Why Kingswood Surgery does not prescribe Benzodiazepines for Flight Anxiety

Kingswood Surgery has evaluated its policy on prescribing benzodiazepines and has decided not to prescribe benzodiazepines or sedatives, such as diazepam, for patients with a fear of flying. This policy aligns with similar decisions made by many other GP practices.

Patients frequently request diazepam for flight anxiety or to aid sleep during flights. Initially introduced in the 1960s, benzodiazepines, including Diazepam (commonly known as 'Valium'), were considered revolutionary. However, it soon became evident that they not only have short-term negative effects on memory, coordination, concentration, and reaction times but are also addictive. Withdrawal can lead to seizures, hallucinations, agitation, and confusion. Long-term use has been linked to cognitive and balance issues. Additionally, benzodiazepines have become a common substance of abuse since their introduction. Consequently, their use has been more strictly regulated globally since the 1980s and 1990s, particularly in the UK. Diazepam is classified as a Class C/Schedule IV controlled drug in the UK. This brief guide outlines the concerns associated with its use in relation to flying and explains why the surgery no longer prescribes these medications for this purpose.

There are several compelling reasons why prescribing this drug is not advisable:

  1. Benzodiazepines can impair reaction times and slow thinking, posing a significant risk during a flight. In the event of a safety-critical incident, a passenger may be unable to respond appropriately, endangering themselves and others. Incapacitation from benzodiazepines is a risk to all on board during an emergency requiring evacuation.
  2. While these sedatives can induce sleep, it is an unnatural non-REM sleep, reducing movement and increasing the risk of developing a blood clot (Deep Vein Thrombosis – DVT) in the leg or lungs. Blood clots are dangerous and potentially fatal, with the risk heightened on flights longer than four hours.
  3. Although most people find benzodiazepines like diazepam sedating, a small number experience paradoxical agitation and aggression. They can also cause disinhibition, leading to uncharacteristic behaviour, which could compromise safety and result in legal issues.
  4. Combining benzodiazepines with alcohol amplifies the risks mentioned above.
  5. According to the British National Formulary, diazepam is contraindicated for treating phobic states and is inappropriate for short-term 'mild' anxiety. Prescribing against these guidelines poses a significant legal risk for doctors. Benzodiazepines are only licensed for short-term use in generalised anxiety crises, which should be managed with proper mental health care rather than flying.
  6. NICE guidelines advise against using medication for mild, self-limiting mental health disorders. In more severe anxiety-related conditions, benzodiazepines, sedating antihistamines, or antipsychotics should not be prescribed.
  7. In some countries, such as those in the Middle East, importing these drugs is illegal, requiring alternative strategies for return journeys or subsequent travel legs. Confiscation or legal issues may arise.
  8. Diazepam remains in the system for an extended period, potentially affecting random drug tests required by certain jobs.
  9. Benzodiazepines have been associated with an increased risk of dementia.
  10. A 1997 study from Stanford University School of Medicine indicated that benzodiazepines might inhibit the normal adjustment response, potentially perpetuating and increasing anxiety over time, especially with repeated use. Shanna Treworgy, Psy.D., from Dartmouth Geisel Medical School, noted that while anxiety may decrease momentarily, benzodiazepines can lead to heightened long-term anxiety reactions.

Given these considerations, we will no longer provide Diazepam for flight anxiety. Instead, we recommend aviation industry-endorsed flight anxiety courses, which are readily accessible for those wishing to overcome their fear of flying, such as:

Flight anxiety is not covered under General Medical Services as defined in the GP contract, and we are not obligated to prescribe for this condition. Patients wishing to use benzodiazepines for flight anxiety are advised to consult a private GP or travel clinic.

It is crucial to declare all medical conditions and medications to your travel insurer to avoid nullifying any insurance policy.

For further information and references:

[i] British National Formulary; Diazepam – BNF Diazepam

[ii] British National Formulary; Hypnotics and Anxiolytics – BNF Hypnotics and Anxiolytics

[iii] NICE Clinical Guideline [CG113] on Generalised Anxiety Disorder and Panic Disorder in Adults: Management, Published January 2011, Last updated July 2019 – NICE Guideline CG113

[iv] Acute and Delayed Effects of Alprazolam on Flight Phobics During Exposure, Behav Res Ther. 1997 Sep;35(9):831-41

[v] Travel Health Pro; Medicines and Travel; Carrying Medication Abroad and Advice Regarding Falsified Medication – Travel Health Pro

Page last reviewed: 11 March 2025
Page created: 11 March 2025