Guide for Aviation Medical ExaminersVersion 09/30/2026
Section 24
PHARMACEUTICALS
54 pagesPages 635–688
PHARMACEUTICAL MEDICATIONS
(Updated 03/30/2022) 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.
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 sheer 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.
DO NOT ISSUE - DO NOT FLY
(Updated 09/30/2026) The information in this section addresses two medication categories that are generally unacceptable for flight or safety-related duties:
DO NOT ISSUE (DNI) MEDICATIONS: AMEs cannot issue. Clearance from the FAA required.
AND
DO NOT FLY (DNF) MEDICATIONS: AMEs must provide additional safety information to applicants and caution them not to fly until a specific period of time has elapsed.
The AME should first consider the safety impact of the underlying condition being treated and then determine the frequency, duration, and side effects (if any) of the medication being used. Contact your Regional Flight Surgeon's (RFS) office or the Aerospace Medicine Certification Division (AMCD) regarding any questions or concerns.
The FAA does not typically review medications with the following characteristics:
Investigational/experimental study drugs:
These medications may currently be in clinical trials and have not been reviewed by the Food and Drug Administration (FDA). They have not been evaluated for a complete safety review.
FDA approved less than 12 months ago:
The FAA generally requires at least one year of post-marketing experience with a new drug class before consideration. This observation period allows time for uncommon, but aeromedically significant adverse effects to manifest.
Contact your RFS office or AMCD for guidance on specific applicants or to request consideration for a particular medication.
IMPORTANT
The lists in the following sections are not intended as all-inclusive or comprehensive, but rather address the most common concerns and provide aeromedical guidance about specific medications or classes of pharmaceutical preparations.
No independent interpretation of the FAA's position with respect to a medication included or excluded should be assumed.
DO NOT ISSUE (DNI) MEDICATIONS
(Updated 09/30/2026) If the applicant is taking any of the following medications, AMEs should DEFER the exam. DO NOT issue a medical certificate to applicants who are using any of the following drug classes or medications for any condition:
DO NOT ISSUE
| ANGINA MEDICATIONS | • nitrates (nitroglycerin, isosorbide dinitrate [Imdur])• ranolazine (Ranexa) |
| ANTICHOLINERGICS (ORAL) | • atropine• Over-active bladder (OAB) medications with tertiary structure that carry strong warnings about the potential for sedation and impaired cognition: o tolterodine (Detrol) o oxybutynin (Ditropan) o solifenacin (Vesicare)• Parkinsonism o benztropine (Cogentin) |
| CANCER TREATMENTS | Including many chemotherapy, radiation therapy, and immunotherapy medications, whether used for induction, maintenance, or suppressive therapy. |
| CONTROLLED SUBSTANCES (SCHEDULES I – V) | • Including medical marijuana, even if legally allowed or prescribed under state law.• Any open prescription for chronic use of any drug or substance with no resolution. (If short-term use, see “pain medication” and “anti-anxiety” in DNF section.) |
| DIABETIC MEDICATION | • pramlintide (Symlin)Most diabetes medications are allowed. See Acceptable Combinations of Diabetes Medications. |
| DOPAMINE AGONISTS | • Used for Parkinson’s disease or other medical conditions: o bromocriptine (Cycloset, Parlodel) o pramipexole (Mirapex), ropinirole (Requip) o rotigotine (NeuPro) |
| HYPERTENSIVE (CENTRALLY ACTING) | • Including but not limited to: o clonidine o guanabenz, methyldopa |
| MALARIA MEDICATION | • mefloquine (Lariam)Most other malaria medications are allowed. |
| PSYCHIATRIC OR PSYCHOTROPIC MEDICATIONS | • Even when used for conditions other than mental health. Including but not limited to: o Antidepressants (some are allowed - see SSRI guidance) o Anti-anxiety (some are DNF - see that section) o Antipsychotics o Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) medications o Mood stabilizers o Stimulants o Tranquilizers |
| SEIZURE MEDICATIONS | Even if used for non-seizure conditions (e.g., migraines) |
| STEROIDS, HIGH DOSE | Greater than 20 mg prednisone or prednisone equivalent per day. |
| WEIGHT LOSS | • Sympathomimetic (such as phentermine [Adipex])• bupropion + naltrexone (Contrave) |
Note: Smoking cessation aid varenicline (Chantix) is allowed.
DO NOT FLY (DNF) MEDICATIONS
(Updated 06/28/2023) The following medications have aeromedically concerning safety profiles. All medications listed below may cause sedation or drowsiness, impairing cognitive function and seriously degrading pilot performance. Impairment can occur even when the individual feels alert and is apparently functioning normally. The pilot can be “unaware of impair.”
AMEs should caution pilots on use and provide additional No Fly wait times where applicable. If applicant is using the following medications routinely, AMEs should DEFER.
DO NOT FLY
| ALLERGY MEDICATIONS (1st GENERATION) | Sedating Antihistamines:• Found in many over-the counter (OTC) allergy and other types of medications, as single agent or in any combination product.• Applies to nasal, ophthalmic, AND oral formulations. o diphenhydramine (Benadryl) o chlorpheniramine (Coricidin; ChlorTrimeton)See pharmaceutical, Allergy – Antihistamine & Immunotherapy Medication |
| ANTI-ANXIETY | • Including but not limited to: o alprazolam (Xanax) o lorazepam (Ativan) o temazepam (Restoril) o triazolam (Halcion) |
| MUSCLE RELAXANTS | • Including but not limited to: o carisoprodol (Soma) o cyclobenzaprine (Flexeril) |
| OTC ACTIVE DIETARY SUPPLEMENTS | • Including but not limited to: o Kava-Kava o Kratom o Valerian |
| PAIN MEDICATION | • May be used occasionally for time-limited conditions that are either single episode or recurrent episodes with resolution.• Annotate Block 60 if use is temporary for a medical procedure or for a medical condition and the medication has been discontinued.• Annotate the start and stop dates and reason for use.• Narcotic pain relievers including but not limited to morphine, codeine, oxycodone (Percodan, Oxycontin), and hydrocodone (Lortab, Vicodin, etc.).• Non-narcotic pain relievers (e.g., tramadol [Ultram]). |
| PRE-MEDICATION OR PRE-PROCEDURE DRUGS | All medications used as an aid to outpatient surgical or dental procedures. |
| SEDATIVES/SLEEP AIDS | • All currently available sleep aids, both prescription and OTC, can cause impairment of mental processes and reaction times, even when the individual feels fully awake. See Sleep Aid and wait times for currently available prescription sleep aids.• Diphenhydramine (Benadryl) - Many OTC sleep aids contain diphenhydramine as the active ingredient (see sedating antihistamines above). o The wait time after diphenhydramine is 60 hours (based on maximum pharmacologic half-life) |
GENERAL NO FLY WAIT TIMES
(Updated 06/28/2023) For Aviation safety, pilots should not fly following the last dose of any medications until a period of time has elapsed equal to:
A. 5-times the maximum pharmacologic half-life of the medication (preferred); or
B. 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. If there is a range, calculate by using the higher number (e.g., 6 hours x 5 = 30 hours No Fly wait time).
LABEL WARNINGS:
Do not fly or perform safety-related duties while using any medication (prescription or OTC) that carries a label precaution or warning that it may cause drowsiness or advises the user to “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 medication has been used before with no apparent adverse effect. Such medications can cause impairment even when the individual feels alert and unimpaired (see “unaware of impair” above).
For more information, see Pharmaceuticals, Over-the-Counter Medications.
Pharmaceuticals (Therapeutic Medications)
(updated 4/29/2026) 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.
- ACNE MEDICATIONS
- ALLERGY – ANTIHISTAMINES & IMMUNOTHERAPY MEDICATION
- ANTACIDS
- ANTICOAGULANTS
- ANTIDEPRESSANTS
- ANTIHYPERTENSIVE
- BIOLOGICS, BIOSIMILARS, NON-BIOLOGICS
- CHOLESTEROL MEDICATION
- CONTRACEPTIVES AND HORMONE REPLACEMENT THERAPY
- CONTROLLED SUBSTANCES AND CBD PRODUCTS
- COVID-19 MEDICATION
- DIABETES MELLITUS – INSULIN TREATED
DIABETES MELLITUS – TYPE II MEDICATION CONTROLLED (NOT INSULIN) DO NOT ISSUE/DO NOT FLY ERECTILE DYSFUNCTION AND BENIGN PROSTATIC HYPERPLASIA MEDICATIONS GLAUCOMA MEDICATION PLAQUENIL STATUS REPORT (Use for hydroxychloroquine/Aralen/chloriquine) MALARIA MEDICATION
- MIGRAINE MEDICATION
- OSTEOPOROSIS MEDICATION
- OVER-THE-COUNTER (OTC) MEDICATION
- SEDATIVES
- SLEEP AIDS
- SMOKING CESSATION
- VACCINES
- WEIGHT LOSS MEDICATION
- ACNE MEDICATIONS
- I. CODE OF FEDERAL REGULATIONS
- 67.113(b)(c); 67.213(b)(c); and 67.313(b)(c)
- II. MEDICAL HISTORY:
Topical acne medications, such as Retin A, and oral antibiotics, such as tetracycline, used for acne are acceptable if the applicant is otherwise qualified.
For applicants using oral isotretinoin (Accutane), there is a mandatory 2-week waiting period after starting isotretinoin prior to consideration. This medication can be associated with vision and psychiatric side effects of aeromedical concern - specifically decreased night vision/ night blindness and depression. These side-effects can occur even after cessation of isotretinoin. A report must be provided with detailed, specific comment on presence or absence of psychiatric and vision side-effects. The AME must document these findings in Block 60, Comments on History and Findings. Some applicants will have to be deferred. For applicants issued, there must be a “NOT VALID FOR NIGHT FLYING” restriction on the medical certificate. A waiting period and detailed information is required to remove this restriction. The restriction cannot be removed until all the requirements are met. See Pharmaceutical Considerations below.
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 40, Skin.
- IV. PROTOCOL: N/A
- V. PHARMACEUTICAL CONSIDERATIONS:
Use of oral isotretinoin must be permanently discontinued for at least 2 weeks prior to consideration date (confirmed by the prescribing physician) and;
Eye evaluation must be done in accordance with specifications in 8500-7 and;
The airman must provide a signed statement of discontinuation that: o Confirms the absence of any visual disturbances and psychiatric symptoms, and o Acknowledges requirement to notify the FAA and obtain clearance prior to performing any aviation safety-related duties if use of isotretinoin is resumed
ALLERGY – ANTIHISTAMINE & IMMUNOTHERAPY MEDICATION
(Updated 09/30/2026)
I. CODE OF FEDERAL REGULATIONS 67.105(b) & (c); 67.113(c); 67.205(b) & (c); 67.213(c); and 67.305(b) & (c); 67.313(c)
II. MEDICAL HISTORY: Item 18.e. Hay fever or allergy
The applicant must report frequency and duration of symptoms, any incapacitation by the condition, treatment, and side effects. The AME must inquire whether the applicant has ever experienced any barotitis (‘ear block’), barosinusitis (‘sinus block’), alternobaric vertigo (‘dizziness’), difficulty breathing, rashes, or any other localized or systemic symptoms that could interfere with aviation safety.
- III. AEROMEDICAL DECISION CONSIDERATIONS:
- See Item 26. Nose
- See Item 35. Lungs and Chest
- IV. PROTOCOL: N/A
V. PHARMACEUTICAL CONSIDERATIONS: Airmen who are exhibiting symptoms, regardless of the treatment used, must not fly. AME must warn that flight/safety-related duties are prohibited until after any applicable observation time. In all situations, the AME must notate the evaluation data in Block 60.
New medications:
o Symptoms must be controlled without adverse side effects.
o Initial observation time: Mandatory 48-hour ground trial required after initial use.
Acceptable medications:
o Do not instill antihistamine eye drops immediately before or during flight/safety related duties, as it is common to develop temporary blurred vision each time the drops are applied. o Initial observation time: Not required for acceptable medications (see chart below).
Conditionally acceptable medications:
o May be used occasionally (1-2 times a week) with the stipulation that the airman not exercise the privileges of airman certificate while taking the medication.
o Daily use is NOT acceptable.
o Initial observation time: Required to mitigate central nervous system risk, either as noted in the table below or 5x the half-life or maximal dosing interval after the last dose.
AMEs are encouraged to look up the dosing intervals and half-life.
For more information, see: “What Over-the-Counter (OTC) Medications Can I Take and Still Be Safe to Fly?”
Immunotherapy: Airman must confirm with their treating physician that no other medication is being taken which would impair the effectiveness of epinephrine (should it be needed) or increase the risk of heart rhythm disturbances.
Allergy injections: Acceptable for conditions controlled by desensitization.
Sublingual immunotherapy (SLIT): Acceptable for allergic rhinitis; however, prohibited for airmen 65 or older who have an asthma diagnosis that does not meet CACI criteria (See Lungs and Chest).
Initial observation time: 48-hour no-fly after the first dose AND 4-hour no-fly after each subsequent dose.
ACCEPTABLE* (Non-Sedating) Antihistamine and Allergy Medications May be used as a single agent or in any combination product, if other certification criteria are met.
| Oral: Most Second-Generation Histamine-H1 receptor antagonists• desloratadine (Clarinex)• loratadine (Claritin)• fexofenadine (Allegra) | ☐ Oral/Nasal: Decongestants• pseudoephedrine(Sudafed)• oxymetazoline (Afrin) nasal spray |
| ☐ Nasal spray: Histamine-H1 receptor antagonist• azelastine (Astepro; Astelin) nasal spray• olopatadine nasal spray (requires longer initial ground trial of 7 days) | ☐ Nasal spray: Corticosteroid |
| ☐ Eye drops: All Second-Generation Histamine-H1 receptor antagonist• alcaftadine (Lastacaft) ophthalmic• azelastine (Optivar) ophthalmic• bepotastine (Bepreve) ophthalmic• cetirizine (Zerviate) ophthalmic• ketotifen (Alaway; Zaditor) ophthalmic• olopatadine (Pataday; Patanol; Pazeo) ophthalmic | ☐ Oral: montelukast (Singulair) |
| ☐ Immunotherapy (require 4 hours wait after each dose)• Allergy injections• Sublingual immunotherapy (SLIT) |
* Airmen are prohibited from flight/safety-related duties after initial use of a new medication until after a 48-hour ground trial and no side effects are noted. See Medications & Flying.
| CONDITIONALLY ACCEPTABLE (Sedating) Antihistamine Medications May be used occasionally (1-2 x per week) as a single agent or in any combination product if other certification criteria are met. NOT FOR DAILY USE. | |
| Medication Drug Class | Initial observation |
| ☐ Oral: All First-Generation Histamine-H1 receptor antagonist | |
| • diphenhydramine (Benadryl)** | 60 hours |
| • doxylamine (Unisom) | 60 hours |
| • brompheniramine | 5 days |
| • chlorpheniramine (Coricidin; ChlorTrimeton) clemastine (No brand) | 5 days |
| ☐ Oral: Some Second-Generation Histamine-H1 receptor antagonist | |
| • cetirizine (Zyrtec) | 48 hours |
| • levocetirizine (Xyzal) | 48 hours |
** Diphenhydramine is the most common medication seen on autopsy in aircraft accidents. It is found in many over-the-counter products and in some combination prescription medications.
ANTACIDS
- I. CODE OF FEDERAL REGULATIONS
- 67.113(b)(c); 67.213(b)(c); and 67.313(b)(c)
II. MEDICAL HISTORY: Item 18.i.,Stomach, liver, or intestinal trouble.
The applicant should provide history and treatment, pertinent medical records, current status report, and medication. If a surgical procedure was done, the applicant must provide operative and pathology reports.
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 38, Abdomen and Viscera, Aerospace Medical Disposition Table.
- IV. PROTOCOL: Peptic Ulcer
- V. PHARMACEUTICAL CONSIDERATIONS
The prophylactic use of medications including simple antacids, H-2 inhibitors or blockers, proton pump inhibitors, and/or sucralfates may not be disqualifying, if free from side effects.
ANTICOAGULANTS
- (Updated 04/27/2024)
- I. CODE OF FEDERAL REGULATIONS
- 67.113(b)(c); 67.213(b)(c); and 67.313(b)(c)
II. MEDICAL HISTORY: Item 18.g. Heart or vascular trouble.
The applicant should describe the condition to include, dates, symptoms, treatment, and provide medical reports to assist in the certification decision-making process. These reports should include, as indicated by the applicable underlying condition(s) and class applied for: 24-hour Holter monitor, operative reports of any coronary intervention (including the original cardiac catheterization report), stress tests (including worksheets and original tracings or a legible copy). For myocardial perfusion imaging, we require the interpretive report and copies of the actual images in both grey-scale and color (in digital format or hard copy.) Per Part 67, for all classes of medical certificates, there is cause for denial if there is an established medical history or clinical diagnosis of myocardial infarction, angina pectoris, cardiac valve replacement, permanent cardiac pacemaker implantation, heart replacement, or coronary heart disease (CHD) that has required treatment (or if untreated, that has been symptomatic or clinically significant).
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 36, Heart, Aerospace Medical Disposition table
IV. PROTOCOL: As per the specific underlying condition(s), see Disease Protocols
V. PHARMACEUTICAL CONSIDERATIONS
Warfarin (Jantoven):
For applicants who are just beginning warfarin (Jantoven) treatment the following is required:
☐ Minimum observation time of 6 weeks after initiation of warfarin therapy; ☐ Must also meet any required observation time for the underlying condition; AND ☐ 6 INRs, no more frequently than 1 per week
For applicants who are on an established use of warfarin (Jantoven), status report from the treating physician should address and include:
☐ Drug dose history and schedule;
☐ Comment regarding side effects; AND ☐ A minimum of monthly International Normalized Ratio (INRs) results for the immediate prior 6 months.
NOAC/DOACs: For applicants who are just beginning treatment with NOAC/DOACs, the following is required:
Minimum observation time of 2 weeks after initiation of therapy; AND
Must also meet any required observation time for the underlying condition
For Non-Valvular Atrial Fibrillation (AFib) – see Emboli Mitigation on the following page.
EMBOLI MITIGATION IN NON-VALVULAR
ATRIAL FIBRILLATION (AFIB)
(Updated 3/27/2024) The CHA2DS2-VASc score is used to estimate thromboembolic risk in atrial fibrillation and inform emboli mitigation requirements. Annual stroke risk increases with increasing score. The following emboli mitigation strategies are acceptable for FAA medical certificate purposes:
| CHA2DS2-VASc Score | Required Emboli Mitigation |
|---|---|
| 2 or higher | Jantoven/warfarin; or NOAC/DOAC or LAA closure |
| 0-1 | Emboli mitigation usually not required for FAA purposes. |
| CHA2DS2-VASc | Score |
|---|---|
| Congestive heart failure | 1 |
| Hypertension | 1 |
| Age > 75 | 2 |
| Diabetes mellitus | 1 |
| Previous stroke/TIA/TE | 2 |
| Vascular disease (prior MI, PAD, or aortic plaque/atheroma) | 1 |
| Age 65-74 | 1 |
| Female (Male = 0) | 1 |
| Total |
Warfarin (Jantoven): For applicants who are just beginning warfarin (Jantoven) treatment the following is required:
☐ Minimum observation time of 6 weeks after initiation of warfarin therapy; ☐ Must also meet any required observation time for the underlying condition; AND ☐ 6 INRs, no more frequently than 1 per week o 80% or more of INR values should be between 2.0 and 3.0. o When used for heart valves, INR goal should be in accordance with standard of care for that type of valve: and o If INR is outside this target range, the physician should explain.
NOAC/DOACs: For applicants who are just beginning treatment the following is required:
☐ Minimum observation time of 2 weeks after initiation of therapy; AND ☐ Must also meet any required observation time for the underlying condition.
ANTIDEPRESSANTS
- (Updated 04/24/2024)
- I. CODE OF FEDERAL REGULATIONS
- First-Class Airman Medical Certificate: 67.107
- Second-Class Airman Medical Certificate: 67.207
- Third-Class Airman Medical Certificate: 67.307
II. MEDICAL HISTORY: Item 18.m., Mental disorders of any sort; depression, anxiety, etc.
An affirmative answer to Item 18.m. requires investigation through supplemental history taking. Dispositions will vary according to the details obtained and the condition(s) being treated. An applicant with an established history of a personality disorder that is severe enough to have repeatedly manifested itself by overt acts, a psychosis disorder, or a bipolar disorder must be denied or deferred by the AME.
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 47., Psychiatric.
IV. PROTOCOL: As per the specific underlying condition(s).
V. PHARMACEUTICAL CONSIDERATIONS
Individuals exhibiting symptoms, regardless of the treatment used, must not fly.
Symptoms must be controlled without adverse side effects.
Individuals can be considered for first, second, or third-class medical certificates while being treated with one of several specific antidepressants.
The Authorization decision is made on a case-by-case basis. The AME may not issue.
Medications used in mental health generally have central nervous system effects and take some time to become effective, and therefore have long initial observation time considerations.
Underlying conditions will require a current evaluation.
See Use of Antidepressant Medications.
The table of Antidepressant Medications is on the following page.
ANTIDEPRESSANT MEDICATIONS
(Updated 08/27/2025) CONDITIONALLY Acceptable Antidepressant Medications with SI (Used as a single agent, if otherwise qualified.)
| Selective serotonin reuptake inhibitors (SSRI):• citalopram (Celexa)• escitalopram (Lexapro)• fluoxetine (Prozac; Sarafem)• sertraline (Zoloft) | Serotonin and norepinephrine reuptake inhibitors (SNRI):• desvenlafaxine (Pristiq)• duloxetine (Cymbalta)• venlafaxine (Effexor) |
| Dopamine/norepinephrine-reuptake inhibitor (NDRI):• buproprion (Wellbutrin) SR/ER formulations ONLY | Selective Serotonin Reuptake Inhibitor/5-HT1A Receptor Partial Agonist:• vilazodone (Viibryd) |
UNACCEPTABLE Antidepressant Medications (Used as a single agent or in any combination product.)
| Selective Serotonin Reuptake Inhibitor (SSRI):• fluvoxamine (Luvox)• paroxetine (Paxil) | Serotonin and norepinephrine reuptake inhibitors (SNRI):• levomilnacipran (Fetzima) |
| Dopamine/Norepinephrine-Reuptake Inhibitor (NDRI):• buproprion (Wellbutrin) IR formulations | Selective Serotonin Reuptake Inhibitor/5-HT1A Receptor Partial Agonist:• vortioxetine (Trintellix) |
| esketamine (Spravato) | All tricyclic antidepressants (TCAs) |
| All monoamine oxidase inhibitors (MAO-I) |
ANTIHYPERTENSIVE (HTN, blood pressure medication)
(Updated 09/30/2026)
I. CODE OF FEDERAL REGULATIONS 67.113(b)(c); 67.213(b)(c); and 67.313(b)(c) II. MEDICAL HISTORY: Item 18.h., High or low blood pressure.
III. AEROMEDICAL DECISION CONSIDERATIONS:
- Item 46. Neurologic Headaches - Migraine, CACI and AASI
- IV. PROTOCOL: N/A. See Hypertension Disposition table
- V. PHARMACEUTICAL CONSIDERATIONS
Seven-day (7) no fly/ground trial is required when starting a new hypertension (HTN) medication to verify no side effects.
AME should issue (if otherwise qualified) if the airman is on 3 or fewer medications
Use of beta-adrenergic blockers ARE allowed with insulin, meglitinides, or sulfonylureas.
| ACCEPTABLE HTN Medications (when certification criteria are met) | |
| ✓ Alpha adrenergic blockers | ✓ Calcium channel blockers |
| ✓ Angiotensin converting enzyme (ACE) inhibitors | ✓ Direct renin inhibitors |
| ✓ Angiotensin II receptor antagonists (ARBs) | ✓ Direct vasodilators |
| ✓ Beta-adrenergic blockers | ✓ Diuretics |
| ✓ Endothelin Receptor Antagonists | |
UNACCEPTABLE HTN Medications
(as a single agent or in any combination product) DO NOT ISSUE
Clonidine (ex. Catapres/Clorpres)
guanabenz
guanfacine/Tenex
methyldopa
Nitrates (ex. nitroglycerin/isosorbide dinitrate/isosorbide mononitrate)
BIOLOGICS, BIOSIMILARS, NON-BIOLOGICS
- (Updated 08/26/2026)
- I. CODE OF FEDERAL REGULATIONS
- 67.113(b)(c); 67.213(b)(c); and 67.313(b)(c)
- II. MEDICAL HISTORY: Item 48. General Systemic
The individual should provide history as to why the medication is used. If taken for a specific condition, see that section. The AME should inquire about when medication was started and if the individual has ever experienced any side effects that could interfere with aviation safety.
- III. AEROMEDICAL DECISION CONSIDERATIONS:
- See Item 48. General Systemic
- IV. PROTOCOL: None
V. PHARMACEUTICAL CONSIDERATIONS o The underlying condition must be acceptable.
o Observation times: Required ground trial and/or no-fly after each dose. o Initial observation: All require a 2-week no-fly/ground trial to verify no side effects.
o Post-dose observation time (no-fly time): See table.
Changing from one biologic/biosimilar to another for the same indication requires a forty-eight (48) hour ground trial to mitigate any aeromedical risk.
o 61.53 applies if any adverse change in condition or adverse medication side effect requiring medical attention.
*Note: Biologics do not have generic medication; they have biosimilar.
FDA-approved biosimilars are also acceptable for any referenced brand name medication (e.g., Hadlima [adalimumab-bwwd] for Humira [adalimumab]).
See the next two pages for table of medications by name.
| ACCEPTABLE BIOLOGICS - MONOTHERAPY MEDICATION Permitted if the underlying condition qualifies; consult the condition pages for details. | |
| Medication Drug Class | |
|---|---|
| Biologic Medications | Post-dose Observation No-Fly times |
| B-Cell Inhibitors• rituximab (Rituxan) | 72 hours |
| Selective Co-stimulation Modulator• abatacept (Orencia) | 24 hours |
| Tumor Necrosis Factor (TNF) Blocking Agent• infliximab (Inflectra; Remicade; Renflexis) | 24 hours |
| Tumor Necrosis Factor (TNF) Blocking Agent• adalimumab (Humira)• certolizumab (Cimzia)• etanercept (Enbrel)• golimumab (Simponi) | 4 hours |
| Interleukin Inhibitor• anakinra (Kineret)• bimekizumab (Bimzelx)• guselkumab (Tremfya)• ixekizumab (Taltz)• mirikizumab (Omvoh)• risankizumab (Skyrizi)• sarilumab (Kevzara)• secukinumab (Cosentyx)• tildrakizumab (Ilumya)• tocilizumab (Actemra)• ustekinumab (Stelara)▪ Warn for posterior reversible encephalopathy syndrome (PRES) | 4 hours |
| Selective Adhesion-Molecule (SAM) Inhibitor• vedolizumab (Entyvio) | 4 hours |
| Non-Biologic Medications | Post-dose Observation No-Fly times |
| Kinase Inhibitor• baricitinib (Olumiant)• tofacitinib (Xeljanz)• upadacitinib (Rinvoq)Warn for cardiovascular events and blood clots (VTE) for all | None |
| Phosphodiesterase-4 Enzyme Inhibitor• apremilast (Otezla)▪ Report any signs of depression | None |
Note: FDA-approved biosimilars are also acceptable for any referenced brand name medication (e.g., Hadlima [adalimumab-bwwd] for Humira [adalimumab]).
| CONDITIONALLY ACCEPTABLE BIOLOGIC MEDICATIONS Monotherapy — Dependent on underlying condition(s), see those pages. | |
| Medication Drug Class | |
|---|---|
| Biologic Medications | Post-dose Observation No-Fly times |
| Interleukin Inhibitors• benralizumab (Fasenra)• brodalumam (Siliq)• canakinumab (Ilaris)• dupilumab (Dupixent)• mepolizumab (Nucala)• reslizumab (Cinqair)• rilonacept (Arcalyst) | 4 hours |
| TSLP (thymic stromal lymphopoietin) Inhibitor• tezepelumab (Tezspire) | 4 hours |
| IgE Inhibitor• omalizumab (Xolair) | 24 hours |
| Selective Adhesion-Molecule Inhibitor• natalizumab (Tysabri)REMS program (due to the risk of progressive multifocal leukoencephalopathy [PML]) | 48 hours |
Note: FDA-approved biosimilars are also acceptable for any referenced brand name medication (e.g., Hadlima [adalimumab-bwwd] for Humira [adalimumab]).
CHOLESTEROL MEDICATION
(Updated 08/27/2025) I. CODE OF FEDERAL REGULATIONS - 67.113(c); 67.213(c); and 67.313(c)
II. MEDICAL HISTORY: Item 37: Vascular System
The applicant should provide history as to why the medication is used. If taken for a cardiac condition, see that section. The AME should inquire if the applicant has ever experienced any side effects that could interfere with aviation safety.
- III. AEROMEDICAL DECISION CONSIDERATIONS:
- See Item 37: Vascular system
- IV. PROTOCOL: N/A
- V. PHARMACEUTICAL CONSIDERATIONS
Cholesterol Medication o All drug classes require the minimum standard 48-hour initial ground trial.
ACCEPTABLE Cholesterol Medications
(As a single agent or in any combination product.) ☐ HMG-CoA reductase inhibitor
atorvastatin (Lipitor; Sortis [INTL])
fluvastatin (Lescol)
lovastatin (Altoprev)
pravastatin (Pravachol)
rosuvastatin (Crestor)
simvastatin (Zocor) ☐Fibric Acid
fenofibrate (Antara, Tricor, Triglide, Trilipix)
gemfibrozil (Lopid) ☐ Omega-3-acid ethyl esters
omega-3-acid ethyl esters (Lovaza)
icosapent ethyl (Vascepa) ☐ Bile Acid Sequestrant
cholestyramine (Prevalite; Questran)
colesevelam (Welchol)
colestipol (Colestid) ☐Nicotinic acid
niacin (Niaspan) ☐ Adenosine Triphosphate-Citrate Lyase (ACL) Inhibitor
bempedoic acid (Nexletol) ☐ 2-Azetidinone
ezetimibe (Zetia)
☐ Monoclonal Antibody - PCSK9 Inhibitor
alirocumab (Praluent)
evolocumab (Repatha)
UNACCEPTABLE Cholesterol Medications
Apolipoprotein B Antisense Oligonucleotide
mipomersen (Kynamro)
CONTRACEPTIVES AND HORMONE REPLACEMENT THERAPY
- I. CODE OF FEDERAL REGULATIONS
- 67.113(b)(c); 67.213(b)(c); and 67.313(b)(c)
II. MEDICAL HISTORY: Use of Oral or Repository Contraceptives or Hormonal Replacement Therapy are not disqualifying for medical certification. If the applicant is experiencing no adverse symptoms or reactions to hormones and is otherwise qualified, the AME may issue the desired certificate.
III. PROTOCOL: N/A
IV. PHARMACEUTICAL CONSIDERATIONS: See Medical History above.
CONTROLLED SUBSTANCES AND CBD PRODUCTS
(Updated 05/25/2022) I. CODE OF FEDERAL REGULATIONS: 14 CFR 67.107 and 67.113(b)(c); 67.207 and 67.213(b)(c); 67.307 and 67.313(b)(c)
II. MEDICAL HISTORY: Item 48 or 18. n.
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 48. General Systemic
- IV. PROTOCOL: N/A
- V. PHARMACEUTICAL CONSIDERATIONS
DEA Schedule Controlled Substances have aeromedically concerning safety profiles.
| Additional Information Required (Used as a single agent or in any combination product.) | |
| CBD (cannabidiol)or products containing CBD | Marijuana contains CBD and THC. With the exception of Epidiolex, CBD oil and other CBDcontaining products are neither FDA approved nor regulated. The safety, efficacy, purity, and potency have not been adequately demonstrated.1. Use of CBD or CBD-containing products is not specifically disqualifying. 2. The condition for which the product is being used may be disqualifying. Review a current detailed Clinical Progress Note to verify the underlying condition. 3. A marijuana-positive DOT drug test resulting from CBD use (intentional or inadvertent) is treated as a positive test. |
| UNACCEPTABLE Medications (Used as a single agent or in any combination product.) | |
| DEA SCHEDULE I Controlled Substances | ALL Medications in this class but not limited to:MDMA (“Ecstasy,” “Molly”) Mescaline (Peyote) GHB (gamma-hydroxybutyric acid) Methaqualone (Quaalude) Heroin (diacetylmorphine) Psilocybin ("Magic Mushrooms") Khat (Cathinone, Cathine) LSD (lysergic acid diethylamide)• Synthetic Cathinones (“bath salts”)• Marijuana (cannabis, THC)• Medical Marijuana• Synthetic marijuana (“Spice,” “K2”) |
| DEASCHEDULE II Controlled Substances | Not limited to:• Barbiturates• Cocaine• Stimulants• Narcotics* |
*The AME must review ANY use of narcotics. No fly or no Safety Related Duties during use. A minimum no fly time must be observed after last use. Frequent flares/ episodes require review of the underlying condition.
COVID-19 MEDICATION
(Updated 09/27/2023) I. CODE OF FEDERAL REGULATIONS - 67.113(b)(c); 67.213(b)(c); 67.313(b)(c)
II. MEDICAL HISTORY: Item 48. General Systemic
The use of medications below may be acceptable if there are no side effects (localized or systemic) which could interfere with aviation safety and the applicant is otherwise qualified.
- III. AEROMEDICAL DECISION CONSIDERATIONS:
- See Item 48. General Systemic, COVID-19 Infections
- IV. PROTOCOL: None
- V. PHARMACEUTICAL CONSIDERATIONS:
FDA or Emergency Use Authorization (EUA) approved COVID-19 medications are acceptable.
COVID-19 medications require a post-dose observation time due to side effects which may affect aeromedical safety.
NO flying or safety-related duties permitted DURING COVID-19 infection.
Follow the current CDC and FAA guidelines for recovery from COVID-19 before return to duty or flying.
See COVID-19 vaccines.
Q: Which COVID-19 medication can I use and still fly?
A: None. You cannot take a COVID-19 medication and fly or perform safety-related duties. See the chart below for more information.
| Conditionally ACCEPTABLE | Post-dose Observation* and Additional Requirements |
|---|---|
| COVID TREATMENT or POST- EXPOSURE PROPHYLAXISAny FDA-approved treatments below are acceptable; however, the following restrictions apply:• DO NOT fly if taking ANY medications listed until ALL items (#1-4) in the next column are met; and• DO NOT fly if symptomatic or infected.Currently FDA approved treatment(s)*✓ molnupiravir (no brand name) ✓ nirmatrelvir + ritonavir (Paxlovid) ✓ remdesivir (Veklury) | ALL of the following criteria must be met BEFORE returning to flight status or safety-related duties:1. Wait 24 hours after the last dose of COVID-19 medication; AND2. Be free of significant side effects after COVID-19 medication; AND3. Meet the current CDC/FAA guidelines for recovery from COVID disease or exposure; AND4. Meet the requirements on the COVID-19 Disposition Table.14 CFR 61.53 applies after any medication use or illness. |
DIABETES MELLITUS - INSULIN TREATED
I. CODE OF FEDERAL REGULATIONS
First-Class Airman Medical Certificate: 67.113(a)(b)(c) Second-Class Airman Medical Certificate: 67.213(a)(b)(c) Third-Class Airman Medical Certificate: 67.313(a)(b)(c)
II. MEDICAL HISTORY: Item 18.k., Diabetes.
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 48, General Systemic Aerospace Medical Disposition table.
IV. PROTOCOL: See Diabetes Mellitus Type I or Type II - Insulin-Treated Protocol
V. PHARMACEUTICAL CONSIDERATIONS
Insulin pumps are an acceptable form of treatment.
Combinations of anti-diabetes medication (s): The chart of Acceptable Combinations of Diabetes Medications (pdf) summarizes the acceptable medications for both monotherapy and combination therapy. The chart organizes medications into groups based on similarity of mechanisms of actions and/or therapeutic effects.
DIABETES MELLITUS TYPE II - MEDICATION CONTROLLED (NOT INSULIN)
- (Updated 01/28/2026)
- I. CODE OF FEDERAL REGULATIONS
- First-Class Airman Medical Certificate: 67.113 (a)(b)(c)
- Second-Class Airman Medical Certificate: 67.213(a)(b)(c)
- Third-Class Airman Medical Certificate: 67.313(a)(b)(c)
II. MEDICAL HISTORY: Item 18.k. Diabetes.
The applicant should describe the condition to include symptoms and treatment. Comment on the presence or absence of hyperglycemic and/or hypoglycemic episodes. A medical history or clinical diagnosis of diabetes mellitus requiring insulin or other hypoglycemic drugs for control is disqualifying. The AME can help expedite the FAA review by assisting the applicant in gathering medical records and submitting a current specialty report such as the Diabetes or Hyperglycemia on Medications Status Report. See Item 48, Diabetes
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 48, Diabetes
IV. DISEASE PROTOCOL: See Diabetes Mellitus Type II - Medication Controlled
V. PHARMACEUTICAL CONSIDERATIONS: Combinations of anti-diabetes medication (s): The chart of Acceptable Combinations of Diabetes Medications summarizes the acceptable medications for both monotherapy and combination therapy. The chart organizes medications into groups based on similarity of mechanisms of actions and/or therapeutic effects.
ACCEPTABLE COMBINATIONS OF DIABETES MEDICATIONS
(Updated 09/30/2026) The chart on the following page outlines acceptable combinations of medications for the treatment of diabetes.
PHARMACEUTICAL CONSIDERATIONS:
Initial Certification/Clearance decision is made by the FAA. The AME must defer.
Unlisted Medications: Consult AMCD or RFS.
See below for acceptable medication combinations and required observation times.
Combination Medication: Count each component in a combination medication separately (e.g., rosiglitazone + metformin = 2 medications).
Combinations of up to 3 non-insulin medications are considered acceptable for routine treatment according to generally accepted standards of care for diabetes (American Diabetes Association, American Association of Clinical Endocrinologists). Follow-up/recertification may be under the AASI program.
4 or more medications may be considered on a case-by-case basis.
Only ONE Medication allowed from each group (A–G).
Insulin Exception: An insulin regimen containing multiple insulin types (e.g., short-acting [aspart] + long-acting [glargine]) counts as 1 medication.
If using insulin (any type), see Medical Certification Using Insulin
Follow observation times on tables.
**NOTE: ALL medication Group Letters have been updated **
- Observation Times
- Non-Insulin
When initiating NEW diabetes therapy (monotherapy or combination medications):
| Starting Medication | Observation Time |
|---|---|
| Group B ONLY | 14 days |
| Group C - G | 30 days |
| Group A2 | 60 days |
When ADDING a new medication to an ESTABLISHED TREATMENT regimen:
| Current Medication | Adding Medication | Observation Time |
|---|---|---|
| on Group A - G | + new Group B - G | 14 days |
| on Group B - G | + new Group A2 | 60 days |
Insulin
When starting insulin or adding insulin to an existing treatment plan.
| Adding/Starting Insulin | Observation Time |
|---|---|
| Group A1 (insulin): | |
| • 3rd class pilots or agency ATCS | 90 days |
| • 1st or 2nd class pilots (must use CGM protocol) | 180 days |
Medication Adjustment
When changing the dose, formulation (e.g., immediate vs. extended release), or switching to a different drug/device within the same class.
| Adjusting Medication | Observation Time |
|---|---|
| Within Group B-G | 48 hours |
| Within Group A2 | 7 days |
| Within Group A1, if adding new type of insulin to regimen *Note: no time is needed for minor dose change within the same drug class (short to short, long to long) | 7 days |
| If transitioning between insulin injection to/from pump; or new insulin/CGM devices | 7 days |
**NOTE: ALL medication Group Letters have been updated **
ACCEPTABLE COMBINATIONS OF DIABETES MEDICATIONS
**NOTE: ALL medication Group Letters have been updated **
ERECTILE DYSFUNCTION AND BENIGN PROSTATIC HYPERPLASIA MEDICATIONS
- (Updated 08/30/2017)
- I. CODE OF FEDERAL REGULATIONS
- 67.113(c); 67.213(c); and 67.313(c)
II. MEDICAL HISTORY: Use of medication for erectile dysfunction (ED) and/or benign prostatic hyperplasia (BPH) may not be disqualifying for medical certification if there are no side effects, the underlying condition is not aeromedically significant, and the applicant is otherwise qualified. If the medication is used for any other condition, do not issue – FAA approval is required.
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 41. G-U System,
IV. PROTOCOL: N/A
V. PHARMACEUTICAL CONSIDERATIONS: The use of medications below for G-U conditions including ED and BPH may not be disqualifying, if free from side effects. For the required minimum wait time after use, see the table below.
If the medications below are used for any other non-G-U condition (e.g., pulmonary arterial hypertension [PAH]) the AME must defer issuance of a medical certificate.
Alpha blockers are allowed for daily use if there no side effects. No minimum wait time is required after use once the airman has successfully passed the 7-day ground trial period required for all hypertension medication.
If alpha blockers are used in combination with PDE5 inhibitors (common examples are listed below), the airman should not fly until verification that no hypotensive episodes or other side effects are noted.
Nitrates are not allowed.
- ERECTILE DYSFUNCTION AND BENIGN PROSTATIC HYPERPLASIA
- PDE-5 INHIBITOR MEDICATION WAIT TIMES
| Trade Name | Generic Name | Required minimum wait time after last dose before resuming pilot duties |
| Cialis (daily use) | Tadalafil | 2.5 or 5 mg daily is allowed if no side effects after 7 days |
| Cialis (prn use) | Tadalafil | 24 hours |
| Levitra | Vardenafil | 8 hours |
| Staxyn | Vardenafil | 8 hours |
| Stendra | Avanafil | 8 hours |
| Viagra | Sildenafil | 8 hours |
EYE MEDICATION
(Updated 04/27/2022) I. CODE OF FEDERAL REGULATIONS - 14 CFR 67.103(e) and 67.113(b)(c); 67.203(e) and 67.213 (b)(c); 67.303(e) and 67.313(b)(c)
II. MEDICAL HISTORY: Item 18.d. Medical History, eye or vision trouble except glasses.
- III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 32, Ophthalmoscopic
- IV. PROTOCOL: N/A
- V. PHARMACEUTICAL CONSIDERATIONS
For applicants using eye drops in the ACCEPTABLE category (below), determination will depend on whether the underlying condition for use is acceptable or disqualifying.
In general, do not instill antihistamine eye drops immediately before or during flight/safety related duties. It is common to develop temporary blurred vision each time the drops are applied.
Pilocarpine (Vuity) is a prescription eye drop used for presbyopia (age-related, blurry near vision). It creates a temporary chemical correction of visual acuity by decreasing pupil size. This can increase depth of focus and give transient improvement to near vision in individuals with presbyopia. There are overt FDA-required warnings from the manufacturer regarding night vision and operating machinery. Since medication and the availability of ambient lighting impact visual acuity, pilocarpine is unacceptable.
Eye Conditions found in a separate section:
Allergy – See Allergy – Antihistamine and Immunotherapy Medication
Glaucoma – See Glaucoma and Ocular Hypertension Medication
| ACEPTABLE Medications if the underlying condition is acceptable (as a single agent or combination product) | |
| ✓ Calcineurin Inhibitor cyclosporine (Restasis) | ✓ Pain management; Postoperative surgery NSAID (Nonsteroidal Anti-inflammatory Drug) |
| ✓ Carbonic anhydrase inhibitors | ✓ Antibiotics |
| ✓ Most Mydriatic cyclopentolate (Cyclogyl) – 24 hour no-fly phenylephrine (Altafrin) – 8 hour no-fly tropicamide (Mydriacyl) – 8 hour no-fly | |
| UNACCEPTABLE Medications due to the underlying condition | |
|---|---|
| Some Mydriatic atropine (Isopto Atropine) | Cholinergic Agonist e.g., pilocarpine (Isopto Carpine; Vuity) |
| Recombinant Human Nerve Growth Factor cenegermin (Oxervate) | Steroid intravitreal implant fluocinolone (Iluvien; Retisert; Yutiq) |
GLAUCOMA AND OCULAR HYPERTENSION MEDICATIONS
(Updated 08/27/2025) I. CODE OF FEDERAL REGULATIONS - 67.113(b)(c); 67.213 (b)(c); and 67.313(b)(c)
II. MEDICAL HISTORY: Item 18.d. Medical History, Eye or vision trouble except glasses. The applicant should provide a current, detailed Clinical Progress Note from the treating physician generated from a clinic visit no more than 90 days prior to the AME exam. It must include a summary of the history of the condition; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.
- III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 32, Ophthalmoscopic
- IV. PROTOCOL: N/A
- V. PHARMACEUTICAL CONSIDERATIONS
Cholinergic agonists cause pupillary constriction which can interfere with visual acuity and night vision. They are no longer first-line Glaucoma agents
| CACI Glaucoma Medications (as a single agent or in a combination product) | ||
| ✓ Beta-Blocker• betaxolol (Kerlone)• carteolol (Ocupress• levobunolol (Betagan) timolol (Timoptic) | ✓ Carbonic Anhydrase Inhibitor• brinzolamide (Azopt)• dorzolamide (Trusopt)• methazolamide | |
| ✓ Alpha2 Agonist• apraclonidine (Iopidine) brimonidine (Alphagan P) | ✓ Rho Kinase Inhibitor netarsudil (Rhopressa) | |
| ✓ Prostaglandin• bimatoprost (Latisse; Lumigan)• latanoprost (Xalatan)• latanoprostene bunod (Vyzulta)• omidenepag isopropyl (Omlonti)• tafluprost (Zioptan) travoprost (Travatan) | ✓ Combination• brimonidine + timolol (Combigan)• brinzolamide + brimonidine tartrate (Simbrinza)• netarsudil + latanoprost (Rocklatan) dorzolamide + timolol (Cosopt) | |
| CONDITIONALLY ACCEPTABLE Glaucoma Medications (Requires SI) (As a single agent or in a combination product.) | ||
| Oral medications e.g., acetazolamide (Diamox) | ||
| UNACCEPTABLE Glaucoma Medications | ||
|---|---|---|
| Cycloplegics e.g., atropine | Cholinergic Agonist e.g., pilocarpine (Isopto Carpine, Vuity) | |
PLAQUENIL STATUS REPORT
Use for hydroxychloroquine/Aralen/Chloroquine (Updated 09/25/2024) Name __________________________________ Birthdate _________________________
Applicant ID# ____________________________ PI#______________________________
Please have the ophthalmologist or optometrist who monitors your medication provide the requested information in the space provided. Return this status summary to your AME for electronic upload to the FAA.
Provider printed name/title: ___________________________ Phone number ___________________
Date hydroxychloroquine (HCQ) or chloroquine (CQ) treatment initiated________________________
Date of most recent HCQ/CQ screening _________________
If yes, explain: ______________________________________________________ Treating Provider Signature ______________________________ Date ____________ Modified from 2016 American Academy of Ophthalmology (AAO) guideline recommendations
MALARIA MEDICATIONS
- (Updated 04/27/2016)
- I. CODE OF FEDERAL REGULATIONS
- 67.113(b)(c); 67.213(b)(c); and 67.313(b)(c)
II. MEDICAL HISTORY: This medication is absolutely disqualifying for pilots. Mefloquine (Lariam) is associated with adverse neuropsychiatric side-effects, even weeks after the drug is discontinued. Because of the association with adverse neuropsychiatric side-effects, even weeks after discontinuation, a pilot who elects to use mefloquine for malaria prophylaxis or who contracts malaria and is treated with mefloquine will be disqualified for pilot duties for the duration of use of mefloquine and for 4 weeks after the last dose. In this instance, the pilot must contact the FAA or his/her Aviation Medical Examiner prior to returning to flight duties after use.
III. AEROMEDICAL DECISION CONSIDERATIONS: For return to pilot duties there must be no history of neurologic or psychiatric symptoms during and or after mefloquine use. Examples of symptoms related to mefloquine use include dizziness or vertigo, tinnitus, and loss of balance; anxiety, paranoia, depression, restlessness or confusion, hallucinations and psychotic behavior.
- IV. PROTOCOL: N/A
- V. PHARMACEUTICAL CONSIDERATIONS:
Use of mefloquine must be discontinued for at least 4 weeks prior to consideration and:
The airman must contact the FAA agency flight surgeon or their AME before resuming pilot duties
For return to pilot duties there must be no history of neurologic or psychiatric symptoms during and or after mefloquine use
MIGRAINE MEDICATION
- (Updated 08/26/2026)
- I. CODE OF FEDERAL REGULATIONS
- 67.109(a)(b); 67.209(a)(b); and 67.309(a)(b)
- II. MEDICAL HISTORY: Item 46. Neurologic
The individual must report frequency and duration of symptoms as well as any incapacitation from the condition or treatment. Specific comments should be made regarding any impairments, such as visual (central vice peripheral loss), hearing, speech, motor loss, or any other symptoms that could interfere with aviation safety.
- III. AEROMEDICAL DECISION CONSIDERATIONS:
- See Item 46. Neurologic
- IV. PROTOCOL: N/A
- V. PHARMACEUTICAL CONSIDERATIONS
See the tables on the following pages:
A. Migraine Prevention Medication (prophylaxis)
B. Migraine Relief/Rescue Medication (taken to stop a migraine)
A. Migraine Prevention (Prophylaxis)
Used for prevention of migraines. Often taken daily to prevent episodes.
Must have ground trial to verify no adverse effects and effectiveness from medication prior to initial consideration.
Botox is not a first-line treatment for migraines. It is reserved for individuals with severe refractory headaches.
o May cause delayed adverse effects such as muscle weakness, excessive fatigue, or eye symptoms.
o Requires Special issuance.
| CACI ACCEPTABLE – Migraine Prevention (Prophylaxis) This list is not all inclusive for individual medications in a noted class. | ||
| Migraine prophylaxis | Ground Trial | No-Fly time |
| ☐☐Beta-Blocker• metoprolol succinate (Toprol XL)• propranolol hydrochloride (Inderal XL) | 7 days | None |
| ☐ Calcium Channel Blocker (CCB)• verapamil (Calan; Isoptin SR; Verelan; Covera HS)• nifedipine (Procardia XL) | 7 days | None |
| ☐ Angiotensin-converting enzyme (ACE) inhibitors• lisinopril (Prinivil; Qbrelis; Zestril) | 7 days | None |
| ☐ Angiotensin II Receptor Blockers (ARB) | 7 days | None |
| ☐ Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist• atogepant (Qulipta)• erenumab (Aimovig)• eptinezumab (Vyepti)• fremanezumab (Ajovy)• galcanezumab (Emgality) | 7 days | None |
| SI CONDITIONAL – Migraine Prevention (Prophylaxis) | ||
| Migraine Prophylaxis | Ground Trial | No-Fly Time After each dose |
|---|---|---|
| botulinum toxin (Botox) | 1 month | 72 hours |
UNACCEPTABLE – Migraine Prevention (Prophylaxis) Use prohibited as a single agent or in any combination product. ᴓ ALL tricyclic antidepressants (TCA) ᴓ gabapentin (Neurontin) ᴓ lacosamide (Vimpat) ᴓ lamotrigine (Lamictal) ᴓ lasmiditan (Reyvow) [unacceptable for prophylaxis/prevention] ᴓ pregabalin (Lyrica) ᴓ topiramate (Topamax) ᴓ valproic acid (Depakote)
B. Migraine Relief/Rescue Medication (taken to stop a migraine.)
Post-dose observation time (no fly warning) is based on medication half-life.
ACCEPTABLE when used occasionally. Unacceptable for daily use.
If multiple relief medications are required on a recurring basis to stop symptoms, this is considered a complicated migraine, and the AME should Defer.
| CACI ACCEPTABLE - Migraine Relief/Rescue Medication | |
|---|---|
| Medication Drug Class | Post-dose observation |
| ☐ Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist• rimegepant (Nurtec)• ubrogepant (Ubrelvy)• zavegepant (Zavzpret) | 24 hours |
| ☐ Ergot Derivative | |
| • dihydroergotamine (Migranal) | 48 hours |
| • ergotamine + caffeine (Wigraine) | 24 hours |
| ☐ Serotonin 5HT1 receptor agonist [Triptan]• almotriptan (Axert)• naratriptan (Amerge)• rizatriptan (Maxalt)• SUMAtriptan (Imitrex) [all formulations]• ZOLMitriptan (Zomig) | 24 hours |
| ☐ Serotonin 5HT1 receptor agonist (longer half-life) [Triptan]• eletriptan (Relpax)• frovatriptan (Frova) | 48 hours |
| ☐ Combinations• meloxicam + rizatriptan (Symbravo)• sumatriptan + naproxen (Treximet) | 24 hours |
| ☐ Nausea and Vomiting (associated with migraine) | |
| • metoclopramide (Reglan) | 36 hours |
| • ondansetron (Zofran) | 24 hours |
| • promethazine (Phenergan) | 96 hours |
| SI CONDITIONAL - Migraine Relief/Rescue Medication | |
| ☐☐Serotonin 5-HT1F Receptor Agonist• lasmiditan (Reyvow) | 48 hours |
| • ketorolac (Toradol) - ALL routes of administrationNote: Used short-term, less than 5 days, for severe and/or intractable headaches. This medication is not intended to be used for mild symptoms. | 36 hours |
| UNACCEPTABLE - Migraine Relief/Rescue Medication Use prohibited as a single agent or in any combination product. | |
| ᴓ Acetaminophen + butalbital (Fioricet) ᴓ Aspirin + butalbital (Fiorinal) ᴓ ALL opioid analgesics ᴓ Acetaminophen + isomethptene + dichloralphenazone (Midrin) | |
OSTEOPOROSIS MEDICATION
(Updated 08/26/2026) I. CODE OF FEDERAL REGULATIONS - 67.113 (b)(c), 67.213 (b)(c), and 67.313 (b)(c)
II. MEDICAL HISTORY: ITEM 48. General Systemic
The applicant must report frequency and duration of symptoms, any incapacitation by the condition, treatment, and side effects.
- III. AEROMEDICAL DECISION CONSIDERATIONS: See Musculoskeletal
- IV. PROTOCOL: N/A
- V. PHARMACEUTICAL CONSIDERATIONS:
| ACCEPTABLE* Osteoporosis Medications (when certification criteria are met) | ||
| Medication Drug Class | Initial observation | Post-dose observation |
| Bisphosphonate (Oral)• alendronate (Fosamax)• ibandronate (Boniva)• risedronate (Actonel) | None | None |
| Bisphosphonate (infusion)- zoledronic acid (Reclast) | 1 week | None |
| Parathyroid Hormone Analog• abaloparatide (Tymlos)• teriparatide (Forteo) | 1 week | None |
| * RANK ligand inhibitors• denosumab (Prolia) | 48 hours | 4 hours |
| * Sclerostin Inhibitor; Monoclonal Antibody• romosozumab (Evenity) | 2 weeks | 4 hours |
| Selective Estrogen Receptor Modulator (SERM)• raloxifene (Evista) | None | None |
| Combination SERM + conjugated estrogens• bazedoxifene (Duavee) | None | None |
*Above guidance is for osteoporosis treatment ONLY. If used for cancer-related conditions, additional observation periods and/or requirements may apply.
UNACCEPTABLE Osteoporosis Medications
ᴓ Interferon
interferon gamma-1b (Actimmune)
OVER-THE-COUNTER MEDICATIONS
- (Updated 05/29/2024)
- I. CODE OF FEDERAL REGULATIONS
- 67.113(c); 67.213(c); and 67.313(c)
- II. MEDICAL HISTORY: Item 48. General Systemic
The use of OTC medication may be acceptable if there are no side effects (localized or systemic) which could interfere with aviation safety and the applicant is otherwise qualified.
- III. AEROMEDICAL DECISION CONSIDERATIONS:
- See Item 48. General Systemic
- IV. PROTOCOL: None
- V. PHARMACEUTICAL CONSIDERATIONS
The use of over-the-counter medications (e.g., antihistamines, cold medications, etc.), some food and/or nutritional supplements, and concentrated herbal medications may cause drowsiness or other adverse side effects which could be hazardous to aviation safety.
The following serves as a general guidance for OTC medications.
Prescription medications may have longer observation times. Follow the underlying condition’s medication guidance.
For specific medication questions for Pilots: Contact AMCD or RFS; ATCS: Report to RFS, according to 3930.3C.
A. SIDE EFFECTS*: Below are examples of common side effects and how they may be presented on a medication label. Also review the label for active ingredients, warnings, and dosing directions.
| CONCERNING SIDE EFFECTS | LABEL WARNING MAY SAY | FOUND IN |
|---|---|---|
| Fatigue, drowsiness | “Drowsiness may occur”“Be careful when driving a motor vehicle or operating machinery” | • Anti-diarrheal• Antiemetic (N/V)• Cough and cold• Motion sickness• Sleep-aid |
| Increase heart rate | “Nervousness, dizziness, or sleeplessness occurs” | • Nasal decongestant |
| Vision disturbance | “Changes in vision may occur” | • Eye drops** |
| Heart symptoms | “May cause nervousness, irritability, sleeplessness, rapid heartbeat” “May cause serious heart problems” | • Anti-diarrheal• Caffeine• Nasal decongestant |
* Examples given are not all-inclusive.
** Eye drops may cause blurry vision immediately after use. DO NOT USE IMMEDIATELY PRIOR TO FLIGHT. For more information see the Eye Medication page.
B. OBSERVATION TIMES: There are two types used for medication safety:
C. INITIAL observation time (also known as “ground trial”):
48 hours after taking a new medication for the first time
If the ground trial time has passed but symptoms or side effects are noted or persist, DO NOT FLY OR PERFORM SAFETY-RELATED DUTIES.
D. POST-DOSE observation time (also known as “no fly time”):
Not needed for all medications.
“NO GO” medications will likely have a post-dose observation time which allows the medication effects to dissipate, reducing the potential risk to aviation safety.
In general, post-dose observation time is:
5-times the maximal pharmacologic half-life of the medication OR
5-times the maximal hour-dose interval if the pharmacologic half-life information is not available.
Sample calculations can be found at: www.faa.gov/go/pilotmeds
Exceptions with longer initial observation times (where half-life is longer than the dosing interval):
Sedating antihistamine (e.g., diphenhydramine [Benadryl] or chlorpheniramine [Coricidin; ChlorTrimeton]). See Allergy – Antihistamine & Immunotherapy Medication.
C. TIPS FOR READING MEDICATION LABELS FOR AVIATION SAFETY:
Identify the active ingredient(s). Verify the medication has been previously taken with no side effects. (Single-ingredient products are preferred over combination products because it is easier to spot disqualifying ingredients.)
Review the “Warnings” section to identify potentially aeromedically concerning side effects.
Read carefully “Directions” of product to calculate any post-observation time to mitigate aeromedically concerning risks, if needed.
Pilot Information: The information presented should not be considered all-inclusive; these are general guidelines.
IMPORTANT - it is not just the medication, but the condition for which you are taking them that could be of aeromedical concern.
For specific medication questions, consult your AME.
For more information, see Medications and Flying Brochure and the following pages for the Over-the-Counter (OTC) Medications Reference Guide - What Over-the-Counter (OTC) Medications Can I Take and Still be Safe to Fly?
OVER-THE-COUNTER (OTC) MEDICATIONS REFERENCE GUIDE
What OTC Medications Can I Take and Still Be Safe to Fly?
(Updated 08-28-2024) 1. First, ask yourself “Do I have an underlying condition that makes me unsafe to fly?”
Title 14 CFR 61.53 is the regulation, which prohibits fight with a known medical deficiency (unless cleared by the FAA) and requires that you determine that you are ft to fly prior to each fight. ☐ Am I sick?
Am I having trouble clearing my ears at ground level?
Do I feel bad enough that I keep thinking about how I feel?
Are others asking me if I am ok?
Do I feel good enough to fly ONLY if I take medication?
Am I getting worse?
Next, consider these issues before operating an aircraft:
☐ In the last few days, have you taken, or do you plan to take any medications before flying? ☐ If currently taking a medication only for symptom relief, would you be safe to fly without it? ☐ Do you have any other underlying health conditions?
Discuss these conditions with your AME or family physician to determine if you are safe to fly.
Specifically ask about your ability “to operate machinery” (including any aircraft).
Discuss if the medication, OTC or otherwise, will pose a problem with the underlying condition or other health conditions and/or other medications that you are taking.
When choosing an OTC Medication, follow these steps:
- !! IMPORTANT !!
- NEVER FLY AFTER TAKING A NEW MEDICATION FOR THE FIRST TIME UNTIL
AT LEAST 48 HOURS HAVE PASSED AND NO SIDE EFFECTS ARE NOTED.
NO GO Medications:
If you take any of the NO GO medications listed in the OTC Medications Reference Table OR if you have previously had side effects from the medication, wait at least five (5) dosage intervals after the last dose before flying. See examples on the following page of dosage interval wait time for the recommended grounding period after discontinuation of the medication.
Dosage Interval Wait Time
| PACKAGE INSTRUCTIONS | 5 TIMES DOSAGE INTERVAL | NO FLY TIME | RECOMMENDATION |
|---|---|---|---|
| Every 4-6 hours^ (Up to 6 times daily) | x 5 | 30 hours | Wait at least 30 hours before flying if taking a medication directed to take every 4-6 hours. |
| Every 8 hours (OR three times daily) | x 5 | 40 hours | Wait at least 40 hours before flying if taking a medication directed to take every 8 hours. |
| Every 12 hours (OR twice daily) | x 5 | 60 hours | Wait at least 60 hours before flying if taking a medication directed to take every 12 hours. |
^If there is a range, use the higher number
Caution: Sedating antihistamine medications have a long half-life so wait time is 60 hours for both diphenhydramine (Benadryl) and doxylamine (Unisom), 5 days for both chlorpheniramine and clemastine.
Always follow 14 CFR 61.53. If it is not familiar to you, please review it. Not only is it a requirement, but it is for your safety and that of your passengers.
When in doubt, SAFETY FIRST - DO NOT FLY.
☐ Do one more check of your condition before considering flying.
☐ Get well before considering return to fight status. Do not push it. ☐ Remember, OTC medications help reduce the symptoms of an illness, but do not cure it. ☐ Even though a medication has been determined to be safe for use by the Food and Drug Administration (FDA), this does not mean that the medication is compatible with flying or even driving.
☐ If you choose to fly on medication, be certain that it will not impair safety. Do not simply hope for the best.
See the OTC Medications Reference Table on the following page for specific information.
OVER THE COUNTER (OTC) MEDICATIONS REFERENCE TABLE
The following table is not all-inclusive or intended to take the place of consultation(s) with your primary care physician and/or Aviation Medical Examiner.
Remember, if you have significant underlying health conditions, it is recommended that you discuss the use of any medication with your physician BEFORE taking the OTC medication. Some medications are not recommended (see column “NO GO” in the table below):
| MEDICATIONS OR SYMPTOMS | COMMONLY FOUND IN | GENERALLY SAFE TO FLYMedication or active ingredientGO | AVOID*These can cause incapacitation. (Examples are not all-inclusive.)NO GO | RATIONALE |
| Antihistamines | Allergy productsCough/cold productsPain products | Non-sedating products:fexofenadine (Allegra)loratadine (Claritin) | Sedating products:brompheniramine (Dimetapp)cetirizine (Zyrtec)chlorpheniramine (Chlor- Trimeton)diphenhydramine (Benadryl)levocetirizine Xyzal) | Histamines affect allergies AND sleep/wake cycle. Sedating antihistamines can cause drowsiness and impaired thinking and judgement.NOTE: Sedating antihistamines are commonly found in autopsy after aircraft accidents. The wait times for these medications are longer than noted in the “Dosage Interval Wait Timetable” due to their longer halflife. Consult your AME. |
| Motion sickness | dimenhydrinate (Dramamine)meclizine (Antivert) | |||
| Sleep aid products | Melatonin (not an antihistamine) | diphenhydramine (e.g., Zzzquil, Benadryl).Doxylamine (e.g., Unisom) | “Hang-over effect” morning after safety concern. NOTE: Taking melatonin at the wrong time can actually worsen jetlag and cause daytime drowsiness. | |
| MEDICATIONS OR SYMPTOMS | COMMONLY FOUND IN | GENERALLY SAFE TO FLYMedication or active ingredientGO | AVOID*These can cause incapacitation. (Examples are not all-inclusive.)NO GO | RATIONALE |
| Nasal steroid | Allergy products | azelastine (Astepro)fluticasone (Flonase)mometasone (Nasonex)triamcinolone (Nasacort) | ||
| Nasal decongestants | Nasal congestion, sinus pressure, and cough/cold products | oxymetazoline (Afrin)phenylephrine (Sudafed PE)pseudoephedrine (Sudafed)Less convenient, but safer, are the nasal saltwater lavages:Saline nasal spraysNeti-pots | CAUTION: Sudafedlike medications can speed up your heart rate; therefore, use caution if you have an underlying heart condition. Be very cautious of an extra cup of coffee or two when feeling subpar. This has caused more than one pilot to end up in the emergency room for a racing heart rate. | |
| Cough | Cough/cold products | Coricidin (allowed if it does not contain chlorpheniramine)guaifenesin (found in Mucinex and Robitussin) | dextromethorphan (Delsym) Also in Dayquil, and Mucinex Fast-Max Severe Congestion and Cough.Most “night-time” or “PM” medications contain a sedating antihistamine. | Most cough medications are safe for flight. Use caution as combination products may contain sedating antihistamines. If the label states PM (for nighttime use) or DM (containing dextromethorphan), you should not fly while using these medications and for |
| MEDICATIONS OR SYMPTOMS | COMMONLY FOUND IN | GENERALLY SAFE TO FLYMedication or active ingredientGO | AVOID*These can cause incapacitation. (Examples are not all-inclusive.)NO GO | RATIONALE |
| Coricidin HBP cough & cold (contains chlorpheniramine)Nyquil (contains doxylamine) | at least 5 dosage intervals after the last dose (see Dosage Interval Timetable). | |||
| Aches and Pains | NSAIDs (nonsteroidal antiinflammatory drugs) and analgesics | acetaminophen (Tylenol)aspirin (Bayer)ibuprofen (Advil/Motrin)naproxen (Naprosyn) | Advil PM Tylenol PMMost “PM” medications contain diphenhydramine | Most OTC pain meds are safe to fly as long as the underlying condition is acceptable.CAUTION: Some OTC meds are combined with a sedating antihistamine, which can cause drowsiness (see antihistamine row). |
| Additional options for headaches | Caffeine (Commonly found in Excedrin.) | Read the label. | ||
| Topical rubsPain patches | Lidocaine patch (Lidoderm)Muscle rubCapsaicin | CAUTION: With lidocaine application, avoid getting on hands or open wounds as this can drop blood pressure or absorb faster. | ||
| Opioid Antidote | Opioid antidote | naloxone (Narcan) | CAUTION: If medication is administered, DO NOT FLY until cleared by FAA. | |
| MEDICATIONS OR SYMPTOMS | COMMONLY FOUND IN | GENERALLY SAFE TO FLYMedication or active ingredientGO | AVOID*These can cause incapacitation. (Examples are not all-inclusive.)NO GO | RATIONALE |
| GastrointestinalNausea Vomiting Diarrhea | Anti-emeticsAnti-motility drugs | bismuth subsalicylate (Kaopectate, Pepto-Bismol) | loperamide (Imodium) | GI illness can cause dehydration, cramps, and pain with increase in altitude.NOTE: Loperamide should not be used during acute illness as it can cause dizziness. When taken daily for a chronic condition, it may require a special issuance. |
| GastrointestinalConstipation Laxatives | Bulk forming (e.g., Benefiber)Osmotic (e.g., MiraLAX)Stool softener (e.g., Colace)Stimulant (e.g., Senna) | magnesium citrate | Use in recommended doses. | |
| GastrointestinalIndigestion | Proton Pump Inhibitors (PPI) | esomeprazole (Nexium)lansoprazole (Prevacid)omeprazole (Prilosec)pantoprazole (Protonix)rabeprazole (Aciphex) | Be careful not to mask the underlying symptoms. | |
| H2 blockers | cimetidine (Tagamet) | Be careful not to mask the underlying symptoms. | ||
| MEDICATIONS OR SYMPTOMS | COMMONLY FOUND IN | GENERALLY SAFE TO FLYMedication or active ingredientGO | AVOID*These can cause incapacitation. (Examples are not all-inclusive.)NO GO | RATIONALE |
| famotidine (Pepcid)nizatidine (Axid)rantidine (Zantac) | ||||
| Antacids | Aluminum hydroxide (Maalox)Calcium carbonate (Tums)Magnesium hydroxide (Milk of Magnesia) | Be careful not to mask the underlying symptoms. | ||
| Urinary tract Infections | Pain reliever | phenazopyridine (AZO standard) | Oxybutynin (Oxytrol for women | Oxybutynin can cause sedation and dizziness.Phenazopyridine is generally allowed after adequate ground trial to monitor for side effects. Symptoms should be resolved, other than slight residual irritation. |
| Skin rash | EmollientsCreamsLotions | Almost all are allowed.Anti-fungal topicalAntipruriticsTopical corticosteroid | Ensure the underlying condition is not an issue with safe flight. | |
| MEDICATIONS OR SYMPTOMS | COMMONLY FOUND IN | GENERALLY SAFE TO FLYMedication or active ingredientGO | AVOID*These can cause incapacitation. (Examples are not all-inclusive.)NO GO | RATIONALE |
| Dry or itchy eyes | Products for dry eyesAllergy/itchy eyesEye lubrication | olopatadine (Pataday)alcaftadine (Lastacaft)artificial tears | Eye ointment or gel during flight. | Temporary blurry vision may occur with use of eye drops. Note: Eye ointment or gels should not be used in flight since the blurry vision may last for minutes. |
- ADDITIONAL RESOURCES
- ➢ AAM-400 Medication Brochure
- ➢ Over-the-Counter Medication
- ➢ Allergy - Antihistamine & Immunotherapy Medication
- ➢ Erectile Dysfunction Medication
- ➢ Hypertension Medication
- ➢ Acceptable Combinations of Diabetic Medications
- ➢ Antidepressant Program
➢ Additional Medication Information in Guide for Aviation Medical Examiners
➢ Do Not Issue (DNI) Do Not Fly (DNF)
DNI - pilots should NOT take any of these medications or classes of medication and fly.
DNF - pilots should NOT fly until these medications are stopped and a period of time has elapsed.
SMOKING CESSATION MEDICATIONS
- (Updated 04/29/2026)
- I. CODE OF FEDERAL REGULATIONS - 67.113(c); 67.213(c) and 67.313(c)
- II. MEDICAL HISTORY: Item 47: Psychiatric
Verify why the medication is used. If taken for a psychiatric condition, see that section. Inquire if any side effects that could interfere with aviation safety have occurred.
- III. AEROMEDICAL DECISION CONSIDERATIONS:
- See Item 47: Psychiatric
- IV. PROTOCOL: N/A
- V. PHARMACEUTICAL CONSIDERATIONS
Usual treatment duration is 12 weeks, however, extended maintenance therapy up to one year may have additional guidance.
| ACCEPTABLE Smoking Cessation Medications (as a single agent or in any combination product) | ||
| Medication | Initial observation (Ground Trial) | Post-dose observation (nofly time after each dose) |
| • nicotine (gum, lozenge, patch) | None | None |
| • nicotine (nasal spray) | 48 hours | None |
| • varenicline (oral) (Chantix) o AME can issue if no history of psychiatric condition(s) or concerns. Annotate Item 60.o If used as an antidepressant see Anxiety, Depression, and Related Conditions Table | 1 week | None |
UNACCEPTABLE Smoking Cessation Medications
bupropion SR (Zyban) o FIRST treatment course
Do NOT issue a medical during active treatment.
Once treatment is complete, a 7 day no-fly after last dose is required. o RECURRENT treatment or EXTENDED therapy > 6 months
Refer to Anxiety, Depression, and Related Conditions Table
nortriptyline (Pamelor)
SEDATIVES
- (Updated 06/24/2020)
- I. CODE OF FEDERAL REGULATIONS
- First-Class Airman Medical Certificate: 67.107
- Second-Class Airman Medical Certificate: 67.207
- Third-Class Airman Medical Certificate: 67.307
II. MEDICAL HISTORY and CONVICTIONS OR ADMINISTRATIVE ACTIONS.
Medical History: Item 18.n., Substance Dependence; or failed a drug test ever; or substance abuse or use of illegal substance in the last 2 years.
"Substance" includes alcohol and other drugs (e.g., PCP, sedatives and hypnotics, anxiolytics, marijuana, cocaine, opioids, amphetamines, hallucinogens, and other psychoactive drugs or chemicals). For a "yes" answer to Item 18.n., the AME should obtain a detailed description of the history. A history of substance dependence or abuse is disqualifying. The AME must defer issuance of a certificate if there is doubt concerning an applicant's substance use.
Convictions or Administrative Actions: Item 18.v. Medical History v. History of Arrest(s), Conviction(s) and/or Administrative Action(s)
Arrest(s), conviction(s), and/or administrative action(s) affecting driving privileges may raise questions about the applicant's qualifications for airman medical certification. All incidents must be reported (even if reported on a previous application), to include even a single driving while intoxicated (DWI) arrest, conviction and/or administrative action. Incidents reported under 18.v. are just part of many factors considered in the overall process of medical certification. See Substances of Dependence/Abuse
NOTE: Checking yes does not relieve the airman of responsibility to report each motor vehicle action to Security. Also, remind the airman that once he/she has checked yes to any item in #18, especially items 18 n., 18 o. or 18 v., they must ALWAYS mark yes to these numbers, even if the condition has been reviewed and granted an eligibility letter from the FAA
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 47., Psychiatric, Aerospace Medical Disposition table.
- IV. PROTOCOL: See Substances of Dependence/Abuse
- V. PHARMACEUTICAL CONSIDERATIONS
- A. Aerospace Medical Dispositions, Item 47. Psychiatric Conditions
SLEEP AIDS
- (Updated 07/29/2020)
- I. CODE OF FEDERAL REGULATIONS
- 67.113(c); 67.213(c); and 67.313(c)
II. MEDICAL HISTORY: Use of sleep aids is a potential risk to aviation safety due to effects of the sleep aid itself or the underlying reason/condition for using the sleep aid.
All the currently available sleep aids, both prescription and over the counter, can cause impairment of mental processes and reaction times, even when the individual feels fully awake. (As examples, see the Food and Drug Administration drug safety communications on zolpidem and eszopiclone)
Medical conditions that chronically interfere with sleep are disqualifying regardless of whether a sleep aid is used or not. Examples may include primary sleep disorders (e.g., insomnia, sleep apnea) or psychological disorders (e.g., anxiety, depression). While sleep aids may be appropriate and effective for short term symptomatic relief, the primary concern should be the diagnosis, treatment, and resolution of the underlying condition before clearance for aviation duties.
Occasional or limited use of sleep aids, such as for circadian rhythm disruption in commercial air operations, is allowable for pilots. Daily/nightly use of sleep aids is not allowed regardless of the underlying cause or reason. See Pharmaceutical Considerations below.
- III. AEROMEDICAL DECISION CONSIDERATIONS: N/A
- IV. PROTOCOL: N/A
- V. PHARMACEUTICAL CONSIDERATIONS:
Because of the potential for impairment, we require a minimum wait time between the last dose of a sleep aid and performing pilot duties. This wait time is based on the pharmacologic elimination half-life of the drug (half-life is the time it takes to clear half of the absorbed dose from the body). The minimum required wait time after the last dose of a sleep aid is 5-times the maximum elimination half-life.
The table on the following page lists several commonly prescribed sleep aids along with the required minimum wait times for each.
| Trade Name | Generic Name | Required minimum waiting time after last dose before resuming pilot duties |
| Ambien | zolpidem* | 24 hours |
| Ambien CR | zolpidem (extended release) | 24 hours |
| Edluar | zolpidem (dissolves under the tongue) | 36 hours |
| Intermezzo | zolpidem (for middle of the night awakening) | 36 hours |
| Lunesta | eszopiclone | 30 hours |
| Restoril | temazepam | 72 hours |
| Rozerem | ramelteon | 24 hours |
| Sonata | zaleplon | 12 hours |
| Zolpimist | zolpidem (as oral spray) | 48 hours |
SLEEP AID WAIT TIMES
* NOTE: The different formulations of zolpidem have different half-lives, thus different wait times.
VACCINES
(Updated 12/03/2025) I. CODE OF FEDERAL REGULATIONS - 67.113(b)(c); 67.213 (b)(c); and 67.313(b)(c)
II. MEDICAL HISTORY: Item 48. General Systemic
The use of vaccines below may be acceptable if there are no side effects (localized or systemic), which could interfere with aviation safety and the applicant is otherwise qualified.
- III. AEROMEDICAL DECISION CONSIDERATIONS:
- See Item 48. General Systemic
- IV. PROTOCOL: None
- V. PHARMACEUTICAL CONSIDERATIONS
Some vaccines will require a post-dose observation time due to either immediate or delayed side effects that will affect aeromedical safety. See table below.
FDA approved vaccines are acceptable. If vaccine is FDA approved and not listed on the table below, contact AMCD/RFS for further guidance.
1If experiencing delayed symptoms (e.g. headache, fatigue, myalgia, or chills) 14 CFR 61.53 applies – NO fly, NO safety-related duties (SRD) until symptom-free.
| Vaccine | Post-dose observation¹ |
|---|---|
| ✓ Bacillus calmette-guerin (intradermal) ✓ Chikungunya vaccine (Vimkunya) (recombinant)* ✓ Diphtheria, tetanus, and pertussis (Boostrix) ✓ Hepatitis A ✓ Hepatitis B ✓ Influenza ✓ Measles, mumps, and rubella vaccines (MMR) (Priorix) ✓ Measles, mumps, rubella, and varicella virus vaccine (MMRV) (ProQuad) ✓ Meningococcal (Menactra, MenQuadfi, Menveo) ✓ Pneumonia ✓ Typhoid, oral (Vivotif) or injection (Typhim Vi) ✓ Yellow Fever• YF-VAX• Stamaril (when YF-VAX is depleted in US) | Not required |
| ✓ COVID-19 Vaccines• Comirnaty - Pfizer/BioNTech• Moderna• Novavax ✓ Shingles | 24 hours |
| ✓ Rabies | 72 hours |
*Ixchiq (live-attenuated) is no longer FDA approved.
WEIGHT LOSS MEDICATION
- (Updated 08/26/2026)*
- I. CODE OF FEDERAL REGULATIONS - 67.113(c); 67.213(c); & 67.313(c)
- II. MEDICAL HISTORY: ITEM 48. General Systemic
The applicant must report frequency and duration of symptoms, any incapacitation by the condition, treatment, and side effects. If the applicant has diabetes, see that page.
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 48. General Systemic
IV. PROTOCOL: See either the Prediabetes or Weight Loss Management disposition tables.
V. PHARMACEUTICAL CONSIDERATIONS: Pilots exhibiting symptoms which may interfere with flight duties, regardless of the treatment used, must not fly in accordance with 61.53. The AME must notate the evaluation data in Block 60.
DIABETIC MEDICATIONS USED FOR WEIGHT LOSS*:
☐ A1C must be 6.4 or less with no diagnosis of diabetes AND ☐ No history of hypoglycemia requiring intervention.
See Weight Loss Management or Prediabetes Status Report. If used for DIABETES, see www.faa.gov/go/diabetic If taking insulin + weight loss medication, see www.faa.gov/go/ITDM
| ACCEPTABLE Weight Loss Medications When certification criteria are met. | |
| Medication Drug Class | Initial observation |
| ☐ Lipase inhibitors – e.g., orlistat [Alli; Xenical] - OTC | 48 hours |
| Treated with a single diabetic medication component: ☐ metformin☐ GLP-1 agonist• liraglutide• semaglutide (Wegovy) [injection or oral]• tirzepatide (Zepbound) [GIP + GLP-1 Agonist]☐ Combination of the following (only one diabetic medication):• orlistat + metformin• orlistat + GLP-1 agonist | • One (1) week after starting for weight loss.• 48-hour observation with each dose increase, medication, or formulation change.See either the Prediabetes or Weight Loss Management disposition tables |
| CONDITIONALLY ACCEPTABLE Weight Loss Medications *(Requires SI) | |
| Combination of two diabetic medications (2 components) e.g., metformin + GLP-1 agonist | See Acceptable Combinations of Diabetes Medications |
| UNACCEPTABLE Weight Loss Medications Use prohibited as a single agent or in any combination product. | |
| Sympathomimetic (such as phentermine)• benzphetamine (Regimex)• diethylpropion (Tenuate, Tempanil)• phendimetrazine (Bontril)• phentermine (Adipex, Fastin)• phentermine + topiramate (Qsymia) | bupropion + naltrexone (Contrave) citric acid + cellulose (Plenity) Serotonin 5HT-2 Receptor Agonist• lorcaserin (Belviq)• fenfluramine hydrochloride (Pondimin) |