Benzodiazepines (e.g. Diazepam/ Lorazepam/Temazepam/Alprazolam/ Clonazepam) are drugs which have been in use since the 1960s for treatment of a wide range of conditions including alcohol withdrawal, agitation and restlessness, anxiety, epilepsy and seizures, neurological disorders. muscle spasms, psychiatric disorders and sleep disturbance

Initially benzodiazepines were hailed as a wonder drug. However, it became increasingly clear that, as well as having short term effects on memory, co-ordination, concentration and reaction times, they were also addictive if used for a long time, with withdrawal leading to fits, hallucinations, agitation and confusion, and further had long-term effects on cognition and balance. Unfortunately, benzodiazepines have also become a widely used drug of abuse since they first came on the market. Because of these reasons the use of benzodiazepines has been a lot more controlled around the world since the 1980-90s, especially in the UK. Diazepam in the UK is a Class C/Schedule IV controlled drug.

We are often asked to prescribe sedative drugs, such as diazepam, 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 deemed safe and is no longer recommended:-

• Benzodiazepines such as Diazepam and other sedative drugs are no longer recommended for treatment of phobias because other treatments are safer and more effective.
• Diazepam is a sedative, which means it makes you sleepy and slows reaction times. If there is an emergency during a flight, it may affect your ability to concentrate, follow instructions and react to the situation. This could have serious safety consequences for you and others.
• The sedative effects of these drugs can affect breathing and cause low oxygen levels, which could be life threatening, especially with the lower circulating oxygen levels on an aeroplane, in people with breathing problems or when combined with alcohol.
• Sedative drugs can make you fall asleep, however this is not a natural sleep. This means you won’t move around as much as during natural sleep and this can increase your risk of developing a blood clot (DVT) in your leg or lung. Blood clots are dangerous and can be fatal. This risk is greater if your flight is longer than four hours.
• Whilst most people find medicines such as diazepam sedating, a small number of people become agitated, aggressive or confused. These medicines can also cause disinhibition and lead to abnormal behaviours. This could impact on your safety as well as that of other passengers.
• According to the prescribing guidelines doctors follow (British National Formulary) diazepam is not recommended in treating phobic states. It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.” 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.
• NICE guidelines suggest that these medications are only advised for the short-term use for a crisis in generalised anxiety disorder in which case a person is not fit to fly. Fear of flying in isolation is not a generalised anxiety disorder.

We recognise that fear of flying is real and frightening and we don’t underestimate the impact it can have. However, we will no longer be having any consultations to discuss medication for fear of flying. Patients who still wish to take benzodiazepines for flight anxiety are advised to consult with a private GP or travel clinic.

We recommend tackling the phobia in a different way 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.

https://www.nhs.uk/mental-health/conditions/phobias/overview/

https://www.fearlessflyer.easyjet.com

https://www.flyingwithoutfear.com/