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the possible effects of injury, intercurrent infections, or sudden interruption of therapy.
There are, of course, numerous other types of medicines, e.g. digitalis preparations, antiemetics,
anticonvulsants, hypoglycaemics, or psychoactive medicines (tranquillizers and anti-depressants), many of
which may not per se produce harmful effects but which would not likely be used for any but a
disqualifying medical disorder.
In recent years, selective serotonin re-uptake inhibitors (SSRIs) sometimes used for migraine headaches and
depression, especially in the early stages, have gained considerable attention and their use is now
widespread. The side-effects of these medicines are usually few and mild, but both drowsiness, confusion
and mania have been reported. They should consequently be used with the utmost caution and under close
supervision and only in cases where the underlying disease per se does not preclude aviation duty.
6.3.2.2.1 Recommendation.— An applicant with depression, being treated with antidepressant
medication, should be assessed as unfit unless the medical assessor, having access to the details of the
case concerned, considers the applicant’s condition as unlikely to interfere with the safe exercise of the
applicant’s licence and rating privileges.
NONSTEROIDAL ANTI-INFLAMMATORY MEDICINES
Anti-inflammatory agents, not having the properties of corticosteroids and the undesirable side-effects of
steroids, have been developed to meet the needs of anti-inflammatory therapy. At the present time, the most
popular are ibuprofen (Advil®, Motrin®), naproxen (Aleve®), indomethacin (Indocin®), sulindac
(Clinoril®, and piroxican (Feldene®). All are effective in the treatment of various inflammatory disorders
ICAO Preliminary Unedited Version — November 2009 III-14-8
involving the musculoskeletal system. However, they have a tendency for side-effects that exceed those of
aspirin compounds. The most common side-effects are dizziness, headaches, gastrointestinal irritation,
gastric ulcers, and in some cases gastrointestinal bleeding. Although naproxen and sulindac may be less
prone than the others to produce such side-effects, this group of medicines should be used with caution
because of the distinct possibility of undesirable side-effects. The musculo-skeletal disorder under
treatment, may itself be disqualifying for flying. That is, a pilot with an arthralgia or tendinitis painful
enough to require this class of medication more than likely should at least be temporarily grounded.
However, many patients can tolerate these medicines without unsafe side-effects, in which case a return to
flying could be considered.
SOCIAL DRUGS
The term “social drug” refers to agents taken not for the treatment of disease, but for pleasure or other
personal reasons. The chief examples of this class are alcohol, tobacco, and illicit drugs.
Alcohol
Blood alcohol concentration (BAC) can be expressed in several different ways:
Unit BAC Dimensions Equivalent to Used in
1 per cent by volume 1/100 (%) g/mL = 1 cg/mL 9.43 mg/g, 0.217 mmol/L United States
1 per mille by volume 1/1000 (‰) g/mL = 1 mg/mL 0.943 mg/g, 0.0217 mmol/L Netherlands, Lithuania, Poland,
Denmark
1 basis point by volume 1/10 000 g/mL = 100 μg/mL 94.3 ppm, 2.17 μmol/L United Kingdom
1 per mille by mass 1/1000 (‰) g/g = 1 mg/g 1.06 mg/mL, 0.0230 mmol/L Finland, Norway, Sweden
1 thousandth molarity 1 mmol/L 46 g/L, 4.6 cg/mL, 4.34 cg/g Hospitals, medical personnel
Table 2.— Various ways in which blood alcohol concentration (BAC) is expressed
The following table indicates the average alcohol blood levels expected in various-sized individuals after
a given number of average “drinks”2
2 “drink”: unit of alcohol. Maximum daily or weekly alcohol intake, recommended by the public health authorities in
several States, is usually expressed in “units of alcohol” or “drinks”, the definition of which varies from one State to
another. In one Contracting State, a unit of alcohol is defined as 15 mL of pure alcohol (ethyl alcohol, ethanol), which
is equivalent to one standard serving of beer, wine or spirits. If not accompanied by food, one such unit of alcohol will
give rise to a blood alcohol concentration of approximately 0.2 g/L in a man (70 kg) and of c. 0.3 g/L in a woman
ICAO Preliminary Unedited Version — November 2009 III-14-9
Male
Female
Approximate Blood Alcohol Percentage
(per cent by volume)
Drinks
Body Weight
40 kg 45 kg 55 kg 64 kg 73 kg 82 kg 91 kg 100 kg 109 kg
90 lb 100 lb 120 lb 140 lb 160 lb 180 lb 200 lb 220 lb 240 lb
1 –
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Manual of Civil Aviation Medicine 2(106)
