Over-the-Counter (OTC) Medications Reference Guide
Over-the-Counter (OTC) Medications Reference Guide
(Updated 08-28-2024)8 Pages
What OTC Medications Can I Take and Still Be Safe to Fly?
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?
2. 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.
3. 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.
Figure (PDF page 1)
4. 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 | AVOIDThese can cause incapacitation. Examples areNOT 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 half-life. 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. | |
| 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: Sudafed-like 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 sub-par. 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.Coricidin HBP cough & cold (contains chlorpheniramine)Nyquil (contains doxylamine) | 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 at least 5 dosage intervals after the last dose (see Dosage Interval Timetable). |
| Aches and Pains | NSAIDs (non-steroidal anti-inflammatory 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. | |
| 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)famotidine (Pepcid)nizatidine (Axid)rantidine (Zantac) | Be careful not to mask the underlying symptoms. | ||
| 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 resolvedother 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. | |
| Dry oritchy eyes | Products fordry 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.