Max Trescott and Rob Mark explore one of the most overlooked killers in aviation: common medications that quietly impair pilots and contribute to fatal crashes. While many aviators think over-the-counter or prescription drugs are safe if they “feel fine,” the NTSB’s recent accident reports tell a different story. In case after case, pilots who ignored FAA medication rules—or failed to understand them—lost control of their aircraft, sometimes within seconds of takeoff. Pilots should read the FAA's Over-the-counter (OTC) Medications Reference Guide before taking an OTC medication.

The episode opens with a discussion of the NTSB’s recent safety recommendation involving Learjet landing-gear inspections, then pivots to a more personal revelation. While preparing a previous show, Max reviewed several fatal accident reports and realized that three of them, selected at random, shared a common factor: medication use. A fourth involved an untreated medical condition. That chance discovery became the foundation for this episode.

The first accident involves N510KC, a Piper Malibu converted to turbine power that crashed shortly after takeoff in Nebraska. Toxicology revealed Ambien (Zolpidem), a powerful sleep aid. The pilot—experienced and well-trained—appeared to rotate normally before the airplane rolled left and hit trees. Rob recalls his own experience with Ambien and how it caused amnesia: “My wife said I was talking and walking before bed, and I had no memory of it.” The NTSB concluded that impairment and overloading likely caused the loss of control.

The next accident centers on N915DV, a Cessna Turbo 206 that struck mountainous terrain in Utah. The pilot had taken cetirizine (Zyrtec), an antihistamine many pilots assume is “safe.” Yet studies show that even mild sedation can impair cognitive performance—especially at altitude. The U.S. Navy found that cetirizine increased errors during flight-simulation tests at 10,000 and 15,000 feet. Zyrtec appears on the FAA’s “no-go” list, and pilots must typically wait up to five days after the last dose before flying.

In another case, N880A, a Cessna 414 stalled after takeoff when the elevator trim was left in a full-nose-up position. The pilot had taken sertraline (Zoloft), an antidepressant that requires special FAA issuance and strict medical monitoring. He hadn’t reported it on his medical. Investigators also found other red flags: diabetes, unresolved maintenance issues, and a non-functioning tachometer. Rob calls leaving the engines running while stepping out of the aircraft “reckless,” and Max explains how unreported antidepressant use can disqualify a pilot without proper documentation.

The final crash involved N4184G, a Nanchang CJ-6A performing a flyover in Colorado. The pilot abruptly pulled into a vertical maneuver, stalled, and spun in. Post-accident analysis revealed uncontrolled diabetes with blood-sugar readings over eight times normal levels. He had previously disclosed diabetes on his FAA medical but failed to list it later—suggesting denial or complacency. Fatigue or blurred vision may have contributed to his erratic control inputs.

Across these four crashes, one lesson stands out: pilots often underestimate how medications affect cognition and coordination. Even “safe” drugs can delay reactions, dull alertness, and create false confidence. Worse, some—like Ambien—suppress the very self-awareness needed to recognize impairment. Max and Rob stress that pilots aren’t receiving enough education about FAA medication restrictions; most training programs and BFRs never address them.

They also highlight the human factor behind the data. “If you cheat,” Max warns, “the only person you’re cheating is yourself—and your family will pay the price.” Rob adds that instructors should explain not just which drugs are disqualifying, but why they impair performance.

The takeaway: check every medication—prescription or over-the-counter—before you fly. Search the FAA’s AME Guide or AOPA’s medication database, and observe all required waiting periods. Pilots pride themselves on discipline and preparation; medication awareness deserves the same rigor.

This powerful episode of NTSB News Talk turns four tragic crashes into lifesaving lessons for anyone who flies—or teaches others to fly.