Whilst traveling abroad is an exciting experience, we regret to inform our patients that we can no longer prescribe benzodiazepines (such as diazepam) for fear of flying.

There are several reasons for this- based on the latest guidelines on prescribing these medications, increasing concerns have been raised about their side effects and risks, with potential legal implications of prescribing these medications for fear of flying both for the prescriber and the patient. Some examples include the following: 

  1. Benzodiazepines are sedative drugs which means they can make you feel drowsy and more relaxed. If there was an emergency during a flight this could affect your ability to follow instructions, or your reaction time could be impaired. This could potentially risk the safety of yourself and other passengers on the flight.  
  1. Although benzodiazepines can make you fall asleep, when you sleep it is an unnatural non-REM sleep. Your movements therefore are reduced which increases your risk of developing a blood clot (deep vein thrombosis). These blood clots can potentially be fatal. The risk is increased further if your flight is longer than 4 hours. 
  1. Benzodiazepines can adversely affect your memory, co-ordination and concentration. They are also addictive if used longer term, with withdrawal leading to fits, hallucinations, agitation and confusion. 
  1. Whilst most people find benzodiazepines sedating, a small number will suffer the opposite effects such as 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 as well as that of other passengers and could also get you into trouble with the law. Benzodiazepine use with alcohol consumption further increases these risks.  
  1. According to national prescribing guidelines doctors follow, benzodiazepines should not be used to treat phobias, such as fear of flying. 
  1. Medical evidence has shown that the use of benzodiazepines stops the normal adjustment response that would gradually lessen anxiety over time and therefore may increase anxiety reactions in the long term. 
  1. In the UK benzodiazepines are Class C controlled drugs. Every country has their own regulations regarding the prescribing and possession of these medications. In some countries they are banned. Diazepam has a long half-life. This means it stays in your system for a significant time, and you may fail random drug testing if you are subjected to this on entering another country. 

We understand that having a fear of flying can cause significant distress. We recommend that you address this through trying a Fear of Flying course which is run by several airlines, some of these are listed below. These are far more effective than taking diazepam and have none of the associated side effects and risks described above of taking diazepam. 

https://www.flyingwithconfidence.com 

https://www.fearlessflyer.easyjet.com  

https://flywith.virginatlantic.com/gb/en/wellbeing-and-health/flying-without-fear.html  

References 

https://bnf.nice.org.uk/treatment-summaries/hypnotics-and-anxiolytics/ 

https://www.nice.org.uk/guidance/cg113  

Acute and delayed effects of Alprazolam on flight phobias during exposure. Behav Res Ther. 1997 Sep; 35 (9): 831-41 

Online link to above article: https://www.sciencedirect.com/science/article/pii/S0005796797000338?ref=pdf_download&fr=RR-2&rr=92768b0a5d90b3c3  

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