Following review of the available guidance, the practice has taken the decision to stop prescribing benzodiazepine medications e.g. diazepam/lorazepam for fear of flying. This policy also covers requests for dental/hospital procedures or scans.
The reasons are for this as follows:
- Diazepam is a sedative, which means it makes you sleepy and more relaxed. 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 safety 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. This can cause you to be at increased risk of developing a blood clot (DVT) in the leg or even the lung. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than four hours.
- Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical agitation and in 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 as well as that of other passengers and could also get you into trouble with the law.
- 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 is the case, you should be getting proper care and support for your mental health and not going on a flight.
- Diazepam and similar drugs are illegal in a number of countries. They may be confiscated or you may find yourself in trouble with the law.
- 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.
- The sedating effects have the possibility of causing some respiratory depression, resulting in a drop in your oxygen level. Normal oxygen levels for a healthy person at 8000ft are around 90%, so with the 2 effects added together, this may become life threatening.
- NICE guidelines suggest that medication should not be used for mild & self limiting mental health disorders; 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, i.e. acute anxiety emergencies & if this is the case, they would not be fit to fly anyway (potential risk to being able to allow completion of the flight without diversion) & fear of flying in isolation is not generalised anxiety disorder.
We appreciate that fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines. We have listed a number of these below.
Easy Jet
- fearlessflyer.easyjet.com
- Tel—0203 8131644
British Airways
- flyingwithconfidence.com/venues/manchester
- Tel—01252 793250
Virgin
- https://flywith.virginatlantic.com/gb/en/wellbeing-and-health/flying-without-fear.html
- Tel—01423 714900/1252250
With regards dental/hospital procedures or hospital scans, as per GMC guidance the responsibility for prescribing lies with the clinician arranging the scan/procedure. Please contact the requesting doctor/dentist to prescribe the benzodiazepine if they feel this is appropriate.