Use of Medication in Aviation – Advice for Aeromedical Examiners

In this article we provide practical information for General Medical Practitioners, consultants, specialists and Aeromedical Examiners (AMEs) about the use of medication for pilots, air traffic controllers (ATCOs) and other aviation professional. 

The Risk of Medication to Aviation Safety

Any medication can cause side effects, some of which may impair the safe performance of pilots, ATCOs and other people 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, it’s important to help improve awareness of the specific challenges of the use of medication in aviation. 

Who is This Article For?

This article is aimed mainly at General Medical Practitioners, consultants, specialists and AMEs.   We have a separate article for pilots, controllers, cabin crew and other aviation personal, which you can find in the Use of Medication for Aviation Professionals article. 

The Key Take-Aways

  • Balance the choice of medication with the potential risk factors to the individual’s working conditions so as to address the patient’s medical condition without compromising aviation safety.    
  • Ensure the safe use of medication through familiarisation with drugs and their side effects.
  • Develop trust and confidence between pilots/ATCOs/cabin crew and his/her AME.
  • Ensure that AMEs objectively consider whether there is a need for a period of unfitness for duty if the medical condition or the potential side effects of medication reduce the ability to perform flying or other aviation duties. 
  • Help to educate pilots/ATCOs and other aviation professionals on the potential risks of medication including self-medication and on the need to seek expert advice. 

Main Principles of Medication Use in Aviation

Medication is used to treat a variety of medical conditions or to relieve symptoms. Many drugs are also available from pharmacists, supermarkets or online for self-medication.

  • Evidence-based prescription: AMEs should ensure that the appropriate medication is prescribed that meets the needs of the patient while taking into account any potential safety risks that might be introduced into their daily working lives.
  • Balance benefit and risk ratio: AMEs should assess the illness itself, the impact of the medication and the risk and benefits for the patient in his/her working environment.
  • Collaboration with the patient is vital to ensure that AMEs and individuals develop a relationship based on trust and openness.  
  • Sources: Only use official sources for information on medication.

General Guidance on Prescribing Medication

  • Identify the type and severity of the medical condition. 
  • Assess the risk of the medical condition itself to the working environment.
  • Consider the working conditions (such as altitude, cabin pressure, stress…) in relation with the medical condition and treatment.
  • Examine the side effects of drugs.
  • Decide on a period of unfitness for duty if needed, depending on the medical condition, the kind of drug being prescribed and the knowledge of any possible side effects.
  • Helpful questions to ask yourself:
    • Does the medical condition itself reduce the ability to perform flying or other aviation duties that might affect the safe operation of aircraft or equipment?
    • Which is the right medication for this disease?
    • Are the potential side effects more of a risk than the medical condition itself?
    • Efficacy of the medication? Individual sensitivity?

Assessment of Fitness

A pilot/ATCO should not exercise the privileges of their licence if:

  • The condition itself makes the pilot/ATCO unfit.
  • The medication could have side effects that could affect the performance or increase the risk of incapacitation.

​In the Case of Common Medical Conditions:

If there is no evidence for adverse effects and the medication is efficacious, the pilot/ ATCO might exercise the privileges of their licence while being under treatment.

In Case of More Severe Medical Conditions:

Determine the risk/benefit ratio and release pilot/ATCO from duty if necessary. For illnesses such as diabetes, heart disease, psychiatric, gastro-intestinal and urological conditions the pilot/ATCO will be assessed as unfit until the stabilisation or improvement of the disease. The follow-up should include monitoring and reassessment of the patient.

Long-term treatments:

For treatments of medical conditions such as diabetes or hypertension the AME should decide on an unfitness period when starting a new medication until assessing its impact and the performance of the patient. If medication proved efficacious without adverse effects, allow the pilot/ATCO to resume their duties. 

Regular supervision of patients who are under long-term treatment is vital.

Establishing Good Relations Between Pilots/ATCOs and Treating Physicians/AMEs

  • It is important to develop a relationship of confidence and trust.
  • Listen to the patient and try to find the best solution for his/her health and needs.
  • Educate pilots/ATCOs on the importance of seeking advice from their AME. 
  • Establish a safe and honest dialogue between the AME and the patient. 
  • Ensure that you have a good knowledge of the medical requirements in aviation.

Guidelines for Treating Physicians and AMEs

  • Accept that all medication can have potential side effects.
  • Educate pilots/ATCOs about the potential risks of self-medication.
  • Consider the impact of side effects in the aviation related working environment.
  • Do not deny pilots/ATCOs justified treatment but inform them about the potential advantages and disadvantages of medication.
  • Always consider a period of unfitness when beginning new treatment.
  • For treating physicians: If in doubt about the effects of illness and/or medication consult your patient’s AME.
  • For AMEs: Understand the regulatory principles, guidelines and regulations.

Guidelines for Pilots/ATCOs

  • Do not exercise the privileges of your licence to operate if there is a need to take medication unless cleared by your AME.
  • Be aware that medications can have side effects which could affect flight safety and work performance.
  • For pilots engaged in flying competitions: be aware of the doping rules.
  • Seek advice from a medical practitioner or pharmacist before taking medication and inform them of your occupation.
  • Inform the AME when taking medication.
  • Be prepared to be prevented from exercising the privileges of your licence when taking medication for the first time.