Prescription drugs

Anticoagulants (Blood thinning drugs)

These are used for a variety of conditions including:

• After a cardiac stent or heart valve replacement
• Following a stroke or mini-stroke
• Atrial Fibrillation or Flutter (irregular heart rhythm)
• Deep Vein Thrombosis (DVT) or Pulmonary Embolus (PE)

The reason that you are taking an anticoagulant must be considered as well as the effects of the medication itself. Anti-coagulants are not all the same and each group of drugs is slightly different in the way they work.

As you can imagine the main risk associated with anticoagulants is that it makes bleeding worse and take longer to stop. Whilst diving this could occur via physical trauma, barotrauma (pressure injury) or Decompression Illness (DCI) and result in a more severe injury.

If your underlying medical condition does not prevent you from diving then you can dive on anticoagulants but your dive doctor will restrict your diving. Normally these restrictions are:

• Maximum depth 20m
• No stop diving (using tables rather than computers)

If you want to go diving on these medications you need to discuss your medical condition and the medication with a doctor specialising in diving medicine. Please arrange a telephone consultation with one of our diving doctors.

Anti-malarial tablets

We usually suggest divers take Malarone. You will have to check that this works in the area you are planning to travel to.

We also recommend starting Malarone 1 week (rather than 2 days) before your trip to ensure you do not suffer any side effects from the medication. Doxycycline would be an alternative providing it gives you adequate protection in the area you are travelling to but you must be careful to avoid sun exposure.

Larium is the anti-malarial to avoid whilst diving.

You cannot get these drugs over the counter, so see your GP or go to a travel clinic to ensure you are fully vaccinated, up to date with your immunisations and that the medication will cover you in your area of travel. We also advise buying your medications from a known reliable source such as a UK based pharmacy since the medications will be of a known, quality and standard.

Anti-depressants

Divers who are taking antidepressants must satisfy certain criteria.

• Patients should only dive on the newer antidepressants. The older tricyclic antidepressants such as amitriptyline can reduce seizure threshold, cause dysrhythmias and are sedative. Modern antidepressants such as the SSRIs including sertraline and citalopram have a low seizure rate and are also less sedating.
• They should only be on one psychotropic medication.
• Patients should be stable on the medications for at least three months before diving.
• Following cessation of the antidepressant the patient should be stable in mood for at least 3 months prior to diving.
• Often the dive doctor will ask for further information from the GP to ensure that compliance with medications is good and that the patient is stable and back to normal activities of daily life.
• An initial depth restriction of 20m is usually advised to ensure there are no interactions with the medication and pressure. No decompression limits are also advised to permit direct return to the surface if necessary. If all goes well this could be increased to 30 metres.