News | Published August 28, 2014 | Written by Scott DeHart, MD, PhD, medical director, occupational health, Mount Nittany Physician Group

Medications and driving

Scott DeHart, MD, PhD, medical director, occupational health, Mount Nittany Physician Group

One of the questions we often get from our Commercial Driver's License (CDL) drivers concerns the kinds of medications that the Department of Transportation allows. This information may be equally relevant to non-CDL driving as well, but is absolutely crucial for CDL drivers in order to obtain their DOT Medical Certificates so that they can continue to drive.

The federal regulations do not spell out specifically all of the medications that might be at issue but rather make the general statement that "A person is physically qualified to drive a commercial motor vehicle if that person does not use a controlled substance identified in 21 CFR 1308.11 as a Schedule I, an amphetamine, a narcotic, or any other habit-forming drug."

The only medications specifically listed by the DOT as prohibited are methadone, insulin and marijuana (this includes medical marijuana in those states where it is legal). In addition, diabetics on insulin can obtain an exemption for insulin use by applying to the federal DOT. Exceptions to the above rules are allowed if the driver is being treated by a licensed medical professional who is familiar with the driver's medical conditions and who testifies that the medication in question will not adversely affect the safe driving of a commercial vehicle. However, CDL medical examiners will not qualify a driver who is on narcotics (natural or synthetic,) either for short or long-term use.

Of course, this all leaves open a vast number of medications (prescription, over the counter and supplements) that potentially have an effect on driver's safety. Medications that increase drowsiness are especially a problem, and these would include many psychiatric medicines, antihistamines, pain medications, sleep medication and mood altering medications. All of these need to be addressed on a case-by-case basis. Medications for depression present a special case since many of them cause an initial drowsiness that may go away in time. The DOT specifically recommends against the use of first generation antidepressants such as Elavil, but the newer medications such as the SSRI drugs may be allowable if the treating physician confirms that use does not present a safety risk. The medical examiner must also take into account the nature and severity of the depression itself in certifying the driver.

Most medications for hypertension and diabetes (with the exception of insulin) do not themselves present a problem as long as the underlying medical condition is kept under control. The same is true for most cardiac medications as well. Another area of concern is that of over the counter medications that can cause drowsiness. These would include antihistamines (as for allergies and cold medications), sleep aids, and some anti-diarrheal medications (such as Lomotil).

The safe use of medications for commercial drivers will need to include input from the treating physician, the DOT medical examiner and the cooperation of the CDL driver.