European Aviation Safety Agency Use of Medication - Guidance for Pilots,

ATCOs and Cabin Crew Members

USE OF MEDICATION
GUIDANCE FOR PILOTS, ATCOs AND CABIN CREW MEMBERS

Prior to exercising the privileges of their licenses and attestation pilots, ATCOs and cabin crew members
should give proper consideration to the following:

(a) Any medication can cause side effects, some of which may impair the safe performance of performing
aviation safety related duties. Equally, symptoms of colds, sore throats, diarrhoea and other abdominal
upsets may cause little or no problem whilst on the ground but may distract the pilot or cabin crew
member and degrade their performance whilst on duty. The in-flight environment may also increase the
severity of symptoms which may only be minor whilst on the ground. Therefore, one issue with
medication and performing aviation safety related duties is the underlying condition and, in addition,
the symptoms may be compounded by the side effects of the medication prescribed or bought over the
counter for treatment. This guidance material provides some help to pilots and cabin crew in deciding
whether expert aero-medical advice by an AME, AeMC, GMP, OHMP or medical assessor is needed.
(b) Before taking any medication and acting as a pilot or cabin crew member, the following three basic
questions should be satisfactorily answered:
(1) Do I feel fit to perform my duties?
(2) Do I really need to take medication at all?
(3) Have I given this particular medication a personal trial on the ground to ensure that it will not
have any adverse effects on my ability to perform my duties?
(c) Confirming the absence of adverse effects may need expert aero-medical advice.
(d) The following are some widely used medicines with a description of their compatibility with performing
aviation safety related duties:
(1) Antibiotics. Antibiotics may have short-term or delayed side effects which can affect pilot or cabin
crew performance. More significantly, however, their use usually indicates that an infection is
present and, thus, the effects of this infection may mean that a pilot or cabin crew member is not
fit to perform their duties and should obtain expert aero-medical advice.
(2) Anti-malaria drugs. The decision on the need of anti-malaria drugs depends on the geographical
areas to be visited, and the risk that the pilot or cabin crew member has of being exposed to
mosquitoes and of developing malaria. An expert medical opinion should be obtained to establish
whether anti-malaria drugs are needed and what kind of drugs should be used. Most of the anti-
malaria drugs (atovaquone plus proguanil, chloroquine, doxycycline) are compatible with
performing aviation safety related duties. However, adverse effects associated with mefloquine
include insomnia, strange dreams, mood changes, nausea, diarrhoea and headaches. In addition,
mefloquine may cause spatial disorientation and lack of fine coordination and is, therefore, not
compatible with performing aviation safety related duties.
(3) Antihistamines. Antihistamines can cause drowsiness. They are widely used in ‘cold cures’ and in
treatment of hay fever, asthma and allergic rashes. They may be in tablet form or a constituent of
nose drops or sprays. In many cases, the condition itself may preclude performing aviation safety
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European Aviation Safety Agency Use of Medication - Guidance for Pilots,
ATCOs and Cabin Crew Members

related duties, so that, if treatment is necessary, expert aero-medical advice should be sought so
that so-called non-sedative antihistamines, which do not degrade human performance, can be
prescribed.
(4) Cough medicines. Antitussives often contain codeine, dextromethorfan or pseudo-ephedrine
which are not compatible with performing aviation safety related duties. However, mucolytic
agents (e.g. carbocysteine) are well-tolerated and are compatible with performing aviation safety
related duties.
(5) Decongestants. Nasal decongestants with no effect on alertness may be compatible with
performing aviation safety related duties. However, as the underlying condition requiring the use
of decongestants may be incompatible with performing aviation safety related duties, expert
aero-medical advice should be sought. For example, oedema of the mucosal membranes causes
difficulties in equalising the pressure in the ears or sinuses.
(6) Nasal corticosteroids are commonly used to treat hay fever, and they are compatible with
performing aviation safety related duties.
(7) (i) Common pain killers and antifebrile drugs. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
and paracetamol, commonly used to treat pain, fever or headaches, may be compatible with
performing aviation safety related duties. However, the pilot or cabin crew member should give
affirmative answers to the three basic questions listed in (b) before using the medication and
carrying out performing aviation safety related duties.
(ii) Strong analgesics including codeine are opiate derivatives, and they may produce a significant
decrement in human performance and, therefore, are not compatible with performing aviation
safety related duties.
(8) Anti-ulcer medicines. Gastric secretion inhibitors such as H2 antagonists (e.g. ranitidine,
cimetidine) or proton pump inhibitors (e.g. omeprazole) may be acceptable after diagnosis of the
pathological condition. It is important to seek for the medical diagnosis and not to only treat the
dyspeptic symptoms.
(9) Anti-diarrhoeal drugs. Loperamide is one of the most common anti-diarrhoeal drugs and is usually
safe to take whilst performing aviation safety related duties. However, the diarrhoea itself often
makes the pilot and cabin crew member unfit for performing aviation safety related duties.
(10) Hormonal contraceptives and hormone replacement therapy usually have no adverse effects and
are compatible with performing aviation safety related duties.
(11) Erectile dysfunction medication. This medication may cause disturbances in colour vision and
dizziness. There should be at least 6 hours between taking sildenafil and performing aviation
safety related duties duty; and 36 hours between taking vardenafil or tadalafil and performing
aviation safety related duties duty.
(12) Smoking cessation. Nicotine replacement therapy may be acceptable. However, other medication
affecting the central nervous system (buproprion, varenicline) is not acceptable for pilots.
(13) High blood pressure medication. Most anti-hypertensive drugs are compatible with performing
aviation safety related duties. However, if the level of blood pressure is such that drug therapy is
required, the pilot or cabin crew member should be monitored for any side effects before carrying

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European Aviation Safety Agency Use of Medication - Guidance for Pilots,
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out performing aviation safety related duties. Therefore, consultation with the AME, AeMC, GMP,
OHMP or medical assessor as applicable, is needed.
(14) Asthma medication. Asthma has to be clinically stable before a pilot or cabin crew member can
return to performing aviation safety related duties. The use of respiratory aerosols or powders,
such as corticosteroids, beta-2-agonists or chromoglycic acid may be compatible with performing
aviation safety related duties. However, the use of oral steroids or theophylline derivatives is
incompatible with performing aviation safety related duties duty. Pilots or cabin crew members
using medication for asthma should consult the AME, AeMC, GMP, OHMP or medical assessor, as
applicable.
(15) Tranquillisers and sedatives. The inability to react, due to the use of this group of medicines, has
been a contributory cause to fatal aircraft accidents. In addition, the underlying condition for
which these medications have been prescribed will almost certainly mean that the mental state
of a pilot or cabin crew member is not compatible with performing aviation safety related duties.
(16) Sleeping tablets. Sleeping tablets dull the senses, may cause confusion and slow reaction times.
The duration of effect may vary from individual to individual and may be unduly prolonged. Expert
aero-medical advice should be obtained before using sleeping tablets.
(17) Melatonin. Melatonin is a hormone that is involved with the regulation of the circadian rhythm.
In some countries it is a prescription medicine, whereas in most other countries it is regarded as
a ‘dietary supplement’ and can be bought without any prescription. The results from the efficiency
of melatonin in treatment of jet lag or sleep disorders have been contradictory. Expert aero-
medical advice should be obtained.
(18) Coffee and other caffeinated drinks may be acceptable, but excessive coffee drinking may have
harmful effects, including disturbance of the heart’s rhythm. Other stimulants including caffeine
pills, amphetamines, etc. (often known as ‘pep’ pills) used to maintain wakefulness or suppress
appetite can be habit forming. Susceptibility to different stimulants varies from one individual to
another, and all may cause dangerous overconfidence. Overdosage causes headaches, dizziness
and mental disturbance. These other stimulants should not be used.
(19) Anaesthetics. Following local, general, dental and other anaesthetics, a period of time should
elapse before returning to performing aviation safety related duties. The period will vary
considerably from individual to individual, but a pilot or cabin crew member should not perform
their duties for at least 12 hours after a local anaesthetic, and for at least 48 hours after a general,
spinal or epidural anaesthetic (see MED.A.020).
(e) Many preparations on the market nowadays contain a combination of medicines. It is, therefore,
essential that if there is any new medication or dosage, however slight, the effect should be observed
by the pilot or the cabin crew member on the ground prior to performing aviation safety related duties.
It should be noted that medication which would not normally affect pilot or cabin crew performance
may do so in individuals who are ‘oversensitive’ to a particular preparation. Individuals are, therefore,
advised not to take any medicines before or during flight unless they are completely familiar with their
effects on their own bodies. In cases of doubt, pilots and cabin crew members should consult an AME,
AeMC, GMP, OHMP or medical assessor, as applicable.

(f) Other treatments

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European Aviation Safety Agency Use of Medication - Guidance for Pilots,
ATCOs and Cabin Crew Members

Alternative or complementary medicine, such as acupuncture, homeopathy, hypnotherapy and several

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