Medication used in gastrointestinal conditions and their acceptability in aviation
Antacids, simeticone and alginates
These medications are acceptable for the short term treatment of dyspepsia and acid reflux provided symptoms are well controlled.
Cimetidine, ranitidine, famotidine and nizatidine are acceptable for relieving symptoms of gastro-oesophageal reflux disease and as maintenance therapy following H pylori eradication. The licence holder is unfit if there is evidence of peptic ulceration.
Proton pump inhibitors
Omeprazole, lansoprazole, esomeprazole, pantoprazole and rabeprazole are acceptable for relieving symptoms of gastro-oesophageal reflux disease, as maintenance therapy following H pylori eradication and for prevention of peptic ulceration in licence holders requiring long term NSAIDs. The licence holder is unfit if there is evidence of peptic ulceration.
Cinnarizine or cyclizine can be used for the prophylaxis of motion sickness provided the medication is taken for at least two days when licence privileges are not being exercised without causing sedation or other adverse reactions. Other indications for antiemetics, including any condition causing nausea, vomiting or vertigo, will require an unfit assessment.
Metoclopramide or domperidone may be helpful in dyspepsia and are acceptable provided they are taken for at least two days when licence privileges are not being exercised to ensure dystonic reactions do not occur.
Antimuscarinic drugs – atropine, dicycloverine, hyoscine and propantheline are not acceptable for aeromedical certification.
Smooth muscle relaxants - alverine, mebeverine and peppermint oil are acceptable if effective in relieving symptoms associated with irritable bowel disease and diverticulosis.
Osmotic laxatives – lactulose and macrogol are acceptable.
Stimulant laxatives are not acceptable for aeromedical certification.
Loperamide can be used for control of diarrhoea provided it has been taken for at least two days when licence privileges are not being exercised and has not caused adverse side effects.
Opiates such as codeine are not acceptable for certification.
Mesalazine, balsalazide and olsalazine are acceptable for maintaining remission in inflammatory bowel disease, provided there are no significant side effects. Renal function testing will be undertaken regularly by the treating physician and results must be submitted to the AME.
Prednisolone, beclometasone, budesonide and hydrocortisone, administered orally or rectally, are effective in the treatment of inflammatory bowel disease but have no role in the maintenance of remission. Anyone requiring steroids for inflammatory bowel disease will be assessed unfit.
Medication affecting the immune response
Ciclosporin, if indicated for the treatment of severe active inflammatory bowel disease, are disqualifying for aeromedical certification.
Mercaptopurine can be effective in maintaining remission of inflammatory bowel disease, but it is unlicenced for this purpose and is potentially toxic. Certificate holders will be assessed unfit while taking this medication.
Azathioprine is acceptable when used to maintain remission of inflammatory bowel disease as long as the certificate holder does not experience side-effects and undertakes regular review (usually every 3 months) to assess for hepatic or renal impairment and bone marrow supression.
Methotrexate is effective in maintaining remission in patients with Crohn’s disease whose active disease has responded to methotrexate. It is associated with blood dyscrasias, liver cirrhosis and pulmonary toxicity. The results of regular full blood count, serum creatinine, urea and electrolytes and liver function tests, which will be undertaken regularly by the treating physician, must be submitted to the AME. Exercise of licence privileges can resume once remission has been achieved.
Adalimumab and infliximab, if indicated for the treatment of severe active inflammatory bowel disease, are disqualifying for aeromedical certification.