Medication used in GI 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 laxatives – Lactulose 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.