AOPA Pilot Magazine - February 2016 - 106

NEWS & NOTES

PILOT PROTECTION SERVICES

MEMBER PRODUCTS

Medication theory,
FAA-style

BY GARY CRUMP

AOPA Senior Medical Specialist

Considering good medications with bad side effects
THE AOPA Pilot Information Center-Medical
Certification gets lots of questions about
the use of medications while flying, and for
good reason. Pilots need to know how certain medications perform while in a human
body that is subjected to altitude changes.
In a recent Pilot Protection Services medical webinar, we talked about how the FAA
reviews a medication to determine its appropriateness for use during flight activities.
We talked specifically about three new
diabetes medications known as sodium
glucose co-transporter (SGLT2) inhibitors: dapagliflozin (Farxiga), canagliflozin
(Invokana), and empagliflozin (Jardiance).
With any new medications, the FAA
requires one year of U.S. Food and Drug
Administration approval before the drug
can be considered for airman medical certification. An FAA committee of physicians
will review the literature on these medications to determine whether they can be used

safely by pilots and, if so, if any limitations
or restrictions are required.
In nondiabetics, glucose is reabsorbed
by the kidney's filtration system, located
in the nephrons-the main structural and
function components in the kidney. Glucose
is routed through the filtration system
for reabsorption, to be stored for cellular
energy that powers our bodies, while some
of the waste products are passed through
the filters and excreted in urine.
To retrieve the glucose through filtration, the kidneys have two types of "carrier
proteins," one of which is sodium glucoselinked transporters, that transport both
glucose and sodium. For people with Type II
diabetes, the filtration process allows excess
glucose to be released back into the body,
resulting in a state of high blood sugar. The
SGLT2 inhibitors reroute the excess glucose
so that it's excreted in urine. Unfortunately,
the process also depletes sodium and other

essential trace minerals, which can disrupt
the balance of the electrolytes that keep
our bodies in sync. The chemical mechanism also can result in a higher-than-normal
potassium level, and a disruption of potassium can result in heart arrhythmias.
Therein lies the rub for the FAA. The
complex process by which these medications work results in a higher risk of side
effects that also can lead to urinary tract
infections, dehydration, fainting (syncope),
constipation, nausea, abdominal pain, and
pancreatitis. The FAA continues to review
the literature, but it is probably safe to say
that these medications are not going to be
allowed for flight activities-despite their
effectiveness in treating diabetes.
Gary Crump is the senior director of medical

certification for AOPA's Pilot Information
Center and a consultant for Pilot Protection
Services (www.aopa.org/pps).

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106 | AOPA PILOT February 2016

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Table of Contents for the Digital Edition of AOPA Pilot Magazine - February 2016