Antibiotics. There are many aprescribed for use in an outpatient consultation. Pilots too may be prescribed antibiotics on occasion, where the treating doctor may inform about specific side effects of the prescribed drug. Yet it is important to be aware of some general side effects or reactions of the wide-range of antibiotics, old and new, available for dispensing.
- Allergic reactions to antibiotics, especially penicillin, are not infrequent. Immediate, sudden incapacitation may occur with anaphylaxis, angioneurotic edema, or asthma. Less dramatic but still potentially dangerous skin rashes, photosensitivity reactions and urticaria too are known to occur.
- Bone marrow toxicity develops with some antibiotics, notably chloramphenicol. The resulting anemia or decreased resistance to infection poses a risk for aviation duties since it may be appear after a while and may take time before being diagnosed.
- Ototoxicity (Toxic effect on inner ear) occurs primarily with the polypeptide group of antibiotics which are ordinarily reserved for more severe infections. Either hearing loss or disequilibrium may result and may result in disabling effect on a pilot.
There are several other possible side effects of the wide range of medication available, which must be kept in mind.
Externally applied Medications. In general, most topical preparations are safe to use with flying. However, some ointments that are petroleum based may oxidise rapidly in the 100% Oxygen environment of a combat pilot’s mask, and ideally should not be used around the face.
Pain Relieving Drugs. Most of the pain relieving drugs though by and large innocuous drugs, on occasions have been known to lead to serious untoward effects especially when taken on empty stomach or in combination with alcohol. Aspirin could lead to serious bleeding from the stomach and intestines. Reduction in tolerance to hypoxia has been found with Aspirin and Anacin®. Besides, aspirin may cause vertigo, ringing in the ears or even deafness on prolonged use. Analgin is known to damage bone marrow.
Anti-allergic Drugs. Anti-allergic drugs are commonly used for relief from running nose or cold, cough or itching with rashes. Their adverse effects include drowsiness, inattention, confusion, mental depression, dizziness and impaired depth perception.
Nasal Drops. Ephedrine nasal drops are commonly advised to relieve “stuffed or blocked nose”. Some aircrew habitually use nasal drops to relieve airway obstruction even during flight, whilst others use them for relief of blocked Eustacian tube during descent. The lining of the inside on nostrils is very richly supplied with blood and medication quickly finds its way in the blood, which may result in side effects like palpitation, nervousness, tremors, lack of coordination and visual disturbances.
Air Sickness Tablets. Promethazine, Prochlorperazine etc. may be prescribed for pilot-trainees who usually experience air sickness during initial phase of flying. These drugs however, cause serious drowsiness, dizziness and blurred vision. Thus it is advisable that they be never used during flight. However, in military aviation, some of the Air Forces, allow air-sickness medication under strict supervision. The military pilot-trainees are thus advised to avail of such supervised therapy, in case they are severely air-sick.
“Pep Pills”/”Go-Pills”. Caffeine, Dextroamphetamine etc., may be advocated for staying awake during night missions; or by a few as “appetite killers” for weight reduction. Their use in aviation environment can be risky and the side effects include a sense of overconfidence, complacency, mental confusion, dizziness or headache.
Tranquilizers, Sedatives and Sleeping Pills/No-Go Pills. These drugs tend to dull the senses. Besides they also depress the body’s “alerting system” and make the pilot less vigilant. Moreover medical conditions for which these medications are usually taken, preclude flying.
Drugs to control lifestyle related illnesses. If an aircrew is taking them for diseases like hypertension (High blood pressure), Diabetes, Peptic Ulcer, etc., s-/he is not fit to fly. Diseases of this type requiring drugs are not ‘mild’ and the drugs used in such cases are generally not ‘safe’. However certain waivers are given for aircrew on such drugs taken within a defined dosage schedule, under supervision, to help them retain their flying fitness without compromising aviation safety.
In conclusion, one must remember that wrong medication can kill. For this reason, it is of paramount importance for the airline/squadron doctor to be aware of any drugs a pilot or aircrew under his/her care may be taking. This may be difficult to do because of the ready availability of certain medications like cold preparations, sleeping pills, and a variety of other “over-the-counter” medicines, without the need for a prescription, at drugstores and some grocery shops. With the increasing spread of medical knowledge amongst the general public through media advertisements and articles in magazines and on the internet, there is a definite possibility of self-diagnosis and self-prescription.
When considering whether a pilot should or should not fly while on medication, the medical condition of the patient should always be the first and overriding concern of the airline/squadron Doctor. Then the effects and side effects of the drug should be considered as they interrelate with the requirements and stresses of flying. It is always prudent to give a trial on ground, to wait and watch for adverse effects, including idiosyncratic ones, to show up rather than hastening the return to the cockpit. More importantly, it is better to follow the laid down guidelines for permissible medications by the civil/military aviation authorities, while prescribing for an aircrew, rather than compromising individual and in turn, aviation safety.
- Say NO! to Self-Medication: First a few Basics
- Say NO! to Self-Medication: Beware of Effects of Drugs
1. Ernsting’s Aviation Medicine. Rainford DJ, Gradwell DP (Editors). 4th Edition. Hodder Arnold, London 2006.
2. Fundamentals of Aerospace Medicine. DeHart RL, Davis JR (Editors). 3rd Edition. Lippincott, Williams & Wilkins, Philadelphia 2002.
3. Human Performance & Limitations – JAA ATPL Theoretical Knowledge Manual. 2nd Edition. Jeppesen GmbH, Frankfurt 2001.
Acknowledgement Image courtesy Freedigitalphotos.net