newly approved by the Food and Drug Administration (FDA) (those drugs issued initial FDA marketing approval within the past 12 months). We require at least one-year of post-marketing experience with a new drug before we will consider whether we can safely certificate an applicant using the drug. New antibiotics, lipid-lowering drugs, and antihypertensive medications can be considered earlier than one year. Please contact the AMCD or Regional Flight Surgeon for guidance on specific applicants.

Do Not Fly

Banned Medications for Aviators (Noninclusive list)

Airmen should not fly while using any of the medications in the Do Not Issue section above or using any of the medications or classes/groups of medications listed below. All of these medications below may cause sedation (drowsiness) or impair cognitive function, seriously degrading pilot performance. This impairment can occur even when the individual feels alert and is apparently functioning normally - in other words, the airman can be "unaware of impair."

For aviation safety, airmen should not fly following the last dose of any of the medications below until a period of time has elapsed equal to:

5-times the maximum pharmocologic half life of the medication; or
5-times the maximum hour dose interval if pharmacologic half-life information is not available. For example, there is a 30-hour wait time for a medication that is taken every 4 to 6 hours (5 times 6)

Sleep aids

All the currently available sleep aids, both prescription and over-the-counter (OTC), can cause impairment of mental processes and reaction times, even when the individual feels fully awake.

Wait times are listed for all currently available prescription sleep aids
Diphenhydramine (e.g., Benadryl). Many OTC sleep aids contain diphenhydramine as the active ingredient. The wait time after diphenhydramine is 60 hours (based on maximum pharmacologic half life)

Allergy medications. Antihistamines found in many allergy and other types of medications can cause sedation and may not be used for flight. This applies to nasal formulations as well as oral.

Exception: Nonsedating antihistamines in this list may be used while flying, if symptoms are controlled without adverse side effects after an adequate initial trial period

loratadine (Claritin),
desloratadine (Clarinex), and
fexofenadine (Allegra)

Label warnings. Airmen should not fly while using any medication, prescription or OTC, that carries a label precaution or warning that it may cause drowsiness or advises the user "be careful when driving a motor vehicle or operating machinery." This applies even if label states "until you know how the medication affects you" and even if the airman has used the medication before with no apparent adverse effect. Such medications can cause impairment even when the airman feels alert and unimpaired (see "unaware of impair" above).

"Pre-medication" or "pre-procedure" drugs. This includes all drugs used as an aid to outpatient surgical or dental procedures.

Narcotic pain relievers. This includes but is not limited to morphine, codeine, oxycodone (Percodan; Oxycontin), and hydrocodone (Vicodin, etc.).

Muscle relaxants. This includes but is not limited to carisoprodol (Soma) and cyclobenzaprine (Flexeril).

Over-the-counter active dietary supplements such as Kava-Kava and Valerian.

Summary: This page reviewed the medical and legal aviation aspects of Grounding Medications compiled from recent FAA and FDA reports.

This page discussed Medications Pilots Must Avoid

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