Miscellaneous conditions: assessing fitness to drive
Source: gov.uk (2025-11-07)

Advice for medical professionals to follow when assessing drivers with miscellaneous conditions.

Excessive sleepiness – including obstructive sleep apnoea syndrome

‘Excessive sleepiness’ having, or likely to have, an adverse effect on driving includes:
- obstructive sleep apnoea syndrome of any severity
- any other condition or medication that may cause excessive sleepiness
- see also guidance on primary/central hypersomnias, including narcolepsy (https://www.gov.uk/guidance/neurological-disorders-assessing-fitness-to-drive#primarycentral-hypersomnias--including-narcolepsy-type-1-narcolepsy-with-cataplexy-and-type-2)
Legislation states that objective sleep study measurements for driving assessment purposes should use the apnoea-hypopnoea index (AHI). Recognising that not all sleep services use AHI, DVLA will accept results of equivalent objective tests.

The ‘Tiredness can kill’ leaflet (INF159) (https://www.gov.uk/government/publications/tiredness-can-kill-advice-for-drivers) is for drivers concerned about excessive sleepiness.

Profound deafness

Cancers – not covered in other sections

HIV and Advanced HIV

Living with HIV and receiving treatment

If there has been no development of an illness affecting the brain, vision, or a physical disability which may impair the ability to drive, people with HIV may drive and do not need to inform DVLA of their condition.

People living with HIV with complications such as illness or requiring a hospital admission may be considered to have more advanced HIV.

People with advanced HIV do not need to inform DVLA unless they:
- have been advised by a medical professional that they must inform DVLA about a specific medical condition
- develop any medical condition that may impact their ability to drive (check relevant sections in AFTD guidance)
In these situations, DVLA must be notified.

Age-related fitness to drive

Older age is not necessarily a barrier to driving.
- Functional ability, not chronological age is important in assessments.
- Multiple comorbidity should be recognised as becoming more likely with advancing age and considered when advising older drivers.
- progressive loss of memory, impaired concentration and reaction time, or loss of confidence that may not be possible to regain.
- Physical frailty in itself would not necessarily restrict licensing, but assessment needs careful consideration of any potential impact on road safety.
- Age-related physical and mental changes vary greatly between individuals, though most will eventually affect driving.
- Professional judgement must determine what is acceptable decline and what is irreversible and/or a hazardous deterioration in health that may affect driving. Such decisions may require specialist opinion.
DVLA has doctors ready to provide guidance to healthcare professionals (https://www.gov.uk/guidance/general-information-assessing-fitness-to-drive#obtaining-advice-from-the-dvla-on-fitness-to-drive).

Transplant – not covered in other sections

Device or implants – not covered in other sections

Cognitive decline or impairment after stroke or head injury

There is no single simple marker for the assessment of impaired cognitive function relevant to driving, although the satisfactory ability to manage day-to-day living could provide a yardstick of cognitive competence.

In-car, on-the-road assessments (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-g-mobility-centres-and-driving-assessment-centres) are an invaluable way of ensuring, in valid licence holders, there are no features liable to present a high risk to road safety, including these examples:
- visiospatial deficits, notable distractibility, impaired multi-task performance
The following are also important in showing there is no impairment likely to affect driving:
- adequate performance in reaction times, memory, concentration and confidence
Cognitive disability

Driving after surgery

Evaluating the likely effects of postoperative recovery.

Notwithstanding any restrictions or requirements outlined in other sections of this guidance, drivers do not need to notify DVLA of surgical recovery unless it is likely to affect driving and persist for more than 3 months.

Licence holders wishing to drive after surgery should establish with their own doctors when it would be safe to do so.

Any decision regarding returning to driving must take into account several issues, including:
- recovery from effects of procedure
- anaesthetic recovery from the effects of the procedure
- any distracting effect of pain
- analgesia-related impairments (sedation or cognitive impairment)
- other restrictions caused by the surgery, the underlying condition or any comorbidities
Drivers have the legal responsibility to remain in control of a vehicle at all times.

Drivers must ensure they remain covered by insurance to drive after surgery.

Temporary medical conditions

Drivers generally do not need to notify DVLA of conditions for which clinical advice has indicated less than 3 months of no driving.

If the judgement of the treating clinician is that DVLA needs to be notified, the healthcare professional should advise the patient to contact DVLA.

Such a judgement may be necessary for any of a range of conditions that may temporarily affect driving, including, but not limited to:
- postoperative recovery (see Driving after surgery (https://www.gov.uk/guidance/miscellaneous-conditions-assessing-fitness-to-drive#driving-after-surgery))
- severe migraine
- limb injuries expected to show normal recovery
- pregnancy associated with fainting or light-headedness
- hyperemesis gravidarum
- hypertension of pregnancy
- recovery following Caesarean section
- deep vein thrombosis or pulmonary embolism
Fractures

A driver does not need to notify DVLA of the fact of a fracture, but if recovery post-fracture is prolonged for more than 3 months, the treating clinician should offer advice on a safe time to resume driving.

Medication effects

It is an offence to drive or attempt to drive while unfit because of alcohol and/or drug use – and driving laws do not distinguish between illegal and prescribed drugs.

Drivers taking prescribed drugs subject to the drug-driving legislation will need to be advised to carry confirmation that these were prescribed by a registered medical practitioner.

Some prescription and over-the-counter medicines can affect driving skills through drowsiness, impaired judgement and other effects.

Prescribers and dispensers should consider any risk of medications, single or combined, in terms of driving – and advise patients accordingly.

Without providing an exhaustive list, the following drug groups require consideration:
- benzodiazepines – these may cause sufficient sedation to make driving unsafe
- antidepressants – sedating tricyclics have a greater propensity to impair driving than SSRIs, which are less sedating. Advice for individual driving safety should be considered carefully for all antidepressants
- antipsychotics – many of these drugs will have some degree of sedating side effect via action on central dopaminergic receptors. Older drugs (chlorpromazine, for example) are highly sedating due to effects on cholinergic and histamine receptors. Newer drugs (olanzapine or quetiapine, for example) may also be sedating; others less so (risperidone, ziprasidone or aripiprazole, for example)
- opioids – cognitive performance may be reduced with these, especially at the start of use, but neuro-adaptation is established in most cases. Driving impairment is possible because of the persistent miotic effects of these drugs on vision
Also refer to psychiatric disorders (https://www.gov.uk/guidance/psychiatric-disorders-assessing-fitness-to-drive) and drug or alcohol misuse and dependence (https://www.gov.uk/guidance/drug-or-alcohol-misuse-or-dependence-assessing-fitness-to-drive).

Hepatic encephalopathy
- Specialist report to include both clinician support for return or continued driving and likely risk of future episode of OHE