What Medications Can I Take While Flying?

This is a commonly asked question by Flight Attendants. As Safety Professionals, the question itself indicates that as Flight Attendants we are aware of drug and alcohol testing requirements and we recognize the link between the use of medications and fitness for duty. In an ongoing effort to comply with these regulations, Flight Attendants tells us the absence of a published list of medications, a “No Fly” list of sorts, that safety-sensitive employees must avoid before or during the performance of their duties is what causes the question to arise. So, if Flight Attendants are safety sensitive professionals subject to DOT testing, why isn’t there such a list?

It’s important to recognize the differences that apply between the various work groups who are considered to be safety-sensitive employees. For example, unlike pilots, Flight Attendants are not medically certified and there is a different set of regulations that apply. The decision about whether a Flight Attendant can fly using a prescription medication is a decision made by the Flight Attendant’s personal physician. The decision about whether a Flight Attendant can fly using an over the counter (OTC) medication is generally made by the Flight Attendant using her/his best judgment about how a substance does or might impact her/him.

There are a vast number of new medications that enter the marketplace on a continuous basis. For Flight Attendants, this could also include non-domestic market streams. If a “no fly” list of medications did exist, it would have to be routinely and consistently updated. More importantly, a Flight Attendant might assume that if a medication is not on the list, then the medication is safe to take. Reactions to medications vary by individual and how those reactions manifest themselves can be significantly different from the norm, especially at 30,000 feet. Any assessment of medication reactions and possible interactions is best left up to medical professionals who are specialized in these areas, namely, our treating physicians. 

Recognizing that our treating physician is not always available to us while we travel and given the availability of over the counter medications, without a list, how do we as Flight Attendants navigate the choice points around medication use before or during a flight assignment? We recommend the following guidelines:

• Never use any medicine that has alcohol as an ingredient (i.e. many cough medicines). An alcohol test positive is a positive. The source of the alcohol is not a factor considered when determining if you have violated alcohol regulations. If there is no ingredient list on the product, don’t take it. 

• For prescription medications, make sure your treating physician has a very clear understanding of your safety-sensitive duties. Consider giving her/him your job description. Make sure she/he re-reads your job description each and every time a prescription medication is recommended. Be very clear to ask whether you can take this medication before and during the performance of your Flight Attendant duties.

• Avoid using OTC medications/herbal supplements purchased overseas. Because of differences in regulatory requirements the label may be incorrect and/or incomplete. The ingredients could contain substances that would cause you to test positive for a controlled substance. 

• Just before or during flight duty, only use an OTC medication that you have used before and that you know does not cause, for you, performance altering side effects. Just because an OTC medication is agreeable with a flying partner does not mean that it will be agreeable with you in the performance of your duties.

• Try not to leave home without an emergency supply of OTC medications that you know are agreeable with you and effective for treating frequent illnesses to which you are susceptible.

• When starting a new medication or having the dosage of an existing medication adjusted, ask your physician if any of the initial side effects that you may experience from these changes could compromise the performance of your safety-sensitive duties. You and your physician may have to do a little more planning around your flight schedule and the initiation of new medications and/or changes in dosages.   

• If the prescription label of your medication directs you to take the medication daily, you must assume that you may be challenged about taking the medication beyond the number of days for which daily medication was dispensed. For example, if you were given 30 tablets of a medication on July 1 with a label that says “take one tablet daily”, taken as directed the medication supply would be exhausted on July 30^th.  However, it’s not uncommon for adjustments to be made during the course of taking a medication. In the event your physician adjusts her/his medical instruction on how you should use a prescribed medication (i.e. your physician directs you to take the medication “as needed” or to “take only half a tablet”), request a new prescription that bears that direction on the label.

You can also read more about “Flight Attendants’ Rights and Responsibility around DOT Drug Testing” on our website. In addition, contact your AFA EAP if you have would like to have a confidential discussion about any questions or concerns you may have about medications. In addition to your MEC & Local Council EAP Professionals, you can reach our AFA International EAP Professionals at 1-800-424-2406.  

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