Fear of Flying

In line with current safe prescribing guidance and the vast majority of UK GP Practices, we have made the joint decision to no longer prescribe Diazepam for fear of flying.

We appreciate some patients may have received this in the past, however, we hope after reading the below you understand why we have made this decision, ultimately for the safety of our patients.

1. 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.
2. Sedative drugs can make you fall asleep, however, this sleep is an unnatural non-REM sleep. This means you won’t move around as much as you would had it been a natural sleep. 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 fatal if undetected. This risk is even higher if your flight is greater than 4 hours.
3. A small number of patients, instead of getting a sedating effect, have paradoxical agitation and increased aggression. Diazepam (and other benzodiazepines) 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 would require to be dealt with as a Police matter. We are aware many patients also utilise alcohol along with this medication which increases the risk.
4. According to the prescribing guidelines that doctors follow (British National Formulary) Benzodiazepines are contraindicated (not allowed) in treating the phobia. 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 and not going on a flight.
5. Diazepam and similar drugs are illegal in an increasing number of countries. They may well be confiscated and in some cases can result in arrest.
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.

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 and you will find that all major airlines offer support and guidance for this. Hypnotherapy and counselling are far more effective and safe for the management phobia than taking a controlled drug.

• https://www.fearlessflyer.easyjet.com
• http://www.flyingwithoutfear.com/
• https://flyingwithconfidence.com/
• https://www.britishairways.com/content/information/travel-assistance/flying-with-confidence (01252 793250)
• https://www.anxietyuk.org.uk/anxiety-type/fear-of-flying/

Dr J Simpson, May 2024

Posted: 18 June 2024