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:
-
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.
-
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.
-
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.
-
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.
-
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.
-
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.
-
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.
Sedation for MRI Scans and Other Hospital Investigations
After careful consideration, Emsworth Medical Practice has decided that we will no longer prescribe diazepam or other sedatives for MRI scans or other hospital investigations. This decision has been made to ensure safe and consistent care for all our patients.
If you think you may need sedation for a hospital test or scan, please speak directly with the hospital team who are arranging your procedure. They are best placed to assess your needs and provide any necessary medication.
Why this change has been made:
-
Safety and effectiveness: Low doses of sedatives (such as 2mg diazepam) often do not provide effective sedation, and in some people can cause unexpected side effects.
-
Timing issues: If your procedure is delayed, a sedative taken before leaving home may no longer work as intended.
-
Hospital expertise: Sedation should only be given by trained hospital staff who can monitor you safely.
-
Prescribing responsibility: Hospital doctors have the same prescribing rights as GPs and can issue any necessary medication through the hospital pharmacy.
The Royal College of Radiologists recommends that sedation for imaging should only be given under the supervision of experienced staff with proper monitoring in place.
“Sedation techniques, together with good analgesia and sympathetic, supportive patient management can improve the patients’ experience by minimising the negative effects of the intervention and optimising patient outcome.
Safe and effective analgesia and sedation should be delivered by an appropriately trained and credentialed team with good access to anaesthetics, pre-procedure assessment, sedation plan and checklist, with appropriate monitoring and availability of resuscitation equipment and reversal agents”.
You can read their guidance here: Safe Sedation Practice for Imaging (RCR) (EXTERNAL PDF LINK)
If you feel you may need sedation for your scan or investigation, please discuss this with your hospital consultant or radiologist, not your GP.