Medication for Flight Anxiety

We are often asked to prescribe benzodiazepines for fear of flying, the most common request is for a medication called Diazepam. 

There are several good reasons why prescribing benzodiazepines for these purposes are not deemed safe and is no longer recommended. We at GPS, have taken the decision to put our patients’ safety first and will no longer issue prescriptions for these reasons: 

• Benzodiazepines such as Diazepam and other sedative drugs are no longer recommended for treatment of phobias because other treatments are safer and more effective. 
• Benzodiazepines are sedating, which means they can slow reaction times. If there is an emergency during a flight, it may affect your ability to concentrate, follow instructions and react to the situation. This could have serious safety consequences for yourself and others on the flight. 
• The sedative effects of these drugs can affect breathing and cause low oxygen levels, which could be life-threatening, especially with the lower circulating oxygen levels on an aeroplane, in people with breathing problems or when combined with alcohol. 
• Sedative drugs do not induce natural sleep. This means you won’t move around as much as during natural sleep, and this can increase the risk of developing a blood clot (DVT). Blood clots are dangerous and can be fatal. This risk is greater if the flight is longer than four hours. 
• Whilst most people find medicines such as diazepam sedating, a small number of people become agitated, aggressive or confused. These medicines can also cause disinhibition and lead to abnormal behaviours. This could impact your safety as well as that of other passengers. 
• According to the British National Formulary, diazepam is not recommended in treating phobic states. It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.”  They are only licensed short term for a crisis in generalised anxiety so prescribing outside of this increases personal risk to the prescriber. 
• NICE guidelines suggest that these medications are only advised for short-term use for a crisis in generalised anxiety disorder, in which case a person is not fit to fly. Fear of flying in isolation is not a generalised anxiety disorder. 

For the reasons outlined above, there will be no exceptions to this policy. Patient UK has links to access Cognitive Behavioural Therapy which is more effective, especially when combined with education. There is also guidance from airlines on the management of flight related anxiety. 

How to manage a fear of flying and flying anxiety (patient.info)

This policy applies to requests for medication prior to a procedure. If the request has been made by a secondary care provider, please get in touch with them to discuss further. If the procedure or scan has been requested by a clinician at GPS, you may request to discuss this with them, in which case please get in touch for an appointment.