May 2003

By Selene Yeager

Drugs Covered in This Article

||| |---|---| | Albuterol Alprazolam Amlodipine Besylate Atenolol Atorvastatin Celecoxib Furosemide Hydrocodone Levothyroxine | Loratadine Meclizine Hydrochloride Micronase Omeprazole Premarin or Ortho-Cyclen Sertraline Sildenafil Citrate Zithromycin |
Most of us wouldn't dream of waking up, smearing some jam on a bagel and firing up a joint before heading out for an 8 a.m. dive. Yet thousands of us pop perfectly legal prescription pills that may cause the same drowsiness and disorientation under water as smoking a J.

In a survey of 700 experienced scuba divers ages 31 to 50 from the U.S. and Australia, researchers found that, though experts recommend avoiding certain drugs prior to diving, divers reported taking a wide variety of pills, some within two hours of a dive. "One quarter of the divers took medication daily," says clinical pharmacist, scuba enthusiast and study author Dr. Simone Taylor. The most commonly taken meds were heart disease (10 percent) and blood pressure pills (9 percent). But there also were a significant number of people taking asthma medication as well as drugs for epilepsy and diabetes, says Taylor.

"The rate of medication use isn't surprising, considering how many people develop diseases that require medical intervention during their diving careers," says emergency medicine researcher and diver Dr. David Taylor. In a different study of 346 divers, he and his coworkers found that 13 percent of the divers required regular medication. More than 10 percent had a history of asthma, and the same number reported having heart disease or high blood pressure. What's more, 47 percent of them were overweight and 11 percent smoked cigarettes, setting them up for future health problems that could require medication.

"Not only are some of these conditions not safe to dive with, but neither are some of the medications that treat them," says Simone Taylor. "Many medications have side effects that can put a scuba diver at risk. Plus the body processes medications differently in the high-pressure underwater environment. The way some drugs are metabolized could hinder a person's diving fitness or judgment," she says.

Based on Simone Taylor's research, here's the lowdown on the most commonly prescribed medications, plus special meds divers regularly take. (Remember: Any drug can cause side effects. Always consult your doctor if you're on a new medication and planning to dive.)

HYDROCODONE

Brand names: Anexsia, Co-Gesic, Hydrocet, Lorcet, Lortab, Oncet, Panacet, Vicodin and Zydone.

Taken for: Major league pain.

Potential dive dangers: Pain-killing narcotics such as these routinely make you drowsy, dizzy and just plain dopey.

Recommended precautions: If you have so much pain that you need a narcotic, you shouldn't be diving. For minor aches and pains, stick to over-the-counter pain relievers like Tylenol, Motrin and Advil (not prescription varieties of these drugs, which contain codeine or other narcotics). Also be aware that pain reliever/narcotic combinations are sold over-the-counter in other countries, so read the labels carefully.

ATORVASTATIN

Brand names: Lipitor.

Taken for: Lowering cholesterol.

Potential dive dangers: Cholesterol drugs have few side effects, but any heart disease related to your cholesterol problem could pose a safety risk.

Recommended precautions: Side effects generally occur within the first few weeks of taking a medication. Be sure you are tolerating the drug well before diving.

PREMARIN OR ORTHO-CYCLEN

Taken for: Premarin is a hormone replacement therapy drug used to treat symptoms of menopause. Ortho-Cyclen is one of many brands of "the Pill" or oral contraceptives.

Potential dive dangers: Any medication containing estrogen can increase the risk of blood clots in the legs, particularly during long periods of sitting, so there's more risk in the long plane flight to the dive destination than the dive itself.

Recommended precautions: "About a quarter of the women in our survey were on the Pill," says Simone Taylor. "For normal, healthy women, taking hormones should not be a concern." On long flights, get up periodically to move your legs.

ATENOLOL

Brand names: Tenormin. Part of a large family of drugs known as beta blockers.

Taken for: Controlling high blood pressure and angina (chest pain).

Potential dive dangers: Both the condition and the drug may cause trouble for divers. Heart disease is a known risk for scuba diving. "Beta blockers slow your heart rate and reduce your exercise tolerance, which could hinder your ability to carry equipment and swim to the boat while weighted down," she says. "The hyperbaric environment might exacerbate these effects."

Recommended precautions: Consult with your doctor before diving.

LEVOTHYROXINE

Brand names: Synthroid, Levoid, Levothroid, Levoxine and Levoxyl.

Taken for: Treating hypothyroidism (a condition in which the body does not produce enough thyroid hormone).

Potential dive dangers: Synthroid usually produces few side effects, but the drug has profound effects on the body, and should be administered in small doses and closely monitored. "I was really surprised that so many U.S. divers were using this drug," says Simone Taylor. "It can cause increased heart rate, abnormal heart rhythms, tremor and excitability. It may also increase the risk of hyperbaric oxygen toxicity. These concerns would mainly be in those people whose dose was too high. If a diver was taking it for hypothyroidism and their disease was well-controlled as verified by thyroid function tests, recreational diving would probably be safe."

Recommended precautions: Consult with your doctor before diving.

ZITHROMYCIN

Brand names: Zithromax; related to erythromycin and Amoxicillin, Trimox, Amoxil and Wymox.

Taken for: Treating a wide variety of bacterial infections, including skin infections, ear infections, genital and urinary tract infections and respiratory infections.

Potential dive dangers: Few, though the conditions for which you're taking these drugs may cause trouble. Respiratory infections can interfere with breathing. These drugs may also cause nausea or diarrhea, which can lead to dehydration, increasing your risk of getting bent. Some antibiotics also can make you sensitive to the sun.

Recommended precautions: Ask your doctor to prescribe an antibiotic with the most manageable side effects. Use a strong sunblock that contains titanium dioxide or zinc oxide.

FUROSEMIDE

Brand names: Lasix. One of a large family of diuretic drugs including HydroDIURIL, Esidrix, Dyazide and Maxide.

Taken for: Treating high blood pressure and other conditions that require the elimination of excess water from the body.

Potential dive dangers: These drugs can cause symptoms like dehydration, dry mouth and irregular heartbeat that don't mix well with scuba diving. What's more, having high blood pressure or other heart conditions can put divers at high risk as well.

Recommended precautions: You may be able to dive safely on diuretics provided you can stay properly hydrated. But you should consult your physician to be safe.

AMLODIPINE BESYLATE

Brand names: Norvasc. One of a family of drugs known as calcium channel blockers.

Taken for: Used to control angina (chest pain) and high blood pressure.

Potential dive dangers: Like most high blood pressure medications, calcium channel blockers slow heart rate and may affect exercising heart rate. And, of course, if you have angina, that means you have heart disease, which by itself puts your diving safety in question.

Recommended precautions: How these meds affect your scuba performance depends upon the dose and how your body reacts to them. Consult your doctor before diving.

ALPRAZOLAM

Brand names: Xanax.

Taken for: Calming anxiety or panic attacks.

Potential dive dangers: Both the anxiety condition and the tranquilizing drugs can pose serious danger to divers. A panic attack under water can be life-threatening, yet in a national survey, more than half of scuba divers, including seasoned vets, reported experiencing panic or near panic behavior on at least one occasion. "If you have anxiety problems serious enough to require medication, diving is unwise," says Simone Taylor. "Likewise, if you're taking a drug to sedate you, it's best to stay on dry land."

Recommended precautions: Xanax is sometimes used to treat a temporary problem, like severe emotional upset following a tragedy. Avoid diving until you are free and clear of your panic and the medication.

ALBUTEROL

Brand names: AccuNeb, Proventil HFA, Ventolin HFA and Volmax Extended Release Tablets.

Taken for: Controlling asthma and bronchial spasms during exercise.

Potential dive dangers: Though some asthma medications can cause racing heartbeat, the real risk is the condition. People with asthma tend to get air trapped in their lungs, which predisposes them to arterial gas embolism (AGE) when they ascend. "Even swimming to the boat is risky. Most asthma-related accidents happen on the surface because aerosols of salt water can provoke hyperactive airways."

Recommended precautions: The medications themselves are generally safe. But asthma triggered by cold or exercise is prohibitive for diving. People with most other types of asthma should consult their doctors, but can dive as long as their condition is well-controlled.

LORATADINE

Brand names: Claritin.

Taken for: Used as an antihistamine to relieve symptoms of allergies such as sneezing, runny nose, stuffiness, and itchy, teary eyes.

Potential dive dangers: Drowsiness. You might not be quite as alert or coordinated as you should be for a challenging dive.

Recommended precautions: Read the labels on prescription or over-the-counter antihistamines (like Benadryl), and avoid types that make you drowsy on days you'll be diving. The same goes for decongestants such as Sudafed, which many divers take to shrink inflamed sinus passages. "These drugs make some people agitated, so be sure you've tried and tolerated whatever drug you take before diving with it," says Simone Taylor.

OMEPRAZOLE

Brand names: Prilosec; related drugs include Prevacid (lansoprazole) and over-the-counter meds like Zantac, Tagamet and Pepcid.

Taken for: Decreasing stomach acid for the treatment of heartburn (gastroesophageal reflux) and stomach ulcers.

Potential dive dangers: Some of these drugs can cause diarrhea, which can contribute to dehydration. And a few, such as Zantac, may cause drowsiness.

Recommended precautions: Stay well-hydrated if diarrhea is a problem. Avoid brands that make you sleepy. Otherwise, these drugs are perfectly safe for scuba.

SERTRALINE

Brand names: Zoloft; related drugs include Paxil (paroxetine hydrochloride) and Prozac (fluoxetine).

Taken for: Relieving depression.

Potential dive dangers: Antidepressants act on your central nervous system, which could predispose you to nitrogen narcosis, says Simone Taylor. These drugs also can make you sleepy or agitated, which can affect your ability to dive safely. Some conditions, like panic disorder, obsessive compulsive disorder and severe mood disorders may pose too high a risk to dive safely.

Recommended precautions: Consult your doctor first. Even if you're considered safe for scuba, avoid diving the first few weeks on an antidepressant, when effects on mental alertness are strongest.

CELECOXIB

Brand names: Celebrex; related drugs include Vioxx (rofecoxib).

Taken for: An anti-inflammatory drug used for relieving arthritis and menstrual pain.

Potential dive dangers: Like any drug, these medications can have side effects like abdominal distress that would make it difficult to dive, but otherwise the meds themselves should be safe for scuba.

Recommended precautions: "When you start these drugs, they can leave you feeling a little fuzzy-headed. Take them for a few weeks and be sure you're tolerating them before you dive," suggests Simone Taylor.

SILDENAFIL CITRATE

Brand names: Viagra.

Taken for: Treating erectile dysfunction.

Potential dive dangers: The little blue pill can cause headaches and sensitivity to light. But the effects are very short-lived.

Recommended precautions: "I wouldn't take Viagra right before a dive. But I can't imagine why anyone would," she says.

MECLIZINE HYDROCHLORIDE

Brand names: Antivert, Bonine; related drugs include Dramamine (dimenhydrinate).

Taken for: Preventing seasickness.

Potential dive dangers: "They're related to antihistamines, so they also can make you drowsy or cloud your thinking," says Simone Taylor. They also cause dry mouth, which can make breathing through a regulator difficult.

Recommended precautions: Most divers can take seasickness meds safely. Experiment to identify which formulation has the least impact on your mental clarity. Be extra careful to stay well-hydrated, and try hard candy to relieve dry mouth.

MICRONASE

Brand names: DiaBeta and Glynase. One of a large family of drugs used to regulate blood sugar.

Taken for: Treating Type II diabetes.

Potential dive dangers: All diabetes medications, including insulin, can cause hypoglycemia, or low blood sugar. "If you have a hypoglycemic episode under water and pass out, that is really dangerous for you and the entire dive crew," says Simone Taylor. "Diving with diabetes itself is very controversial."

Recommended precautions: If your diabetes is not well-regulated, you should probably not be diving. Otherwise, consult with your doctor. If you get a thumb's up, check your blood sugar right before you dive to be sure it's a little on the high side, so you don't have an episode under water.