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There are data that the side effects of many prescription drugs impair the psychomotor and cognitive performance of patients; with psychotropic drugs having even more of these negative side effects. Particularly drugs like benzodiazepines, antipsychotics, barbiturates, trycyclic antidepressants, stimulants, narcotic analgesics, and antihistamines that affect the central nervous system top the list for risks of accidents, injuries, and cognitive impairments. Along with these, anticoagulants, chemotherapeutic agents, antidiarrheals, antiemetics, and steroids should not be allowed for pilots. It is debatable that SSRIs have a mild side effect profile. SSRIs and bupropion are given to military pilots up to 6 months after resolution of anxiety and depressive symptoms in Canada and Australia. But the civil aviation authorities did not grant any privileges to these drugs.
The gold standard in aviation for a pilot to şy efficiently and safely is to be in good mental and physical health and not to be affected by any medication during şights. The regulations both international and national have clear rules that permanently or temporarily restrain pilots from şying activities in the case of any sickness or medication treatment. The rules stating that a sick person cannot function as a pilot in a plane or an air traffic controller in a tower are rational. However since the notion of being sick and the tasks during a şight spread over a wide range, local health authorities can issue "waivers" for special situations. For example pilots with conditions like type-2 diabetes, asthma, rheumatoid arthritis, sarcoidosis, or melanoma cannot şy; but in certain forms of these conditions that are stabilized with treatment, that have not caused serious limitations, and that do not affect performance, the pilot may be allowed to şy. Atopic dermatitis that recover with application of pomades, allergic rhinitis that is treated with nasal sprays, asthma that is treated with steroid inhalers, type-2 diabetes that is controlled with metformin are examples of allowed conditions. The drugs that are assumed not to have any side effects that might affect şight safety are: Aspirin, paracetamol, most antibiotics, depot penicillins, gout and thyroid medication, antiacids, nasal decongestants, oral contraceptives, topical analgesics and steroids, nonsteroidal anti-inşammatory drugs, vitamins, metformin, modafinil, caffeine, etc. Clearly, the patients need to be monitored for the first few days of use considering these drugs may have idiosyncrasies.
It is a problem when pilots take drugs without consulting authorized doctors for fear of şight suspensions. Adding to that reasons like the cost of doctor's visits, losing compensation for the duration of suspension, upsetting supervisors due to disrupted şight schedules may lead pilots to taking OTC drugs. What's worse is that they can order DTC drugs over the internet based on unscientific news, articles, and ads. There are several herbal supplements available in the market today that contain suspicious ingredients that claim to treat pain, help şu like symptoms, reduce stress, aid sleep, improve sexual performance, reduce blood fat levels, help lose weight, prevent aging, or provide vitamins and minerals. Therefore the attempts of the pilots to treat themselves create risks and the unknown side effects of those preparations pose serious problems to şight safety.