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Principles of pharmacotherapy and flight safety ................................................ III-14-2
Undesirable pharmacological actions................................................................... III-14-3
Central nervous system depressants ............................................................ III-14-3
Pharmaca affecting the autonomic nervous system .................................... III-14-4
Specific Classes of Medicines ................................................................................ III-14-5
Analgesic medicines ................................................................................... III-14-5
Antihypertensives ....................................................................................... III-14-5
Miscellaneous pharmaceutical groups ........................................................ III-14-6
Nonsteroidal anti-inflammatory medicines ......................................................... III-14-7
Social drugs ............................................................................................................ III-14-8
Alcohol ....................................................................................................... III-14-8
Tobacco ....................................................................................................... III-14-10
Illicit drugs .................................................................................................. III-14-10
Medicines used for schizophrenia, schizotypal delusional
and bipolar disorders .......................................................................................... III-14-11
Summary ................................................................................................................. III-14-11
References ............................................................................................................... III-14-11
ICAO Preliminary Unedited Version — November 2009 III-14-1
INTRODUCTION
In this chapter, the term “medication” means treatment with one or more medicines (pharmacotherapy); the
term “medicine” means any pharmaceutical preparation, prescribed or over-the-counter, used in medical
treatment; the term “pharmacon” (pl. pharmaca) means the active pharmaceutical ingredient of a medicine;
and the term “drug” means any substance, illicit or legal, used for non-medical purposes. The names of
pharmaca and other substances mentioned in this chapter are primarily based on North American
nomenclature.
The principles apply to all licence holders who require a medical certificate.
Medical illness in a pilot can represent a flight safety hazard. Aircraft accidents have occurred as a result of
pilot disability related to disease and/or medication. Illnesses that interfere with safe aircraft operations may
be only minor problems in other occupational settings. The common cold, minor gastroenteritis, headaches,
mild vertigo, and otitis media, while not precluding work in an office, may pose significant hazards to the
pilot flying in bad weather or congested airspace. What is “minor” to an administrator may be a “major”
problem for the on-duty pilot. Accordingly, one must not only be concerned with the effects of disease on
flying ability but also with the possible effect of the medicines utilized to treat the illness in question.
Self-medication, also with “over-the-counter” medicines such as analgesics and anti-histamines, etc.,
should not be allowed, and licence holders should be encouraged always to consult their medical examiner
before taking any medicine. The medical examiner should avoid prescribing medicines that are new to
market; it is better to wait until a medicine is well established and any side-effects recognized. With all
kinds of medicines, a period of grounding is necessary when starting a new medicine to avoid an
idiosyncratic reaction while flying. As different medicines are available in different States, as the generic
and trade names of medicines may vary from one State to another, as medicines may be licensed for
different purposes in different States, and as local health care practices may vary widely and be dependent
on the prevalence of particular diseases, each State should issue guidance on pharmacotherapy for its
medical examiners
Chapter 6 of Annex 1 refers to the use of medication as follows:
6.2.2 Physical and mental requirements
An applicant for any class of Medical Assessment shall be required to be free from:
d) any effect or side-effect of any prescribed or non-prescribed therapeutic, diagnostic or preventive medication
taken; such as would entail a degree of functional incapacity which is likely to interfere with the safe operation of
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Manual of Civil Aviation Medicine 2(101)
