Medication used in GI conditions

Medication used in gastrointestinal conditions and their acceptability in aviation

Medication used in gastrointestinal conditions

Although some medications may be acceptable while flying or controlling, the underlying medical condition may be disqualifying. Aeromedical advice must be sought following a new diagnosis or recurrence/flare up of a medical condition.


Antacids, simeticone and alginates
These medications are acceptable for the short-term treatment of dyspepsia and acid reflux provided symptoms are well controlled.

H2-receptor antagonists
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.

Antiemetics
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. The taking of these medications should only be considered in consultation with the AME and absence of side-effects documented.  Other indications for antiemetics, including any condition causing nausea, vomiting or vertigo, will require an unfit assessment.

Motility stimulants
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  no adverse side-effects (including dystonic reactions).

Antispasmodics
Antimuscarinic drugs – atropine, dicycloverine, hyoscine and propantheline are not acceptable for aeromedical certification. While using this type of medication the pilot will be assessed unfit and the medical certificate will be temporarily suspended.

Smooth muscle relaxants - alverine, mebeverine and peppermint oil are acceptable if effective in relieving symptoms associated with irritable bowel disease and diverticulosis while the disease is controlled/quiescent.

Laxatives
Osmotic laxativeslactulose and macrogol are acceptable.
Stimulant laxatives are not acceptable for aeromedical certification.

Antimotility drugs
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.
Analgesic opiate medications such as codeine and dihydrocodeine, are incompatible with flying.  While using this type of medication the pilot will be assessed unfit and the medical certificate will be temporarily suspended.

Corticosteroids (Prednisolone, Beclomethasone, Budesonide and Hydrocortisone)
Corticosteroids administered orally or rectally, can be effective in the treatment of active inflammatory disease.  The use of oral steroids is disqualifying therefore while using this type of medication the pilot will be assessed unfit and the medical certificate will be temporarily suspended.  Recertification can be considered when the certificate holder has been off oral steroid therapy for a minimum of two weeks with no recurrence of symptoms and the condition is confirmed quiescent.

Certification may be considered for applicants who require rectal steroids* to maintain remission, however these applicants are likely to require a longer period of grounding to demonstrate stability and an operational limitation (OML or OSL) may be required (see paragraph on Aeromedical Certification below).

Aminosalicylates, Medications Affecting the Immune Response, and Cytokine Modulators
The certificate holder is unfit on each occasion that a ‘flare up’ of the condition occurs and must seek aeromedical advice following any change in clinical condition, or medication.

• Aminosalicylates (Mesalazine, Balsalazide and Olsalazine)
• Medication affecting the immune response (Ciclosporin, Mercaptopurine Azathioprine and Methotrexate)
• Cytokine Modulators (Adalimumab and Infliximab)*

If indicated for the treatment of active inflammatory disease these medications are disqualifying.  These medications may be acceptable for maintaining remission of the disease provided the disease is quiescent, the certificate holder does not experience side-effects and regular review is undertaken.

Aeromedical Certification - Aminosalicylates, Medications Affecting the Immune Response, and Cytokine Modulators* 

ACCEPTABLE MEDICATION

Mesalazine, Balsalazide and Olsalazine

Ciclosporin, Mercaptopurine Azathioprine and Methotrexate

Adalimumab and Infliximab*


Rectal Steroids*

ACTIONUnfit after flare up of condition or starting medication or an increase in dose until:
Minimum of 2 weeks on a stable maintenance dose of medication
The disease is demonstrated to be stable and well controlled
Unfit after flare up of condition or starting medication or an increase in dose until:
Minimum of 4 weeks on a stable maintenance dose of medication
The disease is demonstrated to be stable and well controlled
INVESTIGATIONSMedical reports and up to date blood test results within normal parameters will be required for aeromedical assessment (Guidance for medical reports – General)
Ensure satisfactory symptom control and free of side-effects of medication
Medical reports and up to date blood test results within normal parameters will be required for aeromedical assessment (Guidance for medical reports – General)
Ensure satisfactory symptom control and free of side-effects of medication
CERTIFICATIONClass 1 Unrestricted/OML
Class 2 Unrestricted/OSL
Class 1 OML
Class 2 Unrestricted/OSL/OPL
FOLLOW UPThe result of each clinical review should be copied to the AME on an ongoing basis.
To continue to maintain certification an assessment of the clinical condition and up-to-date blood test results must be included in the follow up report/letter.
The result of each clinical review should be copied to the AME on an ongoing basis.
To continue to maintain certification an assessment of the clinical condition and up-to-date blood test results must be included in the follow up report/letter.
ADDITIONAL NOTES

Applicants will be having periodic blood testing (pre-treatment, bi-weekly, monthly, three monthly, and annual), of blood count, liver and renal functioning to identify bone marrow suppression/blood dyscrasis, hepatic or renal impairment, liver cirrhosis and pulmonary toxicity.
The results of blood tests which are not within normal parameters must be notified to the AME immediately.

Limitations
Some medications are likely to require a longer period of grounding (*up to 4 weeks) to demonstrate stability and for professional pilots an OML limitation (permitting flights as or with a qualified co-pilot), and for private pilots an OSL (operational safety pilot) limitation may be required.