 |
 |
Intern@tion@l Dre@m.net |
|
|
Intern@tion@l Dre@m.net |
By Samuel
Shelanski, M.D.
When it
comes to packing for a dive vacation, most of us put more thought into what
goes in our gear bag than what goes in the toiletries kit. But the medications
you take can have serious effects on your diving.
While the effects of depth
and pressure have not been specifically studied for many common prescription
and over-the-counter medications, a basic understanding of what's in your pill
case and a few commonsense rules can help avoid complications.
Common Medications: Are They Safe?
The
following classes of drugs are discussed in terms of common effects and whether
there is anything in their chemical makeup that makes them unsafe to use while
diving. However, each person's situation is different. Many drugs are
prescribed for a variety of conditions and some medical conditions may preclude
safe diving even if the medication does not. If you take any medication on a
regular basis, be sure your doctor has cleared you to dive with both your
condition and the drug.
Different
companies often market the same drug under several brand names, and in many
cases, a pill may be a combination of several drugs. Medicines are referred to
here by their generic names with the brand name in parentheses. Before you mix
any medication and diving, read the ingredients label closely and consult your
physician if you have any doubts.
Never take
a new drug for the first time right before diving. And if any medication makes
you feel antsy, nervous, sleepy or disoriented, don't dive while taking it,
even if it's considered safe.
What are
they? Decongestants
shrink inflamed nasal and sinus membranes, opening these passages so that air
can pass more easily. Because they can make equalizing easier, decongestants
are commonly used by divers. Pseudoephedrine (Sudafed), phenylpropanolamine,
oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine) are commonly used
decongestants, sometimes combined with an antihistamine and pain relievers in
cold or sinus preparation. Steroids are also becoming more popular to relieve
the symptoms of stuffy nose and sinuses that are caused by allergies. Steroid
inhalers such as triamcinolone (Nasacort) are also available over-the-counter.
Potential downside: While generally well-tolerated,
some people find that these medications may make them agitated, nervous, or
make them feel as though their heart is racing. Reverse squeeze can occur if
the drug wears off during the dive.
Safe for diving? Yes. Make sure that you have used
the medication on land before using it while diving. Use of long-acting
preparations helps to minimize the risk of the medication wearing off mid-dive.
Common brand names: Sudafed, Afrin, Nasacort.
(Top) | (Back to Common Medications)
What are
they?
Antihistamines, often combined with other drugs in cold or sinus preparations,
combat the symptoms of allergies. Common over-the-counter antihistamines
include diphenhydramine (Benadryl), clemastine fumarate, chlorpheniramine
maleate and brompheniramine maleate. Most are also available in prescription
strength doses or in combination with other medicines. Other antihistamines,
including astemizole (Hismanal), loratadine (Claritin), and cetirizine
(Zyrtec), are available by prescription only.
Potential downside: Most over-the-counter
antihistamines cause drowsiness and can interfere with your ability to dive
safely. Many of the newer prescription medications do not have this side
effect.
Safe for diving? Yes, but ... Avoid any
antihistamine that makes you drowsy. As these drugs are frequently found in
cold and sinus pills, read package labels carefully before taking.
Common brand names: Benadryl, Claritin, Zyrtec.
(Top) | (Back to Common Medications)
What are
they? Most pain
relievers act by preventing the body's normal inflammatory response to injury
or illness. Aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin) and
naproxen sodium (Aleve), are all examples. Prescription pain relievers,
including ketoprofen (Orudis) and tramadol (Ultram), also fall into this
category.
Prescription strength doses
of Tylenol and ibuprofen are frequently combined with a narcotic for more
powerful pain relief. Common combinations are acetaminophen/codeine (Tylenol
#3), ibuprofen/hydrocodone (Vicoprofen) and acetaminophen/oxycodone (Percocet).
Potential downside: Any of the pain relievers that
contain narcotics can cause drowsiness and impair judgment, especially if
combined with alcohol.
Safe for diving? Yes, but ... Any over-the-counter
pain reliever sold in the United States can safely be used while diving.
However, pain reliever and narcotic combinations are sold over-the-counter in
many other countries, including Canada. Check the ingredients carefully before
taking any pain relieving medication purchased while traveling.
Common brand names: Tylenol, Advil, Motrin, Aleve.
(Top) | (Back to Common Medications)
What are
they? Motion
sickness medications are a class of drugs with which many divers are familiar.
Common formulations include dimenhydrinate (Dramamine) and meclizine (Bonine).
The primary prescription-only medication that is used for seasickness is the
scopolamine patch (Transderm Scop).
Potential downside: Chemically related to
antihistamines, seasickness medications can make you drowsy. While this may be
just the thing for a long crossing, it can be dangerous while diving. Another
common side effect is dry mouth, which can be aggravated by sucking on a
regulator all day.
Safe for diving? Yes. Try different medications to
identify which one causes the least drowsiness. Staying very well-hydrated and
sucking on a candy or cough drop can help relieve dry mouth.
Common brand names: Dramamine, Bonine, Transderm Scop.
(Top) | (Back to Common Medications)
What are
they? Over the last
decade, antidepressants have become some of the most widely prescribed drugs
among otherwise healthy people. The most common class of these drugs are
Serotonin Selective Re-uptake Inhibitors (SSRIs). These drugs include
fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft), among others.
Also commonly used are an older class of medications called tricyclic
anti-depressants, which includes such medicines as nortriptyline (Pamelor) and
amitriptyline (Elavil). Many other anti-depressants are also available, and
more come on the market each year.
Potential downside: The effects of pressure and depth
on these medications has not been clinically studied, but any drug that affects
the brain is a potential problem when combined with nitrogen narcosis. There is
also the question of the depression itself. Each year, there are a small number
of diving deaths suspected to be suicides. This has the potential to endanger
others on the boat if a rescue attempt is made.
Safe for diving? No. While many people on
antidepressants may be able to dive perfectly safely, the potential risks are
significant and should be discussed with your physician and psychiatric
caregiver. In most cases, however, the underlying psychiatric disorder will
preclude diving.
Common brand names: Prozac, Paxil, Zoloft.
(Top) | (Back to Common Medications)
What are
they? Antibiotics
fight bacterial infection and are prescribed for a variety of conditions from
urinary tract infection to pneumonia. There are hundreds of different
antibiotics available today. Almost all of them are available only by
prescription in the United States, but may be sold over-the-counter in other
countries. Other medications that divers may be taking include those that treat
fungal or yeast infections, and anti-virus medications such as those used to
treat herpes or HIV.
Also in this class are
drugs taken to prevent illness while traveling, such as mefloquine (Lariam),
chloroquine (Aralen) and doxycycline for malaria.
Potential downside: Side effects of these drugs can
include nausea or diarrhea, which can lead to dehydration, increased skin
sensitivity to the sun, and particularly in the case of mefloquine, psychiatric
changes. There are also the risks posed by the infection for which you are
taking the drugs in the first place. Pneumonia or bronchitis can interfere with
breathing, while diarrhea can contribute to dehydration, which increases the
risk of getting bent.
Safe for diving? Yes, usually. Most antibiotics can
be taken safely while diving. If the illness they were prescribed for doesn't
prevent you from diving, then it's unlikely that the medication will.
Divers should be aware of
potential side effects of antibiotics. Some, such as doxycycline, can make you
sensitive to sunburn. Metronidazole (Flagyl) will make a person incredibly sick
if they drink alcohol, and drugs such as erythromycin can cause an upset
stomach. Have your doctor choose an antibiotic with the most manageable side
effects.
Your options are limited
when it comes to anti-malarial drugs. In parts of the world, malaria parasites
are resistant to chloroquine, so doxycyline or mefloquine will be required. The
psychiatric side effects of mefloquine, and the lack of information about how
depth might make this worse, make doxycycline the drug of choice for
divers--just use a high-SPF sunscreen.
Common brand names: Zithromax, Lariam, Aralen.
(Top) | (Back to Common Medications)
What are
they? Medications
to control the pain and burning of gastritis--commonly called heartburn--are
among the most commonly prescribed medications in the United States. These
include prescription-only drugs like omeprazole (Prilosec) and lansoprozole,
and medicines like ranitidine (Zantac), cimetidine (Tagamet) and famotidine
(Pepcid), which are available over-the-counter.
Another stomach problem
that is likely to be encountered by divers is diarrhea. The medicines most
often used to relieve this unpleasant condition include bismuth preparations
(Pepto-Bismol), loperamide (Imodium) and diphenoxylate (Lomotil).
Potential downside: Assuming you stay well-hydrated,
neither the condition or these drugs are likely to be dangerous. Lomotil is a
narcotic drug related to codeine, and can make you sleepy, and some
drugs--notably Zantac--have been reported to make users drowsy.
Safe for diving? Yes. The low incidence of side
effects makes these medications generally safe for diving. The one exception is
Lomotil, a narcotic drug that should be avoided.
Common brand names: Imodium, Pepto-Bismol, Prilosec,
Zantac.
(Top) | (Back to Common Medications)
What are
they? Common drugs
to treat asthma include steroids, beta-agonists, and drugs that interrupt the
chain of events that can precipitate an attack. Steroids, which reduce
inflammation in the airways of the lung, can be taken either as prednisone
pills or via an inhaler. There are currently many different inhaled steroid
preparations on the market, including brand names such as Flonase, Vancenase,
Azmacort and AeroBid. Beta-agonists cause the muscles of the airway to relax
and are usually delivered to the lungs via an inhaler. The most commonly used
beta-agonists are albuterol (Proventil, Ventolin), pirbuterol (Maxair) and
salmeterol (Serevent). Other medications that are commonly used by people with
asthma include ipatropium bromide (Atrovent), zafirkulast (Accolate), cromolyn
sodium (Intal) and theophylline (Slo-Bid, Theo-Dur, Uniphyl).
Potential downside: While some beta-agonists can cause
the heart to race, most of these drugs have minimal side effects. The greater
danger is the asthma itself. An attack while diving could lead to air becoming
trapped in the lungs and arterial gas embolism (AGE) while ascending. The
sensation of being unable to catch one's breath can also trigger panic under
water.
Safe for diving? Maybe. While the drugs are not
generally a problem, the underlying condition can be. Until five years ago, all
asthma was an automatic disqualifier for diving. Today, cases triggered by
exercise or cold are still considered a contraindication to diving, but
sufferers of most other kinds of asthma can dive as long as their condition is
well-controlled. Consult your doctor, and the Divers Alert Network (DAN).
Common brand names: Flonase, Azmacort, Proventil,
Serevent.
(Top) | (Back to Common Medications)
What are
they? Alternative
medications and dietary supplements such as vitamins, herbal cures, and
medicines like melatonin are becoming increasingly popular in the treatment of conditions
ranging from sleeplessness to cancer.
Potential downside: Since these medicines and
supplements are loosely regulated, you can't always be sure what's in them. In
New York City, for example, a popular Chinese "herbal" remedy for
stress was found to contain large amounts of Valium. On a more mundane level,
drugs like Melatonin can cause drowsiness.
Safe for diving? Yes. For the most part these
vitamins and medicines are safe to use while diving. Stick with products from a
reputable manufacturer, and avoid anything that makes you feel tired or jumpy.
If you are taking herbal remedies with any prescribed drugs, clear their use
while diving with your doctor since there can be dangerous interactions.
(Top) | (Back to Common Medications)
What are
they? Birth control
pills are composed of progesterone, often combined with estrogen. The pill
essentially fools a woman's body into thinking it is pregnant so that an egg is
not released during the menstrual cycle. Viagra, initially developed as a blood
pressure medicine, is the first male impotence drug on the market.
Potential downside: Any medicine that has estrogen can
increase a woman's risk of developing blood clots in the legs. This is
particularly likely during long periods of inactivity, like plane flights.
Viagra has few side effects other than lowering blood pressure.
Safe for diving? Yes. There is little risk to diving
while taking birth control pills. But if you are going to use Viagra, I would
recommend skipping the night dive.
