Allowable medicines for flying

[Miroku]

I recently had an operation on a disc in my back which had to be redone. During the second operation it was found that the surrounding tissue was infected and this in turn affected the nerves.

As a result I am taking the following medicines:
Paracetamol
Diclofenac
Gabapentin
Tramadol

I fly on an NPPL licence and would like to know which, if any, of the above I would be allowed to take and fly. My reasoning is that if a truck driver would be allowed to take any of these (same medical as for NPPL) then maybe I could.

I would like to have a 'target' to aim for so that I could continue to fly.

[Old Smokey]

NOT a medically qualified response, so I'll relate how 2 of the 4 listed affect me.

Paracetamol - No significant effect (especially on the pain).

Not familiar with Diclofenac or Gabapentin.

Tramadol makes me go to sleep, very quickly - to be avoided at all cost!

Not even 2c worth, but I hope that this helps.

[Miroku]

Yes, I knew about the Tramadol as it's an opiate I believe but I've managed to reduce these to 2 per day and hopefully to 1 by next week.

I'm less sure about the others, but thanks anyway.

[gingernut]

Not sure if there's a definative list, but would have thought gabapentin and tramadol could cause some problems.

Perhaps the AME's take a different view if they are used in the long term, but only a guess.

[PA-28-180]

First, I'm sorry that you're currently suffering from what I'm sure is a very painful experience.
For the record, Tramadol is NOT an opioid analgesic, like codeine. Gabapentin works on the neurotransmitter GABA - MOST patients do not experience any side effects from this, with the most common being nausea/vomiting. HOWEVER, when combined with tramadol, the risk of drowsiness is greatly increased in most patients-further, if hypersensitive to tramadol, one of the possible side effects is siezure - NOT a good idea for driving OR flying. Diclofenac is a non-steroidal anti-inflamatory (similar to ibuprofen=advil/motrin), most commonly brand named Voltaren. This medication does not have any 'special senses' effects, BUT, as previously mentioned, you should check with your local authority/AMA to ensure you won't be in any violation. Many medications, and other substances, that do not have any adverse effects at sea level CAN create problems at altitude. I hope that everything works out for you and you're able to continue flying. :ok:

[Miroku]

PA-28-180

Many thanks for your mail, the information is very useful.
However, I'm confused about one point regarding Tramadol. You mention that this is NOT an opioid analgesic but in the sheet with the medicine it states that Tramadol is in a 'class of opioids'.

Could you explain further please?

[gingernut]

It has an "opioid effect" and is listed in the "Opioid analgesic" section of the BNF.

It's a bit like saying sleeping with your cousin isn't technically incest.

[PA-28-180]

Good one Gingernut! :ok:

Actually, Tramadol is listed as a 'synthetic opioid", but primarily because it's centrally acting - in other words, it acts on the central nervous system - in America, for example, this medication is not on the Controlled Substance List and canNOT be used for the treatment of opiate withdrawal. It acts more like an antidepressant, which is why you can't use it if you're taking SSRI's, like prozac, or the older, tricyclic antidepressant medications. Antidepressant medications, such as amyltryptaline are often used in chronic pain management cases - but I think that the use of these medications are ALSO not approved for flying. In any case, just given the possible side effects, such as seizure, not a good idea for flying or driving! Also, there IS a withdrawal syndrome associated with Tramadol....so, at least in my practice, I don't use this medication very often...codeine is more effective, with less side effects for most patients when used at the correct, titrated dosage. Best of luck and I hope your feeling better and flying again soon!

[homonculus]

Tramadol works on ascending pathways in the spine. The transmitter it blocks is similar to those blocked by antidepressents, but it is not centrally acting in this respect. In a small number of patients it is metabolised to a substance that works on opiate receptors in the brain, and this gives rise to the confusion.

It means that the drug may have far more analgesic effect on one patient than another, and may be morphine sparing in some and not in others.

From a flying perspective, convertors may be elated and have other morphine like side effects so it is a no no. It is also a no no (clinically at least0 because it can produce depression. And after about 10 weeks of use you can get non dependency withdrawal effects.

IMHO it is a great drug short term if you dont get too many side effects, but for most people poorly tolerated long term if they are working

[Miroku]

Very many thanks to everyone for the clarification.

So, going back to my original question, once I am off the Tramadol could I fly with the other medications?

Or alternatively, replace Tramadol with codeine?

[gingernut]

As SoCall says, probably worth discussion with your AME.

I guess the bottom line is, would I be happy putting my family on a plane when the captain is taking tramadol or codeine ? Probably not.

By the same rule, would I be be happy putting my family on a plane when the captain has severe pain ? Probably not.

Are there any alternative adjuncts ?http://www.nice.org.uk/nicemedia/live/11926/39554/39554.pdf

Keep us popsted, it's an interesting question.

[sycamore]

If you trawl the `sticky` at the top of the threads for the CAA/JAA,you can find a list of allowable medication/dosages.

[PA-28-180]

Have you tried any non-drug therapies, such as physical therapy or a TENS unit (Transcutaneous Electrical Nerve Stimulation)? Many patients respond very well to these modalities.......

[Miroku]

PA-28-180

TENS unit

Many thanks for this idea. I'm seeing my GP tomorrow and will discuss the various options with him, along with reducing the dosage level of my existing medications.

Sycamore,

I've found the CAA page that you mentioned but can't find the page which lists allowable medicines. Could you advise further please?

[PA-28-180]

I'm glad to be able to help you a little with this....as an aside, this forum strikes me as TOTALLY different from the others, i.e., rumors/news, etc...and for this, I'm grateful. From this thread, I'm very happy to see the many people trying to reach out and help another person......and, the information will likely help many others.

Miroku-

Regarding the TENS unit.....about 20 years ago, I had a herniated disc and using the TENS unit helped me a great deal. I've also seen my patients respond well with this....BUT....to echo the posts of others....especially with Tramadol, you do NOT want to just stop taking this or any other medication on your own. You should speak with your doctor FIRST - explain your situation fully and any concerns you have, and then together, you can make an informed decision. Again, I hope that you're feeling better soon and safely back in the skies....take care and God bless!

[Miroku]

I was asked for an update so here goes..........

I saw my GP last Friday and asked his opinion re flying. His reply was that as I had managed to reduce the level of Tramadol significantly he didn't see a problem.

I had a flight with a very experienced instructor today and he was quite happy with my flying. I rent aircraft from the company he part owns.

Please bear in mind that I fly on an NPPL and according to the LAA it's virtually up to me if I fly with regard to medical issues! However, I would certainly NOT fly if I didn't feel up to it.

I also fly with a flying partner and we monitor each other very closely, taking over the workload from each other when necessary.

I would like to thank all the people who have contributed to my question in such a positive manner.