Ask the Flight Surgeon / By CPT Scott A. Cygan, O.D.: Q: Doc, I’ve used a few over-the-counter medications in the past to avoid seeing my flight surgeon. Is this allowed or am I breaking the rules?
FS: Over-the-counter (OTC) medications are defined as drugs that are reasonably safe and effective for use by the general public without seeking treatment from a health care professional. However, this does not mean these medicines should be considered completely safe or free of potential side effects. In addition, all air crewmembers should be astutely aware that many of these medications are strictly prohibited while on active flight status.
According to AR 40-8, self-medication by anyone on flight status is not allowed. However, the Aeromedical Policy Letters contain a list of OTC medications (referred to as Class I medications) that can be taken on a short-term basis when a flight surgeon is not immediately available. Examples include Tylenol (acetaminophen) for mild pain, Sudafed (pseudoephedrine) for mild congestion, antacids for infrequent indigestion, or fiber supplements for occasional constipation. A reasonably prompt consultation with a flight surgeon is still required following use of any of the medications listed to ensure an aeromedically relevant medical condition does not go unrecognized.
Are you saying I have to see a flight surgeon every time I take Tylenol?
No, not necessarily. For example, 65% of Americans are expected to have at least one mild headache every year. Tylenol (acetaminophen) can help dull the symptoms of a mild headache. Informing a flight surgeon of occasional use of an OTC medication to treat infrequent and mild headaches is very reasonable. This information can be annotated within your medical record and unless the headaches change, no further follow-up is necessary until the next annual flight physical. If the headaches become more frequent or symptoms become more severe than previously reported, an appointment with a flight surgeon would be required to reevaluate.
In addition, consider the financial savings from seeing a flight surgeon for mild illnesses or infrequent symptoms. According to the Consumer Health Products Association, the average American household spends $338 per year on OTC medications. As a federal employee, patients directed to take OTCs by their healthcare provider receive these at no cost from a pharmacy within a military treatment facility. This simple step will save some money and ensure only OTCs allowed on flight status are prescribed. It will also ensure all OTCs being taken are documented in the medical record. It’s a win-win for everyone.
Can I get a more comprehensive list of all allowable and/or restricted OTC medicines?
According to the Food and Drug Association (FDA), the government agency tasked with regulating OTC medicines, over 300,000 different products exist on the market. Therefore, providing air crewmembers with an all-inclusive list is just not practical. In addition to the massive number of OTC products available, an endless number of combination products exist as well. For example, a single OTC product for relief of cough and cold symptoms called Vick’s DayQuil contains four different active ingredients: acetaminophen, dextromethorphan, guaifenesin, and phenylephrine. These ingredients serve as a mild pain reliever, cough suppressant, expectorant and nasal decongestant respectively. Common side effects include nervousness, dizziness, sleeplessness, blurry vision, upset stomach and nausea. An explanation of why these side effects could be potentially dangerous in an air crewmember should be self-explanatory.
Besides the potential for dangerous side effects, OTC medications used frequently may mask more serious underlying medical conditions. Antacids, such as Tums (calcium carbonate), Maalox (calcium carbonate) and Rolaids (calcium carbonate and magnesium hydroxide) contain alkaline ions to neutralize stomach acidity. Certain types of food commonly cause occasional and mild indigestion, but consistent mild or more severe symptoms may be signs of gastro-esophageal reflux disease, peptic ulcer disease, or other serious underlying conditions. Reporting changes in the frequency or necessity of OTC medication use will assist a flight surgeon in recognizing the need for a further evaluation.
In summary, it’s prudent to discuss with a local flight surgeon which OTC medications can be used safely while on flight status. Be sure that any medications or supplements are reported during every visit to the clinic. Despite having taken a medication or supplement in the past without side effects, there is no guarantee that side effects will not develop in the future. Do the right thing: don’t risk safety or an aviation career to treat a runny nose.
CPT (Dr.) Scott A. Cygan is a flight surgeon at the U.S. Army School of Aviation Medicine, Fort Rucker, AL.