Status letter question: PPI prescribed by GE, now ENT; who handles it?

[Unregistered]

I'm trying to get all my ducks in a row for my 3rd class renewal and am not sure which doctor should put this in his status report. Back in September I was prescribed Prevacid with 5 refills by my gastroenterologist for mild gastritis (no diagnosis of GERD). I haven't seen that doctor since then. I have also been seeing an ENT for allergies and a pulmonologist for mild intermittent and mostly exercise-induced asthma. At my last visit to the ENT in February I had just had an attack of acute bronchitis and a couple of days of mild asthma symptoms requiring occasional use of Proventil (very much not my norm, I usually only use it before working out in cold weather). The ENT decided that because of the gastritis history, I MIGHT have some small degree of reflux, and since reflux can aggravate asthma, he wrote me another Prevacid script to make sure I didn't run out.

I have a good status letter from the pulmonologist already. Unfortunately the GE doesn't return my calls (it's a mega practice, he may not even be getting the messages). The only other medication the GE has me on is Amitiza for constipation. My AME already called OKC about the Amitiza and said it was no problem, but wasn't clear on whether I needed a status report for it (he said "it couldn't hurt"). So my questions are:

1. Do I need a status report from my GE for the Amitiza?

2. Can my ENT write the Prevacid into his allergies status report or does the GE have to justify that as the original prescribing physician? If the ENT can write it, what should it say?

If I need a report from the GE I will get it, it's just a bit of a hassle. Oh but for the days when a call to the doctor's would get returned the same day! Now it seems I'm lucky if it's the same month...

 

[murphey]

You are an AOPA member, right? If so, call them and talk to the medical experts. If not a member, sign up RIGHT NOW so you can talk to the medical experts. $39 investment.

 

[Unregistered]

Quick followup: there might be another problem with my ENT's letter. He won't write "no adverse reactions" to loratadine (Claritin), which I'm taking for allergies, because he says in some patients it can cause mild drowsiness. The AOPA medications database shows no restrictions for loratadine other than "no adverse reactions", unlike cetirizine (Zyrtec), but he's adamant. So what is the FAA's current position on loratadine? Even my AME didn't have a problem with it, but he wanted a status report for it. The best my ENT is willing to say is "patient reports no drowsiness" as he can't assess my drowsiness level clinically. Is this going to be enough?

Thanks Murphey, OF COURSE I'm an AOPA member. I agree, it's a great value. I suppose I could call them, but it's easier to get complicated information across in writing than over the phone. I'm hoping Dr. Bruce or Dr. Ch will answer my questions.

 

[gismo]

Quick followup: there might be another problem with my ENT's letter. He won't write "no adverse reactions" to loratadine (Claritin), which I'm taking for allergies, because he says in some patients it can cause mild drowsiness. The AOPA medications database shows no restrictions for loratadine other than "no adverse reactions", unlike cetirizine (Zyrtec), but he's adamant. So what is the FAA's current position on loratadine? Even my AME didn't have a problem with it, but he wanted a status report for it. The best my ENT is willing to say is "patient reports no drowsiness" as he can't assess my drowsiness level clinically. Is this going to be enough?

Thanks Murphey, OF COURSE I'm an AOPA member. I agree, it's a great value. I suppose I could call them, but it's easier to get complicated information across in writing than over the phone. I'm hoping Dr. Bruce or Dr. Ch will answer my questions.

I take the recommended dose of Loratadine daily and have indicated this to my AME with no issues. I didn't need any kind of supporting documentation from my doctor either, I just said I'd been taking it for a several months with no adverse reactions. For that matter since it's now available OTC (it was by prescription only when I started) it doesn't seem like your ENT need be involved at all on this particular med. Why not ask your AME on the phone if he's OK with Loratadine on your statement of no adverse effects? I do know the FAA specifically says this med is OK for most folks.

 

[SCCutler]

The doc is, in my view, confused; he is not being asked to certify that no reaction is possible, but rather, that none has been observed in your case.

 

[Unregistered]

OP here. ENT is actually saying that he can't certify that I'm not having a reaction, so it is still possible as far as he is concerned. And he is right, how could he tell? The only way out is if my AME will accept my statement of no adverse reactions and the ENT withdraws the "drowsiness is possible" disclaimer to his status letter, which his first version had and which is obviously NOT appropriate. I didn't see Lance's reply until after my AME's office had already closed, but I think his suggestion is the best one. I'll call my AME on Monday and ask for clarification. The ENT also has me on Nasonex, which is steroidal and prescription-only. It's possible that the AME wanted ENT's side effects statement for that and I misunderstood him to mean that I needed one regarding loratadine also.

Anyway, thanks to all, now hoping one of the AMEs will have an answer for my OP questions.

 

[bbchien]

I take the recommended dose of Loratadine daily and have indicated this to my AME with no issues. I didn't need any kind of supporting documentation from my doctor either, I just said I'd been taking it for a several months with no adverse reactions. For that matter since it's now available OTC (it was by prescription only when I started) it doesn't seem like your ENT need be involved at all on this particular med. Why not ask your AME on the phone if he's OK with Loratadine on your statement of no adverse effects? I do know the FAA specifically says this med is OK for most folks.

If your representation is correct, you're OK as you are currently documented....except that Loratidine is a sedating antihistamine and I have no idea who he spoke to at FAA (if anyone). That'll cause a 10 week delay for certain....while they DQ you and you get onto Allegra. The AOPA database accurately (attached) does NOT show approval for loratidine.

The issue here is reactive airways disease, and no need for ACUTE care in your history. A doc's visit is not an ER visit. That med is better for outside allergies than Allegra, but you will likely not be flying at all on Zyrtec (bad profile for an aviator).

GERD even though it can be a silent triggering issue (particularly if you are heavy) is not an issue. Don't make it one :smile:

 

[Unregistered]

Dr. Bruce, I'll accept your word for it that loratadine is sedating (as my ENT said) and I need to get off of it... but are you sure you searched on antihistamines in the AOPA database? The meds listed in your attachment are in the database as histamine receptor anatgonists, not antihistamines. I'm not sure exactly what the difference is, but when I search on antihistamines for allergies, I DO get Claritin (loratadine) as the only med allowed by the FAA without a wait time. Sorry but I don't know how to do the attachment thingy. But anyway that's why I chose it.

 

[gismo]

If your representation is correct, you're OK as you are currently documented....except that Loratidine is a sedating antihistamine and I have no idea who he spoke to at FAA (if anyone). That'll cause a 10 week delay for certain....while they DQ you and you get onto Allegra. The AOPA database accurately (attached) does NOT show approval for loratidine.

Bruce, WRT the FAA's acceptance of Loratidine (Claritin) I beg to differ. I've attached the complete list of antihistamines off the AOPA drug page and it says this product is acceptable with "no adverse side effects" and no other restrictions.

 

[bbchien]

Bruce, WRT the FAA's acceptance of Loratidine (Claritin) I beg to differ. I've attached the complete list of antihistamines off the AOPA drug page and it says this product is acceptable with "no adverse side effects" and no other restrictions.

Well, if it's on there, then it's on there

So the current status does become critical and he needs the prescribing doc to write to say "no side effects reported". I can ask them on Tuesday !

Sigh.

 

[Unregistered]

Yes, AOPA definitely lists Claritin as allowed by FAA. But unless Bruce was thinking of Zyrtec when he read loratadine (kinda sounds that way from his post), I would trust Bruce over the AOPA database anyday.

Loratadine IS sedating in dosages above the usual 10 mg, and given that dose response is highly individual, some people might experience mild sedation even at the recommended dosage. It wouldn't be completely unreasonable if the FAA changed their policy based on post-marketing experience (note that's IF).

I think lots of us would appreciate definitive clarification in this matter.

 

[Unregistered]

Oops... looks like we cross-posted. Sorry.

 

[bbchien]

Clariitin is allowed with a statement (which the AME can provide) that there are no reported side effects. This from the horse's mouth, this AM.

 

[Unregistered]

Thanks Dr. Bruce.

 

[Unregistered]

Well, I had a look at the (unfortunately still unsigned, wish they'd told me before I drove the 20 miles to his office) second draft of my ENT's note today and the part about Claritin does say "patient reports no drowsiness or mental acuity changes" but he still insisted on adding that "it is, however, known that even second generation antihistamines can cause drowsiness in some patients". After a talk with my AME, I decided not to press the point about this "disclaimer" and take it as is. If I had known he was going to do that I would have either found someone else or insisted on Allegra from the start. Maybe next time around. At least the PPI is well-documented as being "for laryngopharyngeal reflux". My AME is happy, so I guess I'm okay with it.

Thanks to all.