Medication combo red flag?

[Unregistered]

It's about time to hit the AME and get my medical. Doing research, I notice this thread:

http://www.pilotsofamerica.com/forum/showthread.php?t=37778&highlight=actos

Where Dr. Bruce says:

You cannot have Januvia with ACTOS. That is a grounding combination!!!

I can't find anything specifically about this, but I suppose it falls under this clause:

http://www.faa.gov/about/office_org...vs/offices/aam/ame/guide/pharm/oral_diabetes/

"DM medication monotherapy versus combination therapy. Not all combinations of DM medications are acceptable to the FAA, even if each medication within the combination is acceptable as monotherapy. Contact the Regional Flight Surgeon’s office or AMCD for questions."

So a few questions:

1) Here's the list of what drugs I'm on, are there any other red flags here?

Metformin
Actos
Januvia
Atenolol
Amlodipine
Lisinopril

2) Is the actos/januvia combo a denial? Or just a kick to Oklahoma City.

3) What substitution for either actos or januvia can I ask my PCP for?

Thanks!

 

[Unregistered]

Original Poster here:

Continuing my research I find Dr. Bruce over at the red board pointing a fellow diabetic to this bulletin:

http://www.faa.gov/library/reports/medical/fasmb/media/201004_color.pdf

Page 4 middle Column towards the bottom of the page says:

------------------------------------------
"Diabetes mellitus treated with medications. The FAA accepts all oral hypoglycemic agents, but there are policy exceptions. The more recent medication Januvia (sitagliptin) can only be used with metformin and/or the thiazolidinediones (actos). We also accept Januvia and both of the above medications. We do not accept the use of Januvia and a sulfonylurea. If Januvia is being used as the initial treatment for diabetes, then the airman must wait for 60 days to be considered, but if it is being added to the medication regimen, then the airman need only wait 14 days.

"As you know, the combined use of oral agents and beta-blocking medications is limited, but Januvia can be used.
Byetta (exenatide) is an injectable medication that is used with any of the other oral agents. The restriction with this medication is that the air- man must wait for 2 hours after use before flying. Byetta is also acceptable with beta-blocking medications. The new Byetta-type medication, Victoza (liraglutide), has not been approved by the FAA as yet.
The other oral agents acceptable with beta blockers are metformin, either of the thiazolidinediones, and acarbose (Precose)."
-----------------------------------

This seems to say that the combination of Januvia, Metformin and Actos is acceptable. It also says that my diabetes medications are acceptable with the Beta Blocker I'm on Atenolol. It seems that I'm in the clear, although my application might take the scenic route though Oklahoma City.

Anyone see something I don't?

Thanks!

 

[bbchien]

I've been out west and didn't see this. Here are the guidance documents.

I can't do a course and tell you which trade name is in which chemical class of meds. There are just TOO many..

Januvia is very restrictive. You can do metformin, and Actos or Avandia. That's it. The potential to get you wayyy to low to be a pilot exists with the other combinations.

I do multiple doc consult calls for this very issue. A good AME should know this stuff.....