Prevalence of Selective Serotonin Reuptake Inhibitors in Pilot Fatalities of Civil Aviation Accidents, 1990-2001
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are popularly prescribed for treating depression. With a few exceptions, these psychotropic medications are not approved by aeromedical regulatory authorities for use by aviators. Since SSRIs have the potential for impairing performance and causing drug-drug interactions, the prevalence of SSRIs in pilot fatalities of civil aviation accidents was evaluated. Postmortem samples from pilots involved in fatal civil aircraft accidents are submitted to the Civil Aerospace Medical Institute (CAMI) for toxicological evaluation. Findings from such evaluations are maintained in the CAMI Toxicology Database. This database was examined for the presence of SSRIs in pilot fatalities of the accidents that occurred during 1990-2001. Out of 4,184 fatal civil aviation accidents from which CAMI received samples, there were 61 accidents in which pilot fatalities had SSRIs. Of these accidents, 56 were of the general aviation category, 2 were of the air taxi and commuter category, 2 were of the agricultural category, and 1 was of the ultralight category. Blood concentrations of SSRIs in the fatalities were 11-1,121 ng/mL(exp -1) for fluoxetine; 47-13,102 ng/mL(exp -1) for sertraline; 68-1,1441 ng/mL(exp -1) for paroxetine; and 314-462 ng/mL(exp -1) for citalopram. In 39 of the 61 pilots, other drugs (e.g., analgesics, antihistaminics, benzodiazepines, narcotic analgesics, and/or sympathomimetics) and/or ethanol were also present. As determined by the National Transportation Safety Board, the use of an SSRI with or without other drug(s) and/or ethanol has been a contributory factor in at least 9 of the 61 accidents. Numbers of SSRI-involved accidents were low, and blood SSRI concentrations in the associated pilot fatalities ranged from subtherapeutic to toxic levels. However, the interactive effects of other drugs, ethanol, and/or even altitude hypoxia in producing adverse effects in the pilots cannot be ruled out. (8 tables, 51 refs.)7
Document Details
- Document Type
- Technical Report
- Publication Date
- May 01, 2003
- Accession Number
- ADA423836
Entities
People
- Ahmet Akin
- Arvind K. Chaturvedi
Organizations
- Federal Aviation Administration