Advice on Diazepam and Flight Anxiety
After careful consideration and review of our benzodiazepine prescribing practices and following NHS recommendation, we have decided to no longer prescribe sedatives, including diazepam, for the purpose of managing fear of flying.
Many patients come to us requesting diazepam to help them sleep or manage anxiety during flights. However, we have outlined the key reasons why we no longer prescribe this medication for flight-related anxiety:
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Safety Risks and Impaired Reaction Times
Diazepam, a Class C/Schedule IV controlled drug in the UK, is a sedative that causes slowed thinking and delayed reaction times. During a flight, this can significantly impair your ability to react quickly in an emergency, potentially putting your life, or the lives of others on board, at risk. In the event of an emergency requiring evacuation or urgent action, diazepam-induced incapacitation could compromise your ability to respond effectively.
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Increased Risk of Blood Clots
While diazepam can induce sleep, it causes an unnatural, non-REM sleep, which results in reduced movement. This lack of movement increases the risk of developing blood clots, such as Deep Vein Thrombosis (DVT), which can be life-threatening if they travel to the lungs (pulmonary embolism). The risk of DVT is higher on flights lasting more than four hours.
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Paradoxical Reactions
Though most people find diazepam sedating, a small percentage experience paradoxical effects such as agitation, aggression, or disinhibition. This can lead to behaviour that is out of character and could compromise your safety, as well as that of fellow passengers.
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Interaction with Alcohol
Combining diazepam with alcohol can exacerbate the sedative effects, further increasing the risks mentioned above, such as impaired reaction times and increased agitation.
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Clinical Guidelines
According to the British National Formulary (BNF), diazepam is contraindicated for treating phobias and is not recommended for managing mild, short-term anxiety. The National Institute for Health and Care Excellence (NICE) guidelines also suggest that medications like benzodiazepines should not be used to treat mild or self-limiting anxiety conditions. Prescribing diazepam against these guidelines would place your doctor at significant legal risk.
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Long-Term Effects
Diazepam can stay in your system for a long period. If your job requires random drug testing, you could test positive for benzodiazepines after taking this medication. Additionally, prolonged use of benzodiazepines has been linked to an increased risk of dementia.
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Legal and Insurance Risks
In some countries, diazepam and similar medications are illegal or restricted. Carrying them could lead to legal trouble. It is also important to inform your travel insurance provider about any medications you are taking, as failing to disclose this information could invalidate your policy.
Given these concerns, we have decided to discontinue prescribing diazepam for flight anxiety. Instead, we recommend addressing your fear of flying through specialized courses designed by the aviation industry. These courses are proven to be effective and are widely accessible:
Additional Information
Flight anxiety is not considered part of General Medical Services under the GP contract, and as such, we are not obliged to prescribe medication for this condition. Patients who still wish to take benzodiazepines for this purpose may consult with a private GP or travel clinic for further advice.