We are often asked to prescribe sedative drugs, such as diazepam (Valium), for fear of flying. We have recently agreed a practice policy that we will no longer prescribe these drugs for fear of flying. There are a number of good reasons why prescribing of drugs such as diazepam is not safe or recommended:-
- The use of any sort of CNS depressant causes longer reaction times & slowed thinking, which during a flight will put the passenger at significant risk of not being able to act in a manner which could save their life in the event of a safety critical.
- The use of any sort of CNS depressant has potential to increase the risk of DVT - these drugs can induce non-REM sleep which tends to be of a type where the person does not move in their sleep, and therefore increases the possibility of sitting without moving for more than 4 hrs (the amount of time which has been shown to increase the risk of developing DVT whether in an aeroplane or elsewhere).
- The sedating effects have the possibility of causing some respiratory depression, resulting in a drop in 02 sats. Normal sats for a healthy person at 8000ft are around 90%, so with the 2 effects added together, this may become significant.
- A paradoxical increase in aggression may be reported by patients taking benzodiazepines & therefore has potential to put other occupants of the aircraft at risk.
- Reduced inhibitions may put other occupants of the aircraft at risk, or more significant consequences
- Benzo use added to alcohol consumption causes an increase in the risk posed by many of the points above, & many (nervous) flyers will consume alcohol in the terminal before boarding & during their flight, despite any advice that you may give to do otherwise.
- Benzodiazepines are contraindicated in phobic states.
- For some countries it is illegal to import these drugs, eg in the Middle East, and so the passenger will need to use a different strategy for the homeward bound journey and / or any subsequent legs of the journey.
- Standard GP indemnity does not cover you for treatment initiated outside the UK, so you would only be covered for doses to be taken on journeys starting in the UK.
- 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, ie 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.
- Risk of addiction from inappropriate benzo use.
- Possible risk of early dementia in benzo users.
We recognise that fear of flying is real and frightening and we don’t underestimate the impact it can have. We recommend tackling this properly by using self-help resources or considering one of the ‘Fear of Flying’ course run by many airlines. We do not recommend any specific course but you may find the following links useful.
- Easy Jet www.fearlessflyer.easyjet.com Tel 0203 8131644
- British Airways www.flyingwithconfidence.com Tel 01252 793250
- Virgin www.flyingwithoutfear.co.uk Tel 01423 714900
Flight anxiety does not come under the remit of General Medical Services as defined in the GP contract and so we are not obliged to prescribe for this.
Patients who still wish to take benzodiazepines for flight anxiety are advised to consult with a private GP or travel clinic.
It is important to declare all medical conditions and medications you take to your travel insurer. If not, there is a risk of nullifying any insurance policy you may have.