Aeromedical Report
Frequently Asked Questions

Air Line Pilot, September/October 2002, p.5

By Dr. John Stepp

What can I take for my seasonal upper respiratory allergies and continue to fly?

The FAA has approved four classes of medications for a pilot to use during flight only if (a) the medication(s) effectively control the pilot’s symptoms and (b) cause no side effects after a 24-hour ground test. The approved medication classes are non-sedating antihistamines, such as Claritin, Clarinex, and Allegra (note: Zyrtec is NOT approved for use within 24 hours of flight); decongestants, such as ephedrine, pseudoephedrine ("Sudafed"), and Entex; steroid nasal sprays, such as Nasonex and Flonase (note: decongestant nasal sprays such as Afrin are NOT approved); and desensitization injections or "allergy shots."

A pilot may use these medications in any combination as long as the treatment is effective in controlling symptoms and no side effects occur.

I received permission from the FAA to fly while taking Ditropan for an irritable bladder, but I have heard that approval for this medication has been withdrawn. Is this true?

Yes. The FAA recently rescinded approval for this medication after reports of psychological side effects in some individuals. Consequently, pilots currently flying on Ditropan will be denied medical certification if they are still taking the medication at the time of their next FAA medical examination. We recommend that pilots who find themselves in this situation call the ALPA Aeromedical Office for advice.

I was recently found to have coronary artery disease and will soon have an angioplasty. My cardiologist is recommending that he insert what he calls a "medicated stent" into the obstructed vessel after the angioplasty. Does the FAA approve these medicated stents?

So-called "medicated stents" are being studied for effectiveness, but neither the FDA nor the FAA approves them as of yet.

Most obstructions in the coronary arteries are now treated by a technique known as "balloon angioplasty." With this procedure, a thin catheter is inserted into the femoral artery in the groin and threaded up through the heart into the obstructed vessel. Once inside the vessel, a small balloon in the tip of the vessel is inflated, thereby spreading the obstructing "plaque" against the walls of the vessel and reducing the obstruction.

In recent years, inserting a length of wire mesh conduit, called a stent, into the vessel at the site of the reduced obstruction has been shown to reduce the risk of the obstruction forming again, or reocclusion.

Very recently, researchers have developed stents that are coated with agents intended to further reduce the rate of re-occlusion, but their effectiveness has not yet been proved. Consequently, the FDA has not yet approved medicated stents for use in human subjects, and until it does, the FAA will not certify pilots who have had these devices inserted. If, however, your physician implants a standard, non-medicated stent, the FAA will consider reinstating your medical certificate after you have completed a mandatory 6-month observation period. To obtain such consideration, you must submit all of the records from your initial evaluation and treatment, plus a follow-up radionuclide stress test and repeat coronary angiogram taken at the end of the 6-month observation period. (The repeat angiogram is mandatory for first- or second-class medical certificates, but not for third-class.)

My FAA aviation medical examiner told me that the FAA was going to start allowing AMEs to issue "waivers." Is this true?

Not quite. An upcoming change in FAA policy will allow AMEs to re-new previously issued Special Issuance Medical Certificates ("waivers") for third-class applicants only. AMEs will not be authorized to grant the initial Special Issuance certificates for any class of applicant.

I recently passed a kidney stone. Is this disqualifying? If so, what is required to have my medical certificate reinstated?

With the recent security changes that make using the lavatory during flight extremely inconvenient for a pilot, we have seen a dramatic in-crease in the number of pilots with kidney stones. Yes, passing a kidney stone is disqualifying. Before you may legally resume flying, you must present documentation that the following three criteria have been met: (1) You must be free of stones by x-ray. (The specific type of x-ray image taken is up to your treating physician.) (2) Normal kidney function must be demonstrated by laboratory testing. (3) Laboratory evaluation must eliminate the possibility that the stone was caused by an underlying metabolic defect. Once completion of these requirements has been documented, you may either take the reports to your FAA medical examiner or send them to the ALPA Aeromedical Office for help in obtaining FAA certification to resume flying.

Robert John Stepp, M.D., M.P.H., is an associate aeromedical advisor with ALPA’s Aeromedical Office, which is located in Aurora, Colo.