Flight anxiety
Increasing concerns have arisen regarding prescribing benzodiazepines including Diazepam (also known as ‘Valium’). As safety issues have become better understood, it is clear that diazepam has a number of unwanted side effects and risks. This includes short term memory impairment, co-ordination issues and reduced concentration and reaction times. They also have significant risks of addiction. Unfortunately, benzodiazepine use increased over the past couple of decades and it was historically prescribed for fear of flying.
Diazepam is now a Class C/Schedule IV controlled drug in the UK. You can read more about this on the gov.uk website on controlled drugs:
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 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 4 hours.
3) Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical agitation and increased 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.
4) According to the prescribing guidelines doctors follow (BNF) Benzodiazepines are contraindicated (not allowed) in treating 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 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. 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:
https://patient.info/news-and-features/how-to-manage-flight-anxiety
https://www.flyingwithoutfear.com/
https://www.fearlessflyer.easyjet.com/
https://www.britishairways.com/content/information/travel-assistance/flying-with-confidence
https://flywith.virginatlantic.com/gb/en/wellbeing-and-health/flying-without-fear.html
Dental
Some patients request medication prior to dental visits to help with feelings of anxiety. These are usually sedative medications such as Diazepam. GPs have no dental training, so we have limited knowledge of what is entailed in dental procedures. It is therefore not possible for us to determine which medications are safe to use, so we are unable to prescribe.
Dentists have this specialist knowledge and are able to prescribe medications listed in the Dental Formulary. We therefore recommend that you speak to your dentist if you have any concerns about upcoming visits or procedures and they will be able to advise and/or prescribe where appropriate on a case by case basis.
MRI scans
GPs will not issue prescriptions for sedating medications (such as diazepam) prior to MRI scans. There are many resources online that can help prepare patients on what to expect during a scan including step by step explanations and videos of MRIs being performed. In more severe cases, the NHS website suggests that mild sedatives are an option for people with severe MRI anxiety. However, guidance from The Royal College of Radiologists states that a ‘trained and credentialed team should administer sedation and analgesia’, that ‘patients requiring sedation should undergo pre-procedure assessment and have a sedation plan’ and that ‘sedated patients should be appropriately monitored’. This means that GPs are not in a position to prescribe these medications for MRI scans. If you think you need sedation for an MRI scan, this needs to be discussed with the radiology team.