SSRI (s) in Pilot Fatalities of Civil Aviation Accidents, 1990-2001

[Guest guest]

Selective Serotonin Reuptake Inhibitors in Pilot Fatalities of Civil

Aviation Accidents, 1990-2001

Aviation, Space, and Environmental Medicine November 2003, vol.

74, no. 11, pp. 1169-1176(8)

Akin A.; Chaturvedi A.K.

Abstract:

Akin A, Chaturvedi AK. Selective serotonin reuptake inhibitors in

pilot fatalities of civil aviation accidents, 1990-2001. Aviat Space

Environ Med 2003; 74:1169–1176.

Introduction: 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. Methods: 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. Results: 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 11–1121 ng · ml-1 for fluoxetine; 47–13102 ng · ml-1 for

sertraline; 68–1441 ng · ml-1 for paroxetine; and 314–462 ng · ml-1

for citalopram. In 39 of the 61 pilots, other drugs—for example,

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. Conclusions:

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 drug(s), ethanol, and/or even altitude hypoxia in producing

adverse effects in the pilots cannot be ruled out. Findings from

this study should be useful in investigating SSRI and other

substance-involved accidents and in making decisions concerning the

use of SSRIs in aviation.

Keywords: aviation forensic toxicology

Document Type: Research article ISSN: 0095-6562

SICI (online): 0095-6562(20031101)74:11L.1169;1-

Publisher: Aerospace Medical Association

http://www.ingenta.com/isis/searching/Expand/ingenta?

pub=infobike://asma/asem/2003/00000074/00000011/art00007

[Guest guest]

Selective Serotonin Reuptake Inhibitors in Pilot Fatalities of Civil

Aviation Accidents, 1990-2001

Aviation, Space, and Environmental Medicine November 2003, vol.

74, no. 11, pp. 1169-1176(8)

Akin A.; Chaturvedi A.K.

Abstract:

Akin A, Chaturvedi AK. Selective serotonin reuptake inhibitors in

pilot fatalities of civil aviation accidents, 1990-2001. Aviat Space

Environ Med 2003; 74:1169–1176.

Introduction: 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. Methods: 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. Results: 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 11–1121 ng · ml-1 for fluoxetine; 47–13102 ng · ml-1 for

sertraline; 68–1441 ng · ml-1 for paroxetine; and 314–462 ng · ml-1

for citalopram. In 39 of the 61 pilots, other drugs—for example,

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. Conclusions:

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 drug(s), ethanol, and/or even altitude hypoxia in producing

adverse effects in the pilots cannot be ruled out. Findings from

this study should be useful in investigating SSRI and other

substance-involved accidents and in making decisions concerning the

use of SSRIs in aviation.

Keywords: aviation forensic toxicology

Document Type: Research article ISSN: 0095-6562

SICI (online): 0095-6562(20031101)74:11L.1169;1-

Publisher: Aerospace Medical Association

http://www.ingenta.com/isis/searching/Expand/ingenta?

pub=infobike://asma/asem/2003/00000074/00000011/art00007

[Guest guest]

Selective Serotonin Reuptake Inhibitors in Pilot Fatalities of Civil

Aviation Accidents, 1990-2001

Aviation, Space, and Environmental Medicine November 2003, vol.

74, no. 11, pp. 1169-1176(8)

Akin A.; Chaturvedi A.K.

Abstract:

Akin A, Chaturvedi AK. Selective serotonin reuptake inhibitors in

pilot fatalities of civil aviation accidents, 1990-2001. Aviat Space

Environ Med 2003; 74:1169–1176.

Introduction: 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. Methods: 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. Results: 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 11–1121 ng · ml-1 for fluoxetine; 47–13102 ng · ml-1 for

sertraline; 68–1441 ng · ml-1 for paroxetine; and 314–462 ng · ml-1

for citalopram. In 39 of the 61 pilots, other drugs—for example,

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. Conclusions:

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 drug(s), ethanol, and/or even altitude hypoxia in producing

adverse effects in the pilots cannot be ruled out. Findings from

this study should be useful in investigating SSRI and other

substance-involved accidents and in making decisions concerning the

use of SSRIs in aviation.

Keywords: aviation forensic toxicology

Document Type: Research article ISSN: 0095-6562

SICI (online): 0095-6562(20031101)74:11L.1169;1-

Publisher: Aerospace Medical Association

http://www.ingenta.com/isis/searching/Expand/ingenta?

pub=infobike://asma/asem/2003/00000074/00000011/art00007

[Guest guest]

Selective Serotonin Reuptake Inhibitors in Pilot Fatalities of Civil

Aviation Accidents, 1990-2001

Aviation, Space, and Environmental Medicine November 2003, vol.

74, no. 11, pp. 1169-1176(8)

Akin A.; Chaturvedi A.K.

Abstract:

Akin A, Chaturvedi AK. Selective serotonin reuptake inhibitors in

pilot fatalities of civil aviation accidents, 1990-2001. Aviat Space

Environ Med 2003; 74:1169–1176.

Introduction: 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. Methods: 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. Results: 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 11–1121 ng · ml-1 for fluoxetine; 47–13102 ng · ml-1 for

sertraline; 68–1441 ng · ml-1 for paroxetine; and 314–462 ng · ml-1

for citalopram. In 39 of the 61 pilots, other drugs—for example,

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. Conclusions:

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 drug(s), ethanol, and/or even altitude hypoxia in producing

adverse effects in the pilots cannot be ruled out. Findings from

this study should be useful in investigating SSRI and other

substance-involved accidents and in making decisions concerning the

use of SSRIs in aviation.

Keywords: aviation forensic toxicology

Document Type: Research article ISSN: 0095-6562

SICI (online): 0095-6562(20031101)74:11L.1169;1-

Publisher: Aerospace Medical Association

http://www.ingenta.com/isis/searching/Expand/ingenta?

pub=infobike://asma/asem/2003/00000074/00000011/art00007