Bladder instability, also known as overactive bladder (OAB) or urge incontinence, can cause distraction and discomfort in the aviation or controlling environment. Medications used to manage bladder instability can have side effects such as drowsiness, blurred vision and dry mouth. The table outlines considerations to safely use such medications in Class 1, 2 and 3 certificate holders.
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ACCEPTABLE MEDICATION |
ANTIMUSCARINICS Oxybutynin MR (Lyrinel XL) Tolterodine MR (Detrusitol XL) Solifenacin (Vesicare) Darifenacin (Emselex) Trospium chloride IR and MR (Flotros, Regurin, Regurin XL) Fesoterodine fumarate (Toviaz) Propiverine hydrochloride MR (Detrunorm XL)
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BETA3-ADRENOCEPTOR AGONISTS Mirabegron (Betmiga) Vibegron (Obgemsa) |
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ACTION |
Class 1/2/3: Grounded minimum 4 weeks after starting medication or change in dose until stable with satisfactory symptom control. |
Class 1/2/3: Grounded minimum 4 weeks after starting medication or change in dose until stable with satisfactory symptom control. AND AME/GP to document blood pressure, pulse and rhythm prior to commencing treatment and before return to work. Review during treatment, particularly in pre-existing hypertension. |
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INVESTIGATIONS |
Ensure satisfactory symptom control and free of side-effects of medication e.g. dry mouth, blurred vision and drowsiness (anticholinergic). |
Ensure satisfactory symptom control and free of side-effects of medication e.g. urinary tract infection symptoms, headache, GI upset and palpitations. |
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CERTIFICATION |
Class 1 – OML at least 4 months from commencing medication. If dosage remains stable with satisfactory symptom control and no reported side effects, then unrestricted can be considered at 4 months Class 2/3 – if dose of drug remains stable with satisfactory symptom control and no reported side effects, then unrestricted certification can be considered at 4 weeks.
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Class 1 – OML at least 4 months from commencing medication. If dosage remains stable with satisfactory symptom control and no reported side effects, then unrestricted can be considered at 4 months Class 2/3 – if dose of drug remains stable with satisfactory symptom control and no reported side effects, then unrestricted certification can be considered at 4 weeks.
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ADDITIONAL NOTES |
Oxybutynin sustained release formulation only, not acceptable for short-term use prior to bladder surgery. If side-effects do not occur in first few months, then unlikely to occur later. Pilots should be advised to keep themselves hydrated before and during flights. |
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