Guide for Aviation Medical Examiners
Pharmaceuticals (Therapeutic Medications)
As an AME you are required to be aware of the regulations and Agency policy and have a responsibility to inform airmen of the potential adverse effects of medications and to counsel airmen regarding their use. There are numerous conditions that require the chronic use of medications that do not compromise aviation safety and, therefore, are permissible. Airmen who develop short-term, self-limited illnesses are best advised to avoid performing aviation duties while medications are used.
The Federal Aviation Administration (FAA) announced on April 2, 2010 that it will consider waivers (special issuance) of medical certificates to pilots who are taking medication for mild to moderate depression. Previously medications used to treat these conditions had grounded pilots from flying duties.
On a case-by-case basis beginning April 5, 2010, pilots will be eligible to apply for an FAA waiver consideration if they take one of four of these antidepressant medications:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Citalopram (Celexa), or
- Escitalopram (Lexapro)
These aviators must apply for a special issuance (waiver) and may be allowed to fly if they have been satisfactorily treated on the medication for at least 12 months. Your first step in this process will be to contact your AME (Aviation Medical Examiner). The FAA also announced that they will not take civil enforcement action against pilots who take advantage of a six-month opportunity to share any previously non-disclosed diagnosis of depression or the use of these antidepressants. This is effectively an amnesty period for pilots to acknowledge a condition or treatment that they may have previously felt uncomfortable sharing with their AME.
“I’m encouraging pilots who are suffering from depression or using antidepressants to report their medical condition to the FAA,” said FAA Administrator Randy Babbitt. “We need to change the culture and remove the stigma associated with depression. Pilots should be able to get the medical treatment they need so they can safely perform their duties.”
The FAA’s policy follows recommendations from the AOPA, ALPA and the ICAO. There is precedent. The Civil Aviation Authority of Australia, Transport Canada and the U.S Army already allow some pilots to fly using antidepressant medications.
Psychiatrists and Aviation Medical Examiners who have specialized training under the Human Intervention and Motivation Study (HIMS) program are slated to help the FAA evaluate and monitor pilots under this new policy. The HIMS program was established 40 years ago and has been highly effective for the assessment, treatment, and medical certification of pilots who need help with alcohol and drug issues.
The policy statement is on display in the Federal Register to allow for public comment until May 3, 2010.
Aeromedical decision-making includes an analysis of the underlying disease or condition and treatment. The underlying disease has an equal and often greater influence upon the determination of aeromedical certification. It is unlikely that a source document could be developed and understood by airmen when considering the underlying medical condition(s), drug interactions, medication dosages, and the shear volume of medications that need to be considered.
A list may encourage or facilitate an airmen's self-determination of the risks posed by various medical conditions especially when combination therapy is used. A list is subject to misuse if used as the sole factor to determine certification eligibility or compliance with 14 CFR part 61.53, Prohibition of Operations During Medical Deficiencies. Maintaining a published a list of acceptable medications is labor intensive and in the final analysis only partially answers the certification question and does not contribute to aviation safety.
Therefore, the list of medications referenced below provides aeromedical guidance about specific medications or classes of pharmaceutical preparations and is applied by using sound aeromedical clinical judgment. This list is not meant to be totally inclusive or comprehensive. No independent interpretation of the FAA's position with respect to a medication included or excluded from the following should be assumed.
