Anti-inflammatories & flying...

[Plan 10]

Been prescribed Diflocan sodium by GP. Irrespective of the fact that at the moment flying is out the frame with the condition itself, any AME's there who can give the official word on whether that drug is acceptable for flying with? GP seemed to think so, but the leaflet inside mentioned the "do not drive or operate machinery etc.etc.etc..." and he did own up to not being fully conversant with what goes in the Aviation world.

Cheers,

Plan 10

[QDMQDMQDM]

I presume you mean diclofenac sodium, the anti-inflammatory, rather than Diflucan, the anti-fungal?

Anyway, as a GP I have yet to see anyone drowsy or unable to operate machinery as a result of taking diclofenac. The side-effects listed in the product inserts are ridiculously over-extensive in a vain attempt by the drug companies to prevent getting sued. Tediously, I guess you'd better check with your AME that it is indeed permissible -- just phone him / her up. I'm surprised the CAA doesn't have a list of permitted drugs on its website.

QDM

[Plan 10]

Checked the box and yep, Diclofenac sodium.... even the name ain't pilot proof. thanks!

[Hawk]

Hello Plan Ten...probably worth while checking the FAA site approved medications. They list anti-inflammatories and regularly update their site with new approvals. They caution about taking the medication for about 48 hours before resuming flying. This assumes of course, that the medical condition you are being treated for does not interfere with the safe performance of your flying duties.

The drug manufacture does include side effects etc. in their packet literature maybe to prevent being sued and Medical and Health forum also includes that sort of waiver for the same reason.

You dont indicate what part of the world you are from..but I suggest you call your local Authority with a general query.

regards
Hawk

[QDMQDMQDM]

The drug manufacture does include side effects etc. in their packet literature maybe to prevent being sued and Medical and Health forum also includes that sort of waiver for the same reason.

And the great thing about waivers is that they are more or less meaningless when it comes to a court of law. If you have a duty of care, you are negligent in executing that duty of care and the individual concerned comes to harm as a result you can be sued successfully, irrespective of how all-encompassing your waiver was.

The net effect of the over-extensive product inserts which list every symptom, minor or major, ever described is that a high percentage of patients give up ont he medicine before they even start. They just read the product insert, say 'Hey, I don't want to get all this stuff!', and then chuck the pills away.

QDM

P.S. I like your hawk, Hawk.

[Hawk]

Yes QD..quite right.

However, a waiver does indicate that the site's intention is that the forum is for discussion purposes only, if members gain some assistance from opinion here. then well and good. But for them to make decisions about their health based solely on information available here would be unwise. As health professionals we would be acting unprofessionally and unethically to suggest anything else.

I believe this is particularly so given the fact that members are pilots or have other close association with aviation. The safety issues are obvious.

Cheers
Hawk

[QDMQDMQDM]

However, a waiver does indicate that the site's intention is that the forum is for discussion purposes only, if members gain some assistance from opinion here. then well and good. But for them to make decisions about their health based solely on information available here would be unwise. As health professionals we would be acting unprofessionally and unethically to suggest anything else.

Hawk,

You're right, of course, and I don't say you shouldn't have a waiver, just that they are an irritating, if inevitable and stupid, part of modern life. But playing devil's advocate here (moi?!), people are much more likely to come to harm in this forum as a result of following advice on, say, short-field technique in the Private Flying forum than about anti-inflammatories here.

Best,

QDM

[Hawk]

Ok QDM..we leave it there. Im sure we dont want to waste Danny's valuable "air time" caught up in debate. Lots of professional medical sites we can do that on.

Besides, we have poor Plan 10 here, probably struggling to go to work every day to fly his plane, came here for a bit of assistance, he's probably wandered off shaking his head.

cheers
hawk

[QDMQDMQDM]

<<Besides, we have poor Plan 10 here, probably struggling to go to work every day to fly his plane, came here for a bit of assistance, he's probably wandered off shaking his head. >>

Fair's fair, Hawk. I thought I gave some reasonably helpful advice and this forum isn't exactly brimming over with medical contributors.

Anyway, I'll now shut up and apologise for going off topic. You have no idea how bored I am sitting here dealing with an apparently endless stream of sore throats. ;-)

QDM

[gingernut]

I don't know, where's "take the 5th" when you want a good scrap?

I can see your point of view Hawk, and I know you've got to give the official line, but is diclofenac going to affect plan 10's ability to perform in his cockpit ?

The common sense loby would suggest not. I couldn't find anything in the literature about the avoidance of machine operation etc, although there is some sort of tenous link to dizziness. (I would have thought that would have happened by now if it were to occur).

You see, I imagine what people like QDM are good at, is managing risk in the real world. Would I let my family on an aircraft captained by someone who has taken diclofenac? Of course I would.

Anyway, does this academic debate help plan 10's situation? Well it does sound like you are not flying at the moment anyway because of your condition. I imagine that your condition is gradually resoving. Why not ease off the diclofenac as things improve, and perhaps try an alternative therapy, (paracetamol's pretty good for pain, and I havn't read one accident report in which, when used properly it has been implicated)

Anyway back to viral land, hope you find this useful.

[Hawk]

Gingernut.

The "official" line I quoted was the FAA. Surely you are not suggesting that there is any argument about their recommendations? Particularly if Plan 10 is a United States based pilot.

I assume you do not know the underlying medical condition Plan 10 is being treated for, the medication is "secondary" if you like to that. I would have thought that the decision to fly with a pilot would have been based on his medical condition primarily, rather than his medication.

Now, I'm sure if Plan 10 is still reading this thread he will be encouraged to know of QDMs experience with the prescribing of this drug, but in the meantime if either of you wish to debate FAA's recommendations thats fine, however, I dont have anything further to contribute to the discussion.

Regards
Hawk

[QDMQDMQDM]

Hawk,

Your responses baffle me somewhat. What do you want from the contributors to this forum?

Plan 10 asks a question, gets an uncontroversial opinion from me, which includes the advice that he'd better consult an AME. I then diverged off track a bit later in the thread and get slapped down by you for doing so.

The corollary to the above seems to be that advice in this forum must be limited strictly to the issue in question, no divergence allowed, and consist of either...

a) Web links with relevant information from national licencing authorities.

b) The advice to consult a medical professional or AME.

That doesn't make for a very permissive environment in which to discourse and swap ideas and one has to ask what the point of the forum is if that is so. If you're really as worried about getting sued as you appear, maybe it would be best to close down the forum entirely.

Although I may appear to you as if I'm a member of the 'awkward squad', I dont really think I am. I do just feel that you could be a bit more tolerant and welcoming to posters such as my good self who has given a lot of common sense, mainstream medical advice here, most of it apparently welcomed by the recipients.

Cheers,

QDM

[reynoldsno1]

Plan 10,

I have a non-chronic condition that occasionally requires treatment using non-steroidal, anti-inflammatory medication. Not all of them are equal in their side-effects.
I have found indomethacin (Indocid) effective as a treatment, but initial dosage does tend to make me feel 'peculiar'. I recently toll Flameril, and founf it nearly as effective, with no perceptible side-effects.

[Plan 10]

Hi,

Many thanks to all the contributors! I seem to have opened an ethical debate to a certain extent.... a good thing I suppose; reading between the lines the medical profession as an indemnified one does have to tread softly in foreign halls like this, so Hawk is correct in pushing that line... any Captain would recognise that.

I come from a vaguely medical family, and could have got the basics of the advice from back copies of Mims using the propritery name of Voltarol rather than the misspelt generic I attempted.. but the essence of the forum caveats is correct... and heres why...

Despite all the info above, I went driving today after taking one of the tablets.. and after crossing several lanes of the M25 without realising it handed over to my passenger. These tablets have a dizzying effect on me, so i am in that sub-grouping of the CI list. The medical reason I am on them is an SI joint inflammation, that has developed into sciatica, and the practical reason is that I couldn't hold half rudder deflection with confiidence the day I posted, and removed myself from service.

So what have I as a punter taken from the debate... well, the usual.. it's kinda always down to yourself after you got as much input as you can. I followed Hawks advice and checked the FAA advice.... they dont have a list of proscribed medicine as such, but do say that anything can be proscribed if the effects are severe enough.

The ethics that are attached to the medical profession are more visible than those on mine, and the meeting point in this off-limits arena is where the debate above has arisen. QDM, Ginger and Hawk are all correct in their own ways from what I can see.. but at the end of the day, I took the drug, and it aint going to be one I fly with based on my experience to date, regardless of what the books say, period. I got no problem with that. if my company have, I might be back!

Thanks folks.. it really is good to have input across the professional lines, and well appreciated.

Plan 10
(Uk Based!)

[takenthe5thamendment]

Hello Plan 10,

As you seem to be experiencing side effects with Diclofenac, I wonder if you have considered taking an 'alternative' product.

Glucosamine when taken in a dosage of 1500 - 2000mg is thought to be effective in joint conditions - and there are no side effects.
I don't know what QDN and Gingernut's views are on the use of it, but allegedgly there are significant results.

it's worth a try:D

Gingernut - Pleased to see you missed me - have been working too hard lately;)

[QDMQDMQDM]

Glucosamine when taken in a dosage of 1500 - 2000mg is thought to be effective in joint conditions - and there are no side effects.

There is indeed solid objective evidence from randomised controlled trials that glucosamine at 1500mg a day is as effective as anti-inflammatories in osteoarthritis of the knee. There was a Drugs and Therapeutics Bulletin feature on it a couple of months ago to this effect.

I'd be sceptical about any claims of no side-effects for any drug, though, takenthe5th. ;-)

I must admit I was a bit gobsmacked reading the article, as I'm a cynic when it comes to alternative remedies and I've been gently chiding my mother for years as she's been taking the stuff and swears by it. Humble pie.

One other word of caution -- it doesn't necessarily extrapolate that it is as effective as anti-inflammatories in acute conditions. OA of the knee is very much a chronic disorder.

QDM

[takenthe5thamendment]

Yes QDM, you're quite right I'd be sceptical about any claims of no side-effects for any drug

What I should have said was - there are allegedly no side effects, but of course, you need to check those claims out :)

I hope I have 'waivered' enough there :D :D

[Specaircrew]

I'm a military pilot and have been taking Voltarol (prescribed by miltary doctor) for years without any problems. They can give you indigestion so you're better off taking the 'retard' version which is slow release and is taken once a day. Am surprised at the side effects you described as they are very rare. You could try taking aspirin or ibuprofen instead, they're great for hangovers too!

[white knuckles]

Clinical trials have reported adverse reactions associated with diclofenac with the following rates:

Frequent (>10%): none.
Occasional (1-10%): nausea, abdominal pain, dyspepsia, diarrheoa, vomiting, dizziness, headache, rash, itching, altered liver function.
Rare (0.001 - 1%): gastrointestinal haemorrhage, drowsiness, impaired concentration, fatigue, palpitations, hepatitis, asthma.
Isolated (<0.001%): just about anything.

Association does not necessarily mean causation.

As with any drug, individual reactions are unpredictable and can be idiosyncratic. Risks and benefits need to be considered before use. Caution is required with use. Always ask, is this drug really necessary?

Most clinical trials of glucosamine have reported favorable outcomes, with glucosamine being at least as effective as ibuprofen (Motrin, Advil, Brufen) in osteoarthritis of the knee. Many of these trials have been flawed by poor study design.

Mild adverse reactions (nausea, abdominal discomort, fatigue) have been reported. Experimental studies have shown altered glucose metabolism and insulin utilisation (in rats).

Glucosamine is considered a 'nutritional supplement' or 'natural remedy' and is thus not subject to the same scrutiny and regulation as prescription medications.

As with any "natural" remedy:

"Natural" does not always mean safe.
Natural remedies and prescription medicines may interact.
Lack of standardization may result in products with different strengths and effects.
Lack of quality control may allow contamination of products.

[Flyin'Dutch']

According to the NICE guidelines there is no evidence to suggest that NSAIDs as a class are more effective than paracetamol for pain control in acute musculoskeletal conditions.

But........

Ever read the side-effect profile for paracetamol?

Joking apart, as white knuckles so eloquently stated; there is a fair number of patients out there that can not tolerate Diclofenac due to the dizziness it can cause.

Dont have the numbers to hand but it seems that other NSAIDs seem to have this problem a bit less often.

QDM have you seen Hawk of recently; seems to have flown off after your last post.

Ciao

FD

[Mac the Knife]

How about a PPRuNe disclaimer as a sticky?

WARNING!

The reply below appears to be from a medical or paramedical professional. PPRuNe has NOT verified either their qualifications or their bona fides. The publication by PPRuNe of their reply should in no way be interpreted as....
<find a lawyer to fill in the bits>
.....may contain traces of nuts.

[QDMQDMQDM]

The reply below appears to be from a medical or paramedical professional. PPRuNe has NOT verified either their qualifications or their bona fides. The publication by PPRuNe of their reply should in no way be interpreted as....

Mac,

I see where you're coming from, but to be honest I think one should stick with caveat emptor. If you read something on the Internet and come unstuck as a result you have only yourself to blame. That said, there's a lot of good stuff written by ordinary Joes on the Internet and if you want to follow it, that's up to you. Just don't squeal if it goes wrong.

Keep it simple is the best advice. I once started and ran an Internet forum a little like this and with posting levels (1000-2000 a day) of the same sort of order of magnitude as here, even if not as great in absolute terms, and you don't want to get into giving unpaid, hence uncontrollable, users endorsements (and of course the absence of a disclaimer on an individual user -- say I sent them my GMC number and they verified it -- would be an implied endorsement).

Cheers,

QDM

[min]

I've only just gotten around to reading these last few replies (some of us actually have to work for a living!!)

Below is the 'disclaimer' posted on the front of the forum page "Topics that involve news and debate about medical and health issues. Any information gleaned from this forum MUST be backed up by consulting your state-registered health professional or AME".

I'll go out on a limb and say that I do think QDM is right about caveat emptor. Many 'pounce' on info that suits them, without seeking advice from their own doctor, and researching it appropriately through reputable sources. But that's human nature, unfortunately. A little bit of knowledge is not necessarily a good thing! We see a number of patients who are taking complementary therapies, for example, who don't inform the treating doctors of this. Our hospital has just done some research into the numbers of patients who do so, but I don't think the results are out as yet. In addition, it would nice if at the other end of the scale, people took some responsiblity for their own health and well-being - would make the workload for those of us involved in the healthcare sector a little lighter!

M.

[Plan 10]

Sorry to drag this back on topic again.;) Phoned the CAA today under the 21 day rule, and the very pleasant doc there was quite unequivocal about Voltarol; "Nope. Not happy with that."

Now having the status TU is something new to me, so wasn't fully on the ball to ask the reasons why, but there you go. And that was without mentioning the apparently rare side effects I get, from the advice above.

Thanks to all who have contributed, appreciate it.

Plan 10

[Hawk]

Thank you to all who have posted. Plan 10 I hope you are feeling better and are back flying soon.

This one seems to have Waivered ;) off topic a bit, so might be a good opportunity to close now and move on.