Over-the-Counter (OTC) Medications Reference Guide

What Over-the-Counter (OTC) medications can I take and still be safe to fy?

First, ask yourself “Do I have an underlying condition that makes me unsafe to fy?”Title 14 CFR 61.53 is the regulation, which
prohibits fight with a known medical defciency [unless cleared by the FAA] and requires that you determine that you are ft to fy
prior to each fight.
c Am I sick?
c Am I having trouble clearing my ears at ground level?
c Do I feel bad enough that I keep thinking about how I feel?
c Are others asking me if I am ok?
c Do I feel good enough to fy ONLY if I take medication?
c Am I getting worse?

Next, current issues. Consider these issues before operating an aircraft:

c In the last fve days, have you taken or do you plan to take any medications before fying?
c If currently taking a medication only for symptom relief, would you be safe to fy without it?
c Do you have any other underlying health conditions?
o Discuss these conditions with your AME or family physician to determine if you are safe to fy.
o Specifcally ask about your ability “to operate machinery” (including any aircraft).
o Discuss if the medication, OTC or otherwise, will pose a problem with the underlying condition or
o Other health conditions and/or other medications that you are taking.

When choosing an OTC medication:

#1. IDENTIFY the active ingredient(s).

Verify you have taken this medication in the past
with no side efects.
Note: Single ingredient products are preferred over
combination products (because it is easier to spot
potentially hazardous ingredients).

#2. READ the label.

If there is a warning that it “May cause drowsiness”
or if it advises the user to “be careful when driving
a motor vehicle or operating machinery,” then this
medication is NOT safe for fying.

#3. READ carefully.

If this is the frst time you are taking a new
medication, wait at least (5) dosage intervals and
ensure that you sufer no adverse efects from it
before fying while on the medication. (See the table
below for the recommended observation period).
If you take any of the “NO GO” medications (listed below in the “Over-the-Counter (OTC) Medications Reference Table) or if
you have previously had side effects from the medication, wait at least five (5) dosage intervals after the last dose before
flying. See the examples below for the recommended grounding period after discontinuation of the medication).
*Caution: Sedating antihistamine medications have a long half-life so wait time is 60 hours for both
diphenhydraime (Benadryl) and doxylamine (Unisom), 5 days for both chlorpheniramine and clemastine.

Dosage Interval Wait Time

Package 5 Times No Fly
Dosage Recommendation
Instructions Time
Interval
Every 4-6 hours^ Wait at least 30 hours before fying
X5 30 hours if taking a medication directed to
(Up to 6 times daily)
take every 4-6 hours.
Every 8 hours Wait at least 40 hours before fying
(OR three times daily) X5 40 hours if taking a medication directed to
take every 8 hours.
Every 12 hours Wait at least 60 hours before fying
(OR twice daily) X5 60 hours if taking a medication directed to
take every 12 hours.
^If there is a range, use the higher number

BOTTOM LINE
Always follow 14 CFR 61.53. If it is not familiar to you, please review it. Not only is it a
requirement, but it is for your safety and that of your passengers. When in doubt,
safety first - do not fly.
c Never fy after taking a new medication for the frst time until at least 48 hours have passed
and no side efects are noted.
c Do one more check of your condition before considering fying.
c Get well before considering return to fight status ... do not push it.
c OTC medications help reduce the symptoms of an illness, but do not cure it.
c Even though a medication has been determined to be safe for use by the Food and Drug
Administration (FDA), this does not mean that the medication is compatible with flying
or even driving.

Some medications are not recommended (see column “NO GO” on the table below):
• If you choose to fy on medication, be certain that it will not impair safety. Do not simply
hope for the best.

NOTE: This list is not all-inclusive or intended to take the place of

consultation(s) with your primary care physician and/or AME (aviation medical
examiner). Remember, if you have signifcant underlying health conditions,
it is recommended that the use of any medication be discussed with your
physician PRIOR to taking the medication.
 Over-the-Counter (OTC) Medications Reference Table
Type of medication Commonly found Medication or active ingredient Avoid these medications Rationale
or symptoms in generally safe to fy or ingredients*

GO NO GO

Allergy products Non-sedating products: Sedating products: Histamines affect not only your
allergies, but your sleep wake
Cough/cold fexofenadine (Allegra) brompheniramine cycle. Sedating antihistamines
products (Dimetapp) can cause drowsiness, impaired
loratadine (Claritin)
thinking and judgement.
Pain products cetirizine (Zyrtec)
chlorpheniramine (Chlor-
1Sedating antihistamines are
Trimeton)
commonly found on autopsy in
Antihistamines1 diphenhydramine aircraft accidents. The wait times
(Benadryl) for these medications are longer
than noted in the “Dosage
levocetirizine (Xyzal)
Interval Wait Time” table due to
Motion sickness dimenhydrinate their longer half-life. Consult
(Dramamine) your AME.
meclizine (Antivert)
Sleep aid melatonin (not an antihistamine) diphenhydramine “Hang-over efect” morning after
products (such as Zzzquil). safety concern.
Same ingredient in
Benadryl Note: Taking melatonin at the
wrong time can actually worsen
Doxylamine (such as jet-lag and cause daytime
Unisom) drowsiness.
Nasal steroid Allergy products azelastine (Astepro) None
fluticasone (Flonase)
mometasone (Nasonex)
triamcinolone (Nasacort)
Nasal congestion oxymetazoline (Afrin) Caution: Sudafed-like
Sinus pressure medications can speed up your
heart rate; therefore, use caution
Cough/cold if you have an underlying heart
products phenylephrine (Sudafed PE)
condition. Be very cautious of an
pseudoephedrine (Sudafed) extra cup of cofee or two when
feeling sub-par. This has caused
Nasal more than one pilot to end up in
decongestants the emergency room for a racing
Less convenient, but safer, are heart rate.
the nasal salt water lavages:
saline nasal sprays
Neti-pots
Coricidin (allowed if no dextromethorphan Most cough medications are
Cough/cold chlorpheniramine) (Delsym), also in Dayquil, safe for flight. Use caution as
products and Mucinex Fast-Max combination products may
Severe Congestion and contain sedating
Cough. antihistamines. If the label
guaifenesin (found in states PM (for nighttime use) or
Mucinex and Robitussin) Most “night-time” or DM (containing
“PM” medications contain dextromethorphan), you should
Cough a sedating antihistamine. not fly while using these
medications and for at least 5
- Coricidin HBP cough &
cold (contains dosage intervals after the last
chlorpheniramine) dose (see Dosage Interval Time
- Nyquil (contains table).
doxylamine)

Frequently Used OTC Medications *These efectively can cause incapacitation (examples are not all-inclusive)
Type of medication Commonly found Medication or active ingredient Avoid these medications Rationale
or symptoms in generally safe to fy or ingredients*

GO NO GO

NSAIDs (non- acetaminophen (Tylenol) Advil PM, Most OTC pain meds are safe
steroidal anti- to fy as long as the underlying
infammatory aspirin (Bayer’s) Tylenol PM condition is acceptable.
drugs) and
ibuprofen (Advil/Motrin) (Most “PM” Caution: Some OTC meds are
analgesics
medications contain combined with a sedating
naproxen (Naprosyn) diphenhydramine) antihistamine, which can cause
Aches and Pains drowsiness (see above for
Additional cafeine (commonly found in Read the label. examples).
options for Excedrin)
headaches Lidocaine: Caution with
application. Avoid getting on
Topical pain relief lidocaine patch (Lidoderm)
hands or open wounds as this
muscle rub can drop blood pressure or
absorb faster.
capsaicin
2If
medication is administered,
Opioid Antidote Opioid antidote naloxone (Narcan)2
DO NOT FLY until cleared by
FAA.

Anti-emetics bismuth subsalicylate loperamide (Imodium)3 GI illness can cause dehydration,

anti-motility (Kaopectate, Pepto-Bismol) cramps & pain with increase in
drugs altitude.
Gastrointestinal 3Loperamide
Illness: nausea, should not be used
vomiting, diarrhea, during acute illness as it can
constipation, cause dizziness. When taken
laxatives daily for a chronic condition,
may require a special issuance.
Bulk forming (e.g. Benefiber) magnesium citrate Use in recommended doses.
Laxatives Osmotic (e.g. MiraLAX)
Stool softener (e.g. Colace)
Stimulant (e.g. Senna)
Proton Pump esomeprazole (Nexium) None Be careful not to mask the
Inhibitors (PPI) lansoprazole Prevacid) underlying symptoms.
omeprazole (Prilosec)
pantoprazole (Protonix)
rabeprazole (Aciphex)
H2 blockers cimetidine (Tagamet) None Be careful not to mask the
underlying symptoms.
famotidine (Pepcid)
Gastrointestinal
Illness: indigestion nizatidine (Axid)
rantidine (Zantac)
Antacids aluminum hydroxide (Maalox) None Be careful not to mask the
calcium carbonate (Tums) underlying symptoms.
magnesium hydroxide (Milk of
Magnesia)
Frequently Used OTC Medications *These efectively can cause incapacitation (examples are not all-inclusive)
Type of medication Commonly found Medication or active ingredient Avoid these medications Rationale
or symptoms in generally safe to fy or ingredients*

GO NO GO

Pain reliever phenazopyridine (AZO standard) oxybutynin (Oxytrol for Oxybutynin can cause sedation &
Women) dizziness.

Urinary Tract
Infections Phenazopyridine is generally
allowed after adequate ground
trial to monitor for side efects.
Symptoms should be resolved
other than slight residual
irritation.
Emollients almost all are allowed Ensure the underlying
condition is not an issue with
Skin Rash Creams safe flight.
Lotions antifungal topical
antipruritics
corticosteroid topical

Products for olopatadine (Pataday) Eye ointment or gel Temporary blurry vision may
Dry eyes during flight4 occur with use of eye drops.
Eyes (Ophthalmic) alcaftadine (Lastacaft) 4Eye
Allergy/ ointment or gels should not
Itchy eyes artificial tears used in flight since the blurry
Eye lubrication vision may last for minutes.

Frequently Used OTC Medications *These efectively can cause incapacitation (examples are not all-inclusive)
 Additional Resources

AAM-400 Medication Brochure

Over-the-Counter Medication

Allergy - Antihistamine & Immunotherapy

Medication

Erectile Dysfunction Medication

Hypertension Medication

Diabetes Medications
Acceptable Combinations of Diabetic Medications

Antidepressant Program

Additional Medication Information in Guide for Aviation Medical Examiners

Do Not Issue (DNI) Do Not Fly (DNF)

DNI—pilots should NOT take any of these medications or

classes of medication and fly
DNF—pilots should NOT fly until these medications are stopped and a period
of time has elapsed

OK-20-0302 11-15-2023