Flying with Basic Med after having singles

[msa@anastasmail.com]

I’m sure someone has had to deal this situation before and am looking for information on their experience - an old GA pilots with a Basic Med medical had shingles and is now taking gabapentin to control postherpetic neuralgia that developed after the shingles outbreak. I'd just like to understand if there’s is an issue and how the FAA views situation.

For context, a symptom that’s apparently pretty common after a shingles outbreak clears up, is that there’s sometimes continuing nerve-related pain in the area of the outbreak. The condition is called Postherpetic neuralgia and can last for a few weeks, several months or even longer after the outbreak. The common treatment prescribed to deal with this pain to take a medication called grabapentin.

It turns out gabapentin is also used to control certain types of seizures in people who have epilepsy so apparently, it’s on the FFA’s no-fly list. This likely would be a bigger issue if the pilot had a Class I, II, or III medical but since he flies on Basic Med and is not taking the gabapentin to control epileptic seizures, it would seem if his Basic Med Dr says it is OK to fly while taking the medication, there wouldn’t be any issues.

Is that how you understand Basic Med works and has anyone had to deal with this situation in the past?

 

[lbfjrmd]

no fly with gabapentin.

 

[Half Fast]

no fly with gabapentin.

What prohibits it when on Basic Med?

 

[tsts4]

My understanding is if something would ground you under an FAA medical, it would generally ground you under basic med— the difference is it’s up to the pilot to figure it all out under the honor system. IOW basic med isn’t supposed to be a free for all where no rules apply.

From the AOPA Basic Med FAQ on medication:
“While there is no list of specific medications that are prohibited for pilots flying under BasicMed rules, certain medications are not safe to be used at all while flying and others require a reasonable waiting period after use. Physicians should be mindful of prescription and over-the-counter drugs that may impact the safe operation of a motor vehicle, in this case a private recreational aircraft. This can include, but is not necessarily limited to, the use of sedatives, psychotropic drugs, antihistamines, narcotics or any other medication that can impair cognition if used while the pilot is operating an aircraft.

Pilots and the physician should consult available aeromedical resources to understand potential flight hazards associated with any medications being taken, such as whether the underlying condition the medication is being taken for makes flight unsafe, or to understand side-effects that may be unnoticeable before flight but could impair the ability of a pilot to make sound decisions in flight. In addition to the BasicMed rules, pilots taking medication must also comply with existing Federal Aviation Regulations, such as the self-grounding requirements of FAR 61.53 and FAR 91.17’s prohibition on operations while using any drug that has affects the person’s faculties in any way contrary to safety.”

 

[bbchien]

(1) The do not issue do not fly list, as noted in the "instructions to the state licensed physician" in form 8700-2.
(2) Your conscience, if you have one. That drug is terrible for thought flexibilty and executive functioning.

 

[Brad Z]

Practically speaking, the "do not issue do not fly" applies to pilots operating under BasicMed in the same way that it applies to pilots exercising Sport Pilot privileges.

Under BasicMed, the state licensed physician attests the following on the BasicMed exam checklist:

"I certify that I discussed all items on this checklist with the individual during my examination, discussed any medications the individual is taking that could interfere with their ability to safely operate an aircraft or motor vehicle, and performed an examination that included all of the items on this checklist. I certify that I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft."

There is no regulatory or statutory hook that specifically requires adherence to part 67 standards. A reasonable physician applying sound clinical judgement would not sign off a BasicMed pilot taking a medication that is unsafe for usage, but there is nothing compelling that doctor to do so.

As a pilot you're given a long leash medically with BasicMed. Use it wisely and don't ruin it for the rest of us by making bad decisions.

 

[msa@anastasmail.com]

Thanks to everyone for the clarifications - it's clear from the posts Basic Med comes with the same FAA medication restrictions as the other Class I, II, or III medicals. My Basic Med assumptions stated above were incorrect.

Since gabapentin and a set of similar meds are on the FAA no-fly list, flying is simply not allowed while being taken to control shingles related postherpetic neuralgia or any other affliction.

Next question - does anyone have experience or know of any other effective meds or treatments for shingles related postherpetic neuralgia that are OK for use by the FAA?

Thanks

 

[lbfjrmd]

indeed, there are no rules concerning medications ... and I am sure some basic med non-AME doctors could be more tolerant of prohibited meds. There is also a liability that an airman flying with said drugs could be exposed to in case of a mishap. Time will reveal more of this and other basic med issues as they arise.

 

[Lindberg]

Next question - does anyone have experience or know of any other effective meds or treatments for shingles related postherpetic neuralgia that are OK for use by the FAA?

Hard to say, since it can go away on its own, but I believe that acupuncture helped me. When I told my doc I wouldn't take gabapentin or the other, similar drug he offered, he had no other medical suggestions.

 

[kmacht]

Just take a few weeks off from flying. If you are flying under basic Med then you aren’t doing it for a living so what’s the rush to get back in the air? You won’t be on gabapentin forever. Rest, heal, work your way back off the meds and then worry about getting back in the air.

I had shingles and also had some nerve pain after the shingles went away. It took a few more weeks but it eventually disappeared as well. Just try giving it some time. If the urge to fly is too great while you wait then go up for a flight with a CFI or see if you can tag along right seat in a friends plane. Just because you can’t be PIC doesn’t mean you can’t still get up in the air. Again, health first. Heal up, get off the meds, and then go enjoy flying again.

 

[WDD]

“While there is no list of specific medications that are prohibited for pilots flying under BasicMed rules, ”

I think that sums it up. It's up to you and your doctor to decide if a medication has side effects that will degrade your ability to fly. I see our resident expert has weighed in with his opinion. Illegal maybe not, but the question for your friend is "should you".

What's not listed is how much is being taken, how long, how the person reacts to it, etc. Is any amount OK? I have no idea. FWIW, I believe it makes you drossy - no "heavy machinery". Would you go flying after taking Nyquil?

Good question for the doctor is whether there is an alternative that would work better/less side effects.

 

[lbfjrmd]

no alternatives, and i am not sure gabapentin works either.

 

[Lindberg]

no alternatives, and i am not sure gabapentin works either.

My doc suggested gabapentin or lyrica on a "do you want to try it and see if it helps" basis. I said no way and went to the acupuncturist (which he also thought was a fine idea). Four months later and it's mostly gone.... I didn't have it as bad as some do, so it wasn't worth being grounded for me.