What Over-the-Counter (OTC) medications can I take
and still be safe to y?
First, ask yourself “Do I have a 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, 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.
**If you answered to any of the above questions: YES---STOP. You might not be t to y!**
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First, ask yourself “Do I have a condition that makes me unsafe to fly?” Title 14 CFR 61.53 is the regulation, which
prohibits flight with a known medical deficiency [unless cleared by the FAA] and requires that you determine that
you are fit to fly prior to each flight.
Am I sick?
Am I having trouble clearing my ears at ground level?
Do I feel bad enough that I keep thinking about how I feel?
Are others asking me if I am ok?
Do I feel good enough to fly ONLY if I take medication?
Am I getting worse?
Next, consider these issues before operating an aircraft:
In the last five days, have you taken or do you plan to take any medications before flying?
If currently taking a medication only for symptom relief, would you be safe to fly without it?
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 fly.
o Specifically 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
other health conditions and/or other medications that you are taking.
**If you answered to any of the above questions: YES---STOP. You might not be fit to fly!**
When choosing an OTC medication:
#1. IDENTIFY the active ingredient(s).
Verify you have taken this medication in the past
with no side effects.
Note: Single ingredient products are preferred over
combination products (because it is easier to spot
disqualifying 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 suffer no adverse effects 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 table) or if you have had side effects from the
medication before, wait at least ve (5) dosage intervals after the last dose before ying see the examples
below for the recommended grounding period after discontinuation of the medication).
Package
Instructions
5 Times
Dosage
Interval
No Fly
Time
Recommendation
Every 4-6 hours^
(Up to 6 times daily)
Every 8 hours
(OR three times daily)
Every 12 hours
(OR twice daily)
Wait at least 30 hours before ying
if taking a medication directed to
take every 4-6 hours.
Wait at least 40 hours before ying
if taking a medication directed to
take every 8 hours.
Wait at least 60 hours before ying
if taking a medication directed to
take every 12 hours.
X5
X5
X5
30 hours
40 hours
60 hours
^If there is a range, use the higher number
Review 14 CFR 61.53 if it is not familiar to you and always follow it. Not only is it a
requirement, but it is for your safety and that of your passengers. When in doubt, safety
rst - do not y.
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 ying
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.
BOTTOM LINE
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.
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Antihistamines
Allergy products
Cough/cold
products
Pain products
Non-sedating products:
fexofenadine (Allegra)
loratadine (Claritin)
Sedating products:
brompheniramine (Dimetapp)
cetirizine (Zyrtec)
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.
Sleep aid
products
Melatonin (not an
antihistamine)
diphenhydramine (such as
Zzzquil). Same ingredient in
Benadryl)
Doxylamine (such as Unisom)
“Hang-over effect” morning
after safety concern.
NOTE: taking melatonin at
the wrong time can actually
worsen “jet-lag" and cause
daytime drowsiness.
Nasal steroid
Allergy products
fluticasone (Flonase),
triamcinolone (Nasacort)
None
Nasal
decongestants
Nasal congestion
Sinus pressure
Cough/cold
products
oxymetazoline (Afrin),
phenylephrine (Sudafed PE),
pseudoephedrine (Sudafed)
Less convenient, but safer, are
the nasal salt water lavages
such as
saline nasal sprays
Neti-pots
(Considered safe in
recommended dosages)
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 coffee 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.
Cough
Cough/cold
products
Coricidin (allowed if no
chlorpheniramine)
guaifenesin (found in Mucinex
and Robitussin)
Mucinex fast-max severe
congestion and cough (liquid)
Identify combo vs isolated
dextromethorphan (Delsym)
Dayquil (contains
dextromethorphan)
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, but
caution for combination
products with sedating
antihistamines. If the label
states PM (for nighttime
use) or DM (containing
dextromethorphan), you
should not fly for at least 5
half-lives after the last
dose (see above).
Frequently Used OTC Medications *These effectively can cause incapacitation (examples are not all-inclusive)
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Urinary Tract
Infections
Pain reliever
phenazopyridine (AZO standard)
None
Generally allowed after
adequate ground trial to
monitor for side effects.
Symptoms should be
resolved other than slight
residual irritation.
NSAIDs (non-
steroidal anti-
inflammatory 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 fly as long as the
underlying condition is
acceptable.
Aches and
Pains
Other options for
headaches
caffeine (commonly found in
Excedrin)
Read the label.
Caution. Some OTC meds
are combined with a
sedating antihistamine,
which can cause
drowsiness (see above for
examples).
Topical pain relief
lidocaine patch (Lidoderm)
muscle rub
(Considered safe in
recommended dosages)
Lidocaine-Caution with
application, avoid getting
on hands or open wound
as this can drop blood
pressure or absorb faster.
Skin Rash
Emollients and mild
corticosteroid creams
almost all are allowed
Stay within the dosage to
not exceed an acceptable
risk
Ensure the underlying
condition is not an issue
with safe flight.
Anti-emetics anti-
motility drugs
bismuth subsalicylate
(Kaopectate, Pepto-Bismol)
loperamide (Imodium)
Loperamide can cause
sedation & dizziness.
Be careful not to mask the
underlying symptoms. GI
illness can cause
dehydration, cramps &
pain with increase in
altitude.
Gastrointestinal
Illness:
indigestion
Proton Pump
Inhibitors (PPI)
eomeprazole (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
Antacids
aluminum hydroxide (Maalox)
calcium carbonate (Tums)
magnesium hydroxide (Milk of
Magnesium)
None
Frequently Used OTC Medications *These effectively can cause incapacitation (examples are not all-inclusive)
Gastrointestinal
Illness:
nausea,
vomiting,
diarrhea
Additional Resources
AAM-400 Medication Brochure
Medication Brochure Link
Erectile Dysfunction Medication
sildenal (Viagra)
tadalal (Cialis)
Erectile Dysfunction Medication Link
Hypertension (HTN) Medication
Hypertension Medication Link
SSRI (antidepressant) Program
SSRI PROGRAMS LINK
citalopram (Celexa)
escitalopram (Lexapro)
uoxetine (Prozac)
sertraline (Zoloft)
Additional medication information found in the AME Guide:
Additional Medical Information in AME Guide
Do Not Issue (DNI) Do Not Fly (DNF)
Do Not Issue Do Not Fly Link
DNI—airmen should NOT take any of these medications or
classes of medication and y
DNF—airmen should NOT y until these medications are stopped and
a period of time has elapsed
Oral Diabetes Medications
Oral Diabetic Medications Link
See Item V. Acceptable Combinations of Diabetic Medications
OK-20-0302 11-13-19