This policy applies to surgeries within the Drake Medical Alliance PCN:

• Knowle House 
• Lisson Grove & Woolwell 
• North Road West
• Roborough
• Wycliffe

The above surgeries do NOT prescribe sedatives for fear of flying. All prescribers working in the PCN adhere to this policy. The reasons for this can be found below:

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 four hours.
3. Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical 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.
4. NICE guidelines suggest that medication should not be used for mild and self-limiting mental health disorders. (1) 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. Fear of flying in isolation is not a generalised anxiety disorder.
5. According to the prescribing guidelines doctors follow diazepam (2) is contraindicated (not allowed) in treating phobic states. It also states “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.” (3) 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.
6. Diazepam and similar drugs are illegal in a number of countries. (4) They may be confiscated or you may find yourself in trouble with the police.
7. 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.
8. 8. 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. Please contact your airline for more details.

References

1. NICE. www.nice.org.uk. [Online].; 2020 [cited 2022 12 4. Available from: https://www.nice.org.uk/guidance/cg113
2. British National Formulary. bnf.nice.org.uk. [Online].; 2022 [cited 2022 12 4. Available from: https://bnf.nice.org.uk/drugs/diazepam/
3. British National Formulary. bnf.nice.org.uk. [Online].; 2022 [cited 2022 12 4. Available from: https://bnf.nice.org.uk/treatment-summaries/hypnotics-and-anxiolytics/
4. National Travel Health Network and Centre. travelhealthpro.org.uk/. [Online].; 2019 [cited 2022 12 4. Available from: https://travelhealthpro.org.uk/factsheet/43/medicines-abroad