Greetings, fellow aviators!
It’s a pleasure to join the Midwest Flyer Magazine family as your new voice in aviation medicine. Dr. Bill Blank is a hard act to follow, but I will do my best. For those of you I haven’t had the opportunity to meet, I’m a Senior Aviation Medical Examiner (AME) and a HIMS-designated AME, based at Middleton Municipal Airport/Morey Field (C29) in Madison, Wisconsin. I have been flying since 1980. As a pilot advocate, I’ve spent decades working with pilots of all levels, from students to airline captains, and as an instrument and multiengine-rated pilot, I understand firsthand the importance of keeping our medical certification current, accurate, and aligned with FAA expectations. In each column, I’ll be diving into timely topics to help demystify FAA medical policy, offering insight into how you can stay healthy, certified, and flying.
Let’s begin with something that’s been generating a lot of questions lately: “GLP-1 medications.”
You may have seen television ads for drugs like Ozempic or Wegovy. The medications, along with other similar medications, belong to the category of GLP-1 receptor agonists. GLP stands for glucagon like peptide, a hormone released by the small bowel in response to eating. This hormone tells your pancreas to produce insulin (lowering blood sugar), tells your liver to stop making sugar, slows down the emptying of food from your stomach (so you feel full longer), and works on your brain to make you feel less hungry. As an “agonist,” the drug mimics the effect of the natural hormone, boosting the effects of the natural hormone. As a result, these medications are very helpful in treatment of Type II diabetes and obesity. Although very expensive, this class of medication has become extremely popular because the medications are extremely effective.
The FAA is concerned not only with any drug you may take, but also the reason for using the medication. If you are taking the medication for weight loss, clearance by your AME is easy. You need to bring the FAA’s Weight Loss or Pre-Diabetes Status Report, filled out by your provider. If all looks good, your AME can issue you a medical certificate. (https://www.faa.gov/ame_guide/media/Weight_loss_prediabetes_status_report.pdf)
If you are on the medication for Type II diabetes, the medication is permissible, however, you will need to obtain a special issuance. The AME must defer your exam to the FAA. You will need to provide a report from your provider, including a detailed summary of the condition, current medications, physical exam, lab tests (including hemoglobin A1C), diagnosis, assessment and plan. The FAA’s Diabetes or Hyperglycemia on Oral Medication Status Report form does the trick. Although most GLP-1 medications have been supplied in injectable form, newer medications, such as Rybelsus that are now available in oral form, are likely to follow.
As with any new medication, I suggest you have a discussion with your AME prior to starting the medication.
GLP-1 Medications: What Pilots Need To Know
You’ve probably heard of medications like Ozempic, Wegovy, Mounjaro, and Saxenda. These drugs belong to a class called GLP-1 receptor agonists, initially developed for type 2 diabetes, but which are now widely prescribed for weight loss—even in non-diabetic individuals.
Given the popularity of these medications, pilots are understandably asking: “Can I still fly if I’m taking one of these drugs?” The answer is: yes—but with conditions, and with proper documentation.
These medications can be approved under two pathways: CACI (Condition and AME Can Issue) or as Special Issuance, depending upon the condition being treated.
The FAA permits the use of certain GLP-1 medications, including semaglutide (Ozempic, Wegovy), liraglutide (Saxenda), and tirzepatide (Mounjaro, Zepbound), provided specific safety criteria are met.
CACI Conditions: Weight loss or pre-diabetes:
- The condition being treated must be well controlled.
- The airman’s A1C must never have exceeded 6.5
- The airman is accompanied by a clinic note from the treating provider within 90 days, stating that there are no symptoms or complications associated with diabetes, side effects from the medication, or hypoglycemic events.
- The AME will review the FAA’s Weight Loss Management Worksheet
Special Issuance Conditions (diabetes):
- Tirzepatide (Mounjaro), even as a single agent, requires Special Issuance due to its unique dual-action mechanism.
- An initial grounding period is required:
- Minimum 2 weeks off flying when starting treatment for weight loss.
- 72 hours grounding after any dose changes.
Safety First
GLP-1 medications can cause side effects that impact airman safety: nausea, dizziness, fatigue, or—rarely—mood changes. That’s why the FAA insists on the observation period and clinical stability before returning to the cockpit.
The pilot’s treating physician must provide documentation confirming stable use and no impairing side effects. That documentation, along with a current clinical note, must be reviewed by your AME using the FAA’s CACI – Weight Loss Management Worksheet.
Not All Weight-Loss Meds Are Approved
A reminder: some popular weight-loss medications are outright disqualifying, such as:
- Phentermine (and its combinations like Qsymia)
- Bupropion/naltrexone (Contrave)
- Lorcaserin (Belviq)
These are not permitted for any aviation medical certification, and there’s currently no Special Issuance path available.
Final Thoughts: If you’re considering or currently taking a GLP-1 medication, the best advice is this: talk to your AME. A short conversation can save months of paperwork and keep you flying safely and legally.
That’s all for now! In the next issue, we’ll explore the FAA’s approach to sleep apnea—another topic where clarity is often needed.
Blue skies and tailwinds!
