Prohibited Prescription Medications for Flight Attendants
Federal Aviation Administration (FAA) and Department of Transportation (DOT) regulations govern the use of medications for all flight crew, including flight attendants, to ensure crewmembers are not impaired while on duty. The core principle is that any substance that affects a person's faculties in a way contrary to safety is prohibited. This includes medications that cause drowsiness, impair judgment, or alter coordination.
Psychotropic and Sedating Drugs
One of the largest and most strictly prohibited categories includes psychotropic and other sedating medications. These drugs directly affect the central nervous system and can severely compromise a flight attendant's ability to respond to in-flight emergencies. Prohibited examples include:
- Sedatives and Hypnotics: Sleep aids such as Ambien and Lunesta, as well as over-the-counter sleep aids containing antihistamines, are prohibited due to their potential to cause impairment and a 'hang-over effect'.
- Anti-anxiety drugs (Anxiolytics): Medications like Xanax (alprazolam), Valium (diazepam), and Ativan (lorazepam) are disqualifying because they can impair cognition and alertness.
- Antipsychotics: These medications are not permitted for use by flight crew.
- Attention Deficit/Hyperactivity Disorder (ADHD) medications: Stimulants such as Ritalin (methylphenidate) and Adderall are prohibited.
- Most Antidepressants: The use of most antidepressants is disqualifying. However, in some cases, specific SSRIs like Prozac, Lexapro, Celexa, and Zoloft may be considered for a special issuance authorization, though the condition itself and any side effects are scrutinized.
Narcotic Pain Relievers and Opioids
Narcotic pain relievers are another major category of prohibited substances. The DOT specifically tests for opioids and amphetamines, and while a legal prescription can lead to a negative test result after review by a Medical Review Officer (MRO), the use of these drugs can still be flagged as a safety concern by the employer. Prohibited narcotics include:
- Hydrocodone (Vicodin)
- Oxycodone (OxyContin, Percodan)
- Codeine
- Morphine
- Tramadol (Ultram)
Other Restricted or Prohibited Medications
Beyond psychotropics and narcotics, other classes of drugs are restricted:
- Muscle Relaxants: Medications such as Flexeril and Soma are prohibited.
- Marijuana: The use of marijuana is strictly prohibited, regardless of state or local laws regarding medical or recreational use.
- Cancer Treatment Medications: Many chemotherapy and radiation treatments require the flight attendant to be grounded until treatment is completed due to the side effects and the severity of the underlying condition.
Over-the-Counter (OTC) Medication Guidelines
While OTC medications are often seen as less serious, they are subject to strict regulations for flight attendants. The FAA emphasizes that any medication carrying a warning about drowsiness or operating heavy machinery is prohibited.
The 'Wait and See' Rule for New Medications: When taking any new medication for the first time, an employee should not fly until at least 48 hours have passed without any apparent adverse side effects. This is critical as individual reactions to a medication can differ, especially in the cabin environment.
The 'Five Half-Life' Rule: For any medication with significant side effects, the FAA recommends a waiting period equal to five times the maximum pharmacological half-life or five times the maximum dose interval. For instance, a medication taken every 6 hours would require a 30-hour waiting period before returning to flight duty.
Comparison Table: Sedating vs. Non-Sedating Antihistamines
This table illustrates the difference between acceptable and prohibited OTC allergy medications based on their sedating properties.
| Feature | Sedating Antihistamines (Prohibited) | Non-Sedating Antihistamines (Acceptable) |
|---|---|---|
| Common Examples | Benadryl (diphenhydramine), Zyrtec (cetirizine), Xyzal (levocetirizine), Chlor-Trimeton (chlorpheniramine), Unisom (doxylamine) | Allegra (fexofenadine), Claritin (loratadine), Astepro (azelastine) |
| Mechanism | Cross the blood-brain barrier, affecting the central nervous system | Minimal effect on the central nervous system |
| Safety Concern | Can cause drowsiness, impaired judgment, and delayed reaction time, even if the person feels awake | Generally safe, provided no adverse side effects occur during a trial period |
| Flight Status | Prohibited for flight duties | Permitted for flight duties, assuming no side effects |
General Best Practices and Consequences
It is imperative for flight attendants to follow these safety rules rigorously. Failing to do so can have severe consequences, not only for their career but for the safety of all passengers.
Key Regulations and Practices:
- Do not mix medications and alcohol: Never take medication with alcohol. A positive alcohol test is a positive test, regardless of the source.
- Report all new medications: Flight attendants are required to inform their employer and, if applicable, the MRO about all new prescriptions, especially those for controlled substances.
- Never borrow or share medication: The effects of any drug can be highly individual. Sharing prescriptions is both illegal and extremely unsafe in an aviation context.
- Read the labels carefully: Many OTC medications contain combinations of active ingredients. It is essential to read all labels to identify any sedating components.
The Importance of Communication
When a flight attendant is prescribed a medication, they must have a frank and open discussion with their healthcare provider, informing them of their safety-sensitive duties. The healthcare provider's sign-off is a critical step in ensuring the medication is safe to use while flying.
Conclusion
For flight attendants, medication use is a matter of both personal health and public safety. The overarching rule is to prioritize caution and avoid any substance, whether prescription or OTC, that has the potential to cause impairment, drowsiness, or negatively affect judgment. Strict FAA and DOT guidelines prohibit a range of medications, particularly those affecting the central nervous system, and require careful monitoring of any drug's effects before reporting for duty. By understanding and adhering to these rules, flight attendants ensure they are in a fit and alert condition to perform their critical safety functions.
For more detailed information, flight crew can consult the official FAA Guide for Aviation Medical Examiners: https://www.faa.gov/ame_guide/.
