Antiemetic and sedative levels found together in 26 civil aviation pilot fatalities, 2000-2006.
BACKGROUND
Antiemetics and sedatives are two drug classes that may have harmful side effects when mixed. This is especially dangerous for pilots. Although many of these compounds are considered disqualifying by the FAA, their use occurs. Some pilots may be unaware of the danger of combining compounds from these two drug classes. Our laboratory was interested in evaluating the circumstances surrounding accidents in which the pilot was found positive for drugs from each of these two classes.


METHODS
Epidemiological, toxicological, and aeromedical findings from pilots involved in such accidents were collected for the 7-yr period from 2000 through 2006. Case histories, accident information, and the probable cause of the aviation accidents were obtained from the National Transportation Safety Board (NTSB). Toxicological information was obtained from the Civil Aerospace Medical Institute's (CAMI's) Forensic Toxicology Research Laboratory.


RESULTS
Of the 2184 fatal aviation accidents over this time period, 26 were found positive for compounds from both the antiemetic and the sedative drug classes. All 26 aircraft were operated under 14 CFR Part 91 as general aviation. All pilots were male; 21 tested positive for a disqualifying substance that may have affected their ability to control the aircraft.


CONCLUSIONS
Although the percentage of accidents in which the pilot tests positive for a compound from each class is small, it is important for all pilots to understand the dangers of self-medicating and concomitant use of such substances. Under-reporting of medications by pilots during their certification process occurs; education is the key to preventing inadvertent drug-drug interactions.
Botch
Sabra R
SR
Civil Aerospace Medical Institute, Federal Aviation Administration, Analytical Toxicology and Accident Research Laboratory, AAM-610, CAMI Building, RM 351, 6500 S. MacArthur Blvd., Oklahoma City, OK 73169-6901, USA. sabra.botch@faa.gov
Johnson
Robert D
RD
D000060:Accidents, Aviation / Q000401:mortality*; D000062:Accidents, Occupational; D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000009:adverse effects*; D015331:Cohort Studies; D004357:Drug Synergism; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012651:Self Medication / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000150:complications*; D014481:United States / Q000453:epidemiology
D000932:Antiemetics; D006993:Hypnotics and Sedatives