Prescribing Policy - Sedatives for fear of flying

Policy for Prescribing Sedatives for "Fear of Flying"

Trinity Court and Claverdon Surgery does not prescribe sedatives for fear of flying. This policy has been made by the GP Partners and is adhered to by all the prescribing doctors working at the practice.

Our concerns around using diazepam (or other Benzodiazepines) in patients who are nervous about flying are as follows:

Diazepam is a sedative, which means it makes you sleepy, more relaxed and can significantly delay your reaction times. If there is an emergency during the flight, it may impair your ability to concentrate, follow instructions and react to the situation. This could have serious consequences for you and those around you.

Sedative drugs can make you fall asleep, however when you do sleep it is an unnatural (non-REM) sleep. This means you won’t move around as much as during natural sleep. There is concern this can cause you to be at increased risk of developing a blood clot (DVT) in the leg or even the lung, which can be dangerous and even fatal. This risk is even greater if your flight is more than four hours.

Whilst most people find sedative medications like diazepam have a relaxing effect, a small number of people can feel more agitated or even aggressive after taking it. Diazepam can also cause disinhibition and lead you to behave in a way that you would not normally. This can impact on your safety, the safety of those around you or even get you in trouble with the law.

According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) in treating phobic states. [i] It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.” [ii]

Your doctor would be taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health.

NICE guidelines suggest that medication should not be used for mild and self-limiting mental health disorders [iii]. In more significant anxiety related states, benzodiazepines, sedating antihistamines, or antipsychotics should not be prescribed. Benzodiazepines are only advised for the short-term use for a crisis in generalised anxiety disorder in which case they are not fit to fly. Fear of flying in isolation is not a generalised anxiety disorder.

A study published in 1997 from the Stanford University School of Medicine [iv] showed that there is evidence use of Benzodiazepines stops the normal adjustment response that would gradually lessen anxiety over time and therefore perpetuates and may increase anxiety in the long term, especially if used repeatedly.

Diazepam and similar controlled drugs are illegal in some countries [v]. They may be confiscated, or you may find yourself in trouble with the police. The passenger may also need to use a different strategy for the homeward bound journey and/or other legs of the journey.

Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testing you may fail this having taken diazepam.

It is important to declare all medical conditions and medications you take to your travel insurer. If not, there is a risk of nullifying any insurance policy you may have.

Given the above we will no longer be providing Diazepam or similar drugs for flight anxiety. 

We appreciate that fear of flying is very real and very frightening. A lower risk approach is to tackle this properly and hopefully permanently, with a Fear of Flying course run by the airlines and we have listed a number of these below or there are also some free online courses:

Easy Jet www.fearlessflyer.easyjet.com Tel: 0203 8131644
British Airways www.flyingwithconfidence.com Tel: 01252 793250
Virgin  www.flyingwithoutfear.co.uk Tel: 01423 714900
thefearofflying.com/programs/fly-and-be-calm

[i] British National Formulary; Diazepam – bnf.nice.org.uk/drug/diazepam.html

[ii] British National Formulary; Hypnotics and anxiolytics – bnf.nice.org.uk/treatment-summary/hypnotics-and-anxiolytics.html

[iii] Generalised anxiety disorder and panic disorder in adults: management. NICE Clinical guideline [CG113] Published date: January 2011 Last updated: July 2019 www.nice.org.uk/guidance/cg113

[iv] Acute and delayed effects of Alprazolam on flight phobics during exposure. Behav Res Ther. 1997 Sep;35(9):831-41

[v] Travel Health Pro; Medicines and Travel; Carrying medication abroad and advice regarding falsified medication – travelhealthpro.org.uk/factsheet/43/medicines-abroad