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Medication Class — Allergy/Colds/Upper Respiratory Infections (URI)

Medication Class Description:

For more information please search in our Medical Articles section for "allergies".

The over-the-counter (OTC) decongestants pseudoephedrine and phenylephrine (the active ingredient in plain Sudafed and Sudafed PE) and guaifenesine (active ingredient in medication like Entex, Duratuss) are approved for flight use provided  they are not combined with sedating antihistamines.  Note that the FDA has recalled phenylpropanolamine (PPA) because of cardiac arrhythmias and deaths associated with its' use.  In general, only the "non-drowsy" or "daytime" products should be used. 

The only OTC non-sedating antihistamine authorized is Claritin (loratadine).   Additionally, the prescription non-sedating antihistamines Clarinex ( desloratadine) and Allegra (fexofenadine) are authorized for flight deck and ATC use following a 48 hour ground test free of side effects. In addition Allegra D, Claratin D, Clarinex D are also approved. These medications have the decongestant Sudafed added.

Currently, the FAA does not approve the prescription antihistamines Zyrtec (cetirizine), levocertirizine (Xyzal) or Astelin (azelastine) for use during flight duty.  Use of these medications requires a 24 hour grounding period following the last dose.   See Allergies in the VFS Medical Information Center.

Recently, some pilots who have listed Clarinex, Claritin or Allegra as medications they are using to control allergic symptoms have received letters from the FAA indicating the use of these medications are prohibited within 48 hours of flight.   These letters were sent because the pilot or AME did not make comments on the FAA Form 8500-8, Airman Medical Application, that the medication was tolerated without side effects.  A comment on the application regarding the absence of side effects would not result in a restriction.  Discussion with representatives of the FAA confirm that pilots who do not have any side effects from Allegra, Clarinex or Claritin may disregard these letters, but should note the absence of side effects on their next physical.

Many physicians now prescribe Singulair for allergies.  If this is appropriate for you, make sure that you take your AME documentation to shows that you do not have asthma since this medications was traditionally used in control of that condition.

The FAA approves treatment with desensitization injections (allergy shots). This treatment should be documented and reported to the FAA during your routine FAA airman medical examination.

The FAA also permits airmen to use nasal steroid inhalers such as Beconase,Vancenase, Nasalide and Flonase.  Inhalers such as Afrin are not permitted for use prior to flight.  It may be reasonable to carry some Afrin in a flight bag for use in emergency situations with ear or sinus blocks on descent.   Its' ongoing use for more than 2-3 days is not recommended due to the risk of "rebound" nasal congestion once the nasal spray is stopped.  Note that the nasal spray Astelin is not approved for use within 48 hours of flight duty.  Atrovent nasal Spray is authorized for use during flying after a two week ground testing period without side effects.

Allergy medications such as Patanol to control allergic manifestations in the eye are also allowed provided that the underlying condition is well controlled without adverse side effects.

All other OTC cold and allergy medications require that you wait twice the dosing interval since your last dose of the medication before you fly again. In other words, if the label states, "Take every 6 hours," you must wait at least 12 hours since your last dose before flying again.

A study published in the Annals of Internal Medicine on 7 March 2000 demonstrated that the effect of taking Benadryl, an OTC antihistamine, impaired driving performance significantly more than a blood alcohol concentration of 0.1% (legally intoxicated) or Allegra, a "non-sedating" antihistamine.  It also demonstrated that subjective drowsiness was not an accurate measure of driving performance.  Two of the study's authors are consultants to the manufacturer of Allegra, which may introduce some bias in the results.

Many liquid and inhalant medications contain alcohol, which may produce a positive reading if you take an alcohol breath test. The FARs prohibit airmen from ingesting alcohol in any form within 8 hours of flying.  Some prescription cough medications contain codeine, a narcotic which is prohibited for use within 24 hours of flight.   VFS physicians recommend a 72 hour waiting period from the last dose of a narcotic before flying if a pilot subject to DOT drug testing to avoid the possibility of a positive drug test for opiates.

The FDA has recently issued a voluntary recall to manufacturer's of PPA and a consumer health advisory for products containing phenylpropanolamine (PPA).  A recent study released by Yale University showed an increased risk of hemorrhagic (bleeding) stroke in women and a theoretic risk in men using PPA.  PPA is used in prescription and over-the-counter (OTC) nasal decongestants and OTC weight control products.

Relenza (Zanamir) is a new category of medication used to reduce the duration and intensity of flu symptoms.   Good only for influenza A and B, not for common cold.  Must be taken within the first 2 days of symptoms and used for 5 days.  Inhaled from of dosing.

Tamiflu (Oseltamivir Phosphate) is a new category of medication used to reduce the duration and intensity of flu symptoms.   Good only for influenza A and B, not for common cold.  Must be taken within the first 2 days of symptoms and used for 5 days. 

Medications Within Class:

Sudafed (Pseudoephedrine), Sudafed PE (Phenylephrine), Afrin, Clarinex, Allegra, Zyrtec, Astelin, allergy shots, Immunotherapy, Beconase, Vancenase, Nasalide, Flonase, Atrovent, Bendadryl, Entex (phenylpropanolamine) , Relenza (Zanamir), Tamiflu (Oseltamivir Phosphate)  Claritin (loratadine), Singulair,  Patanol, levocertirizine (Xyzal)