Over-the-Counter (OTC) Medications Reference Guide
What Over-the-Counter (OTC) medications can I take and still be safe to y?
First, ask yourself “Do I have an underlying condition that makes me unsafe to y?”Title 14 CFR 61.53 is the regulation, which
prohibits ight with a known medical deciency [unless cleared by the FAA] and requires that you determine that you are t to y
prior to each ight.
c Am I sick?
c Am I having trouble clearing my ears at ground level?
c Do I feel bad enough that I keep thinking about how I feel?
c Are others asking me if I am ok?
c Do I feel good enough to y ONLY if I take medication?
c Am I getting worse?
Next, current issues. Consider these issues before operating an aircraft:
c In the last ve days, have you taken or do you plan to take any medications before ying?
c If currently taking a medication only for symptom relief, would you be safe to y without it?
c Do you have any other underlying health conditions?
o Discuss these conditions with your AME or family physician to determine if you are safe to y.
o Specically ask about your ability “to operate machinery” (including any aircraft).
o Discuss if the medication, OTC or otherwise, will pose a problem with the underlying condition or
o Other health conditions and/or other medications that you are taking.
When choosing an OTC medication:
#1. IDENTIFY the active ingredient(s).
Verify you have taken this medication in the past
with no side eects.
Note: Single ingredient products are preferred over
combination products (because it is easier to spot
potentially hazardous ingredients).
#2. READ the label.
If there is a warning that it “May cause drowsiness”
or if it advises the user to “be careful when driving
a motor vehicle or operating machinery,” then this
medication is NOT safe for ying.
#3. READ carefully.
If this is the rst time you are taking a new
medication, wait at least (5) dosage intervals and
ensure that you suer no adverse eects from it
before ying while on the medication. (See the table
below for the recommended observation period).
If you take any of the “NO GO” medications (listed below in the “Over-the-Counter (OTC) Medications Reference Table) or if
you have previously had side effects from the medication, wait at least five (5) dosage intervals after the last dose before
flying. See the examples below for the recommended grounding period after discontinuation of the medication).
*Caution: Sedating antihistamine medications have a long half-life so wait time is 60 hours for both
diphenhydraime (Benadryl) and doxylamine (Unisom), 5 days for both chlorpheniramine and clemastine.
Dosage Interval Wait Time
Package
Instructions
5 Times
Dosage
Interval
No Fly
Time
Recommendation
Every 4-6 hours^
(Up to 6 times daily)
X5 30 hours
Wait at least 30 hours before ying
if taking a medication directed to
take every 4-6 hours.
Every 8 hours
(OR three times daily)
X5
40 hours
Wait at least 40 hours before ying
if taking a medication directed to
take every 8 hours.
Every 12 hours
(OR twice daily)
X5
60 hours
Wait at least 60 hours before ying
if taking a medication directed to
take every 12 hours.
^If there is a range, use the higher number
BOTTOM LINE
Always follow 14 CFR 61.53. If it is not familiar to you, please review it. Not only is it a
requirement, but it is for your safety and that of your passengers. When in doubt,
safety first - do not fly.
c Never y after taking a new medication for the rst time until at least 48 hours have passed
and no side eects are noted.
c Do one more check of your condition before considering ying.
c Get well before considering return to ight status ... do not push it.
c OTC medications help reduce the symptoms of an illness, but do not cure it.
c Even though a medication has been determined to be safe for use by the Food and Drug
Administration (FDA), this does not mean that the medication is compatible with flying
or even driving.
Some medications are not recommended (see column “NO GO” on the table below):
• If you choose to y on medication, be certain that it will not impair safety. Do not simply
hope for the best.
NOTE: This list is not all-inclusive or intended to take the place of
consultation(s) with your primary care physician and/or AME (aviation medical
examiner). Remember, if you have signicant underlying health conditions,
it is recommended that the use of any medication be discussed with your
physician PRIOR to taking the medication.
Over-the-Counter (OTC) Medications Reference Table
Type of medication
or symptoms
Commonly found
in
Medication or active ingredient
generally safe to y
Avoid these medications
or ingredients*
Rationale
GO NO GO
Allergy products
Cough/cold
products
Pain products
Non-sedating products:
fexofenadine (Allegra)
loratadine (Claritin)
Sedating products:
brompheniramine
(Dimetapp)
cetirizine (Zyrtec)
Antihistamines
1
chlorpheniramine (Chlor-
Trimeton)
diphenhydramine
(Benadryl)
levocetirizine (Xyzal)
Histamines affect not only your
allergies, but your sleep wake
cycle. Sedating antihistamines
can cause drowsiness, impaired
thinking and judgement.
1
Sedating antihistamines are
commonly found on autopsy in
aircraft accidents. The wait times
for these medications are longer
than noted in the “Dosage
Interval Wait Time” table due to
their longer half-life. Consult
your AME.
Motion sickness dimenhydrinate
(Dramamine)
meclizine (Antivert)
Sleep aid
products
melatonin (not an antihistamine)
diphenhydramine
(such as Zzzquil).
Same ingredient in
Benadryl
Doxylamine (such as
Unisom)
“Hang-over eect” morning after
safety concern.
Note: Taking melatonin at the
wrong time can actually worsen
jet-lag and cause daytime
drowsiness.
Nasal steroid Allergy products None azelastine (Astepro)
fluticasone (Flonase)
mometasone (Nasonex)
triamcinolone (Nasacort)
Nasal
decongestants
Nasal congestion
Sinus pressure
Cough/cold
products
Caution: Sudafed-like
medications can speed up your
heart rate; therefore, use caution
if you have an underlying heart
condition. Be very cautious of an
extra cup of coee or two when
feeling sub-par. This has caused
more than one pilot to end up in
the emergency room for a racing
heart rate.
oxymetazoline (Afrin)
phenylephrine (Sudafed PE)
pseudoephedrine (Sudafed)
Less convenient, but safer, are
the nasal salt water lavages:
saline nasal sprays
Neti-pots
Cough
Cough/cold
products
Coricidin (allowed if no
chlorpheniramine)
guaifenesin (found in
Mucinex and Robitussin)
dextromethorphan
(Delsym), also in Dayquil,
and Mucinex Fast-Max
Severe Congestion and
Cough.
Most
“night-time” or
“PM”
medications contain
a sedating antihistamine
.
- Coricidin HBP cough &
cold (contains
chlorpheniramine)
- Nyquil (contains
doxylamine)
Most cough medications are
safe for flight. Use caution as
combination products may
contain sedating
antihistamines. If the label
states PM (for nighttime use) or
DM (containing
dextromethorphan), you should
not fly while using these
medications and for at least 5
dosage intervals after the last
dose (see Dosage Interval Time
table).
Frequently Used OTC Medications *These eectively can cause incapacitation (examples are not all-inclusive)
Type of medication
or symptoms
Commonly found
in
Medication or active ingredient
generally safe to y
Avoid these medications
or ingredients*
Rationale
GO NO GO
Aches and Pains
NSAIDs (non-
steroidal anti-
inammatory
drugs) and
analgesics
acetaminophen (Tylenol)
aspirin (Bayer’s)
ibuprofen (Advil/Motrin)
naproxen (Naprosyn)
Advil PM,
Tylenol PM
(Most “PM”
medications contain
diphenhydramine)
Most OTC pain meds are safe
to y as long as the underlying
condition is acceptable.
Caution: Some OTC meds are
combined with a sedating
antihistamine, which can cause
drowsiness (see above for
examples).
Lidocaine: Caution with
application. Avoid getting on
hands or open wounds as this
can drop blood pressure or
absorb faster.
Additional
options for
headaches
caeine (commonly found in
Excedrin)
Read the label.
Topical pain relief lidocaine patch (Lidoderm)
muscle rub
capsaicin
Opioid Antidote Opioid antidote naloxone (Narcan)
2
2
If medication is administered,
DO NOT FLY until cleared by
FAA.
Gastrointestinal
Illness: nausea,
vomiting, diarrhea,
constipation,
laxatives
Anti-emetics
anti-motility
drugs
bismuth subsalicylate
(Kaopectate, Pepto-Bismol)
loperamide (Imodium)
3
GI illness can cause dehydration,
cramps & pain with increase in
altitude.
3
Loperamide should not be used
during acute illness as it can
cause dizziness. When taken
daily for a chronic condition,
may require a special issuance.
Laxatives
Bulk forming (e.g. Benefiber)
Osmotic (e.g. MiraLAX)
Stool softener (e.g. Colace
)
Stimulant (e.g. Senna)
Use in recommended doses.
Gastrointestinal
Illness: indigestion
Proton Pump
Inhibitors (PPI)
esomeprazole (Nexium)
lansoprazole Prevacid)
omeprazole (Prilosec)
pantoprazole (Protonix)
rabeprazole (Aciphex)
None Be careful not to mask the
underlying symptoms.
H2 blockers cimetidine (Tagamet)
famotidine (Pepcid)
nizatidine (Axid)
rantidine (Zantac)
None Be careful not to mask the
underlying symptoms.
Antacids aluminum hydroxide (Maalox)
calcium carbonate (Tums)
magnesium hydroxide (Milk of
Magnesia)
None Be careful not to mask the
underlying symptoms.
Frequently Used OTC Medications *These eectively can cause incapacitation (examples are not all-inclusive)
magnesium citrate
Type of medication
or symptoms
Commonly found
in
Medication or active ingredient
generally safe to y
GO
Avoid these medications
or ingredients*
NO GO
Rationale
Pain reliever phenazopyridine (AZO standard) oxybutynin (Oxytrol for Oxybutynin can cause sedation &
Women) dizziness.
Urinary Tract
Infections
Phenazopyridine is generally
allowed after adequate ground
trial to monitor for side eects.
Symptoms should be resolved
other than slight residual
irritation.
Emollients almost all are allowed
Skin Rash Creams
Ensure the underlying
condition is not an issue with
safe flight.
Lotions antifungal topical
antipruritics
corticosteroid topical
Eyes (Ophthalmic)
Products for
Dry eyes
Allergy/
Itchy eyes
Eye lubrication
olopatadine (Pataday)
alcaftadine (Lastacaft)
artificial tears
Temporary blurry vision may
occur with use of eye drops.
4
Eye ointment or gels should not
used in flight since the blurry
vision may last for minutes.
Frequently Used OTC Medications *These eectively can cause incapacitation (examples are not all-inclusive)
E
ye ointment or gel
during flight
4
Additional Resources
AAM-400 Medication Brochure
Over-the-Counter Medication
Allergy - Antihistamine & Immunotherapy
Medication
Erectile Dysfunction Medication
Hypertension Medication
Diabetes Medications
Acceptable Combinations of Diabetic Medications
Antidepressant Program
Additional Medication Information in Guide for Aviation Medical Examiners
Do Not Issue
(DNI) Do Not Fly (DNF)
DNI—pilots should NOT take any of these medications or
classes of medication and fly
DNF—pilots should NOT fly until these medications are stopped and a period
of time has elapsed
OK-20-0302
11-15-2023