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The alpha 1 blocking agents, i.e. doxazosin, prazosin and the centrally acting products clonidine,
moxonidine and methyldopa, are not permitted.
It should be re-emphasized that no matter what agent is utilized, a trial period of at least two to three weeks
prior to return to aviation activities must be observed to rule out adverse side-effects and idiosyncracy. Even
if the diuretics seem to be tolerated well, one still must maintain patient surveillance for possible
hypokalaemia, hyperuricaemia, and raised blood sugar levels. These chemical effects do not usually
preclude aviation activities but may necessitate additional therapeutic measures, e.g. potassium
supplements or uricosuric therapy. In addition, an adequate trial period allows for cerebral autoregulation to
reset (almost certainly the cause for the fatigue seen when any antihypertensive treatment is started or a new
antihypertensive medicine added); it also allows some time to determine whether any given medication will
work adequately in a particular patient.
Regardless of the type of medication employed, the following general measures should be applied to every
case: obesity control, salt restriction, and regular exercise conditioning.
All therapy should be initiated using minimal therapeutic doses, increasing the dosage only as necessary.
As a general rule, one does not wish to utilize the same full dosage in a licence holder that one might not
hesitate to use in a non-aviation environment. For example, 160 mg of propanolol daily may be appropriate
for some patients, but probably not for a pilot-patient.
Miscellaneous pharmacological groups
Special attention has been given to those medicines that affect the central and autonomic nervous systems,
because of the crucial nature of such effects; the antihypertensive medicines have been emphasized because
of certain practical aspects that were cited. There are many other medicines, however, that must also be
mentioned because of their widespread usage. These medicines are generally not flight hazards per se and
may well be appropriate for usage by flight crews under certain circumstances.
Antihistamines are typically sedative in their action and should be discouraged during flying activities. In
addition, a pilot with allergic symptoms severe enough to require medication should probably not be flying.
Certain non-disqualifying allergic disorders, however, may well be treated by non-sedating antihistamines
such as fexofenadine (Allegra®, Telfast®), terfenadine (Seldane®) or loratidine (Clarityn®). It should be
noted, however, that even non-sedating antihistamines may have a mild sedative effect in some individuals.
As with all medications on first usage, a trial period before resumption of flying duties would be required
before a final decision can be made concerning usage while flying.
Antibiotics administered orally are, in general, safe for flying. The major flight safety issue is usually the
effect of the infection being treated rather than the antibiotic being used. However, some antibiotics should
be avoided or used with particular caution, e.g. minocycline (vestibular toxicity) and ciprofloxacin
(neurotoxicity).
Antitussives, if non-narcotic, and not combined with sedative agents or antihistamines, are not
contraindicated for flying.
Antacids in an essentially insoluble form should be permitted for flying but only if the symptoms being
treated are not clinically significant.
ICAO Preliminary Unedited Version — November 2009 III-14-7
Omeprazol (Losec®) should not pose a safety hazard once it has been established that no untoward side
effects occur during a trial period while not flying.
Steroids, in general, are prohibitive for flying because of the complex nature of their action and because the
disorders usually requiring such medication are in themselves disqualifying. However, “physiological
replacement therapy” as, for example, might be indicated for a stable case of adrenal gland insufficiency or
hypopituitarism, may be permissible while flying. Clinical experience would indicate that a “physiological”
dose relative to prednisone would be 6-8 mg daily for males and 4-6 mg daily for females. The following
table shows equivalent dosages for various steroid preparations in common usage:
Steroid Equivalent doses (mg)
Cortisone acetate 25
Hydrocortisone 20
Prednisone 5
Methylprednisone 4
Triamcinolone 4
Dexamethasone 0.75
Betamethasone 0.60
Table 1.— Equivalent doses of steroids
Pilots on steroid therapy should have regular medical surveillance at intervals of probably no longer than six
months. Any pilot on steroid therapy should be well instructed in the principles of steroid therapy, including
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Manual of Civil Aviation Medicine 2(105)
