Flight Anxiety Prescribing Policy

Following a review of our prescribing practices, we have decided that we will no longer issue prescriptions for benzodiazepines or other sedative medications, including diazepam, for individuals who experience anxiety related to flying. This approach is now common across many GP practices.

Patients occasionally request diazepam to reduce anxiety before air travel or to help them sleep during a flight. While benzodiazepines were widely adopted after their introduction in the 1960s, experience and research over subsequent decades have highlighted a number of significant concerns associated with their use.

Potential short-term effects include impaired memory, reduced alertness, poor coordination, diminished concentration, and slower response times. Longer-term use can result in dependence, and withdrawal may lead to serious symptoms such as confusion, agitation, hallucinations, and seizures. Evidence also suggests possible long-term effects on cognitive function and balance. In addition, benzodiazepines are frequently misused and are recognised as drugs with abuse potential.

As a result, prescribing restrictions have become increasingly stringent internationally since the late twentieth century, particularly within the UK.

In the United Kingdom, diazepam is classified as a controlled drug under Class C and Schedule IV legislation.

The reasons our practice does not prescribe diazepam for fear of flying or routine medical procedures are outlined below.

Why We Do Not Prescribe Diazepam for Flying Anxiety

Reduced Ability to Respond in Emergencies

Benzodiazepines can impair judgement, slow thinking, and delay reaction times. In the unlikely event of an in-flight emergency, these effects could limit a passenger’s ability to respond appropriately, potentially affecting their own safety and that of others.

Higher Risk of Deep Vein Thrombosis (DVT)

Although diazepam may promote sleep during a flight, the sleep induced is not the same as natural restorative sleep. Reduced movement for prolonged periods can increase the likelihood of developing blood clots, particularly on flights lasting more than four hours. In some cases, these clots can have serious or life-threatening consequences.

Unexpected Adverse Reactions

A small proportion of people experience paradoxical effects from diazepam, meaning that instead of becoming calmer, they may become restless, agitated, aggressive, or behave impulsively. Such reactions can create safety concerns and may have legal implications.

Interaction with Alcohol

The sedative effects of alcohol and benzodiazepines can reinforce one another, increasing the risk of impaired judgement, excessive sedation, and other adverse outcomes.

National Prescribing Guidance

The British National Formulary (BNF) advises against the use of diazepam for phobic disorders and does not support its use for mild, short-lived anxiety. Prescribing outside these recommendations may place clinicians at medico-legal risk.

NICE Recommendations

Guidance from the National Institute for Health and Care Excellence (NICE) does not recommend medication for mild, self-limiting anxiety disorders. Furthermore, benzodiazepines, sedating antihistamines, and antipsychotic medicines are generally not advised for the treatment of anxiety-related conditions in these circumstances.

Travel and Legal Considerations

Some countries have strict regulations regarding benzodiazepines, and carrying these medicines across borders may be prohibited. Travellers could have medication confiscated or face legal difficulties depending on local laws.

Employment-Related Drug Testing

Diazepam can remain detectable in the body for an extended period. Individuals working in occupations that require workplace drug screening should be aware that taking diazepam could result in a positive test.

Possible Association with Dementia

Research has identified a potential link between long-term benzodiazepine use and an increased risk of dementia, although the relationship remains an area of ongoing study.

Alternative Sources of Support

In light of the concerns outlined above, our practice will not prescribe diazepam for fear of flying. Instead, we encourage patients to consider evidence-based alternatives such as NHS Talking Therapies, hypnotherapy, or specialist aviation anxiety programmes.

NHS Talking Therapies
https://notts-talk.co.uk/getting-support/

EasyJet Fearless Flyer
https://fearlessflyer.easyjet.com
Telephone: 0203 813 1644

British Airways Flying with Confidence
https://flyingwithconfidence.com
Telephone: 01252 793250

Important Information

Fear of flying is not included within the services covered by the NHS General Medical Services (GMS) contract. Consequently, GP practices are not required to prescribe medication for this condition.