Medications for ‘Fear of Flying’
We have recently reviewed the practice’s Benzodiazepine policy and have agreed that we will no longer prescribe Benzodiazepines or sedatives (such as Diazepam or Temazepam) to patients for ‘fear of flying’ (or other phobias such as dental procedures or MRI scans). Many other GP practices have a similar policy.
There are several good reasons for this:
1) Diazepam is a sedative, which means it makes you sleepy and more relaxed, which may impair your ability to concentrate, follow instructions and react in an emergency situation. This could put yourself, other passengers and aircraft staff at serious risk.
2) Sedative drugs can make you fall asleep; however, it is an unnatural non-REM sleep. This means you will not move around as much as during natural sleep. This can cause you to be at increased risk of developing a blood clot in the leg (DVT) or the lung (PE). This can be serious and in some cases be life-threatening/fatal.
3) Whilst most people find Benzodiazepines like Diazepam sedating, a small number of people experience paradoxical agitation and aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety and the safety of other passengers, and could also get you into trouble with law enforcement officers.
4) According to the prescribing guidelines doctors follow (BNF), Benzodiazepines are contraindicated (not allowed) in phobia. Your doctor is taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis in generalised anxiety. If this were the case, you would need proper care and support for your mental health and should not be going on a flight.
5) Diazepam and similar drugs are illegal in a number of countries. They may be confiscated or you may find yourself in trouble with the police.
6) 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. They will also impair your ability to drive or operate heavy machinery.
We appreciate that ‘fear of flying’ can be very frightening. It is recommended to tackle this properly with a ‘Fear of Flying’ course such as those run by the airlines listed below:
Easy Jet
British Airways
Virgin
If you still wish to consider Diazepam for fear of flying, we suggest consulting with a private GP or a private travel clinic, who may be able to help you further - however, this is entirely their discretion and they are likely to adopt a similar view to us.
Regarding prescribing benzodiazepines prior to hospital or dental procedures, please see the reasons outlined below to explain our concerns.
· Small doses of diazepam may be sub-therapeutic for most adults for any effective sedation. Although diazepam makes most people who take it sleepy, in some rare situations it can have the opposite effect and make people aggressive or agitated. This may result in your procedure being delayed.
· A patient may take a sedative an hour before their assumed procedure, to then attend the hospital and find that the procedure has been delayed, therefore the timing of the anxiolytic being sub optimal.
· GP’s are not regularly involved, skilled, or trained to provide the correct level of sedation for a procedure/scan.
· It is the responsibility of the hospital consultants/doctor requesting the imaging to prescribe medication if they deem necessary. They can do this through the hospital pharmacy or organising a prescription themselves.
· Sedated patients should be monitored regularly for any adverse effects of the medication.
· The Royal College of Radiologists’ own guidelines on sedation for imaging makes no mention of GP involvement or provision of low dose anxiolytics and stresses the importance of experienced well-trained staff involved and the monitoring of sedated patients.
We would be grateful if you could discuss this with the relevant specialist who has requested this, and to prescribe as they see fit.