Fear of Flying

Medication Requests for Flight Anxiety

Our practice does not prescribe diazepam, lorazepam, temazepam, zolpidem, or other sedative/anxiolytic medications for use during air travel. This policy reflects established medical guidance and concerns regarding the safety and appropriateness of these medicines when used specifically for fear of flying.

Why We Do Not Prescribe Sedatives for Air Travel

Benzodiazepines, including diazepam, lorazepam, temazepam, alprazolam, and clonazepam, have been used for many years to treat conditions such as severe anxiety, alcohol withdrawal, epilepsy, muscle spasms, sleep disturbances, and certain psychiatric disorders.

When first introduced, these medications were considered highly effective and gained widespread popularity. However, over time it became evident that they can cause significant side effects, including impaired memory, reduced concentration, slower reaction times, and poor coordination. Long-term use may also lead to dependence, with withdrawal symptoms ranging from agitation and confusion to seizures and hallucinations. In addition, these drugs have become commonly associated with misuse and abuse.

As a result, prescribing controls have become increasingly strict, particularly in the UK, where diazepam is classified as a Schedule IV/Class C controlled drug.

Many patients request sedative medication to help manage flight-related anxiety or to aid sleep during a journey. Although these medicines may produce a calming effect, there are several important reasons why prescribing them for this purpose is not considered appropriate.

Clinical Guidance

The prescribing guidance used by healthcare professionals, including the British National Formulary (BNF), advises that diazepam should not be used to treat phobic disorders. The BNF also states that benzodiazepines are unsuitable for the management of mild, short-term anxiety.

Prescribing outside these recommendations may expose clinicians to significant professional and legal risks. Benzodiazepines are generally reserved for short-term use in exceptional circumstances involving severe generalised anxiety, where ongoing assessment and support are required. A fear of flying alone does not fall into this category.

National Institute for Health and Care Excellence (NICE) guidance similarly recommends that medication should not be routinely used for self-limiting anxiety conditions. For anxiety disorders, benzodiazepines and other sedating medications are generally not advised except in very limited circumstances.

Safety Concerns During Flights

Sedative medications can reduce alertness, impair judgement, and slow reaction times. While serious incidents during air travel are uncommon, passengers may need to respond quickly in the event of an emergency. Reduced awareness caused by sedatives could affect a person’s ability to follow safety instructions or evacuate promptly if required.

Increased Risk of Blood Clots

Although sedatives often induce sleep, the sleep they produce differs from normal restorative sleep. People under the influence of these medications tend to remain still for longer periods, reducing natural movement during a flight. This may increase the risk of developing a deep vein thrombosis (DVT), particularly on journeys lasting more than four hours. In some cases, blood clots can travel to the lungs and become life-threatening.

Unexpected Behavioural Effects

While many individuals experience drowsiness when taking benzodiazepines, some people react in the opposite way. Rare side effects include agitation, irritability, aggression, and disinhibited behaviour. Such reactions may create safety concerns both for the individual and for fellow passengers and could potentially lead to legal consequences.

Potential for Increased Anxiety

Research has suggested that benzodiazepines may interfere with the natural process by which individuals gradually become less anxious through repeated exposure to a feared situation. Consequently, repeated reliance on these medications may maintain or even worsen flight-related anxiety over time rather than helping to overcome it.

Travel Restrictions

Some countries have strict regulations regarding controlled medications, including diazepam and similar drugs. Travellers may be required to provide documentation, could have medication confiscated, or may face legal difficulties if carrying restricted medicines.

Employment Considerations

Diazepam can remain detectable in the body for an extended period. Individuals whose employment involves workplace drug screening should be aware that use of this medication could result in a positive test.

Travel Insurance

Travellers should ensure that all medical conditions and prescribed medications are declared to their travel insurance provider. Failure to disclose relevant information may affect the validity of a policy or any subsequent claim.

Alternative Support for Fear of Flying

In light of these considerations, our practice does not prescribe diazepam or similar sedative medications for flight anxiety. Instead, we encourage patients to consider specialist fear-of-flying programmes that focus on education, coping strategies, and anxiety management techniques.

For further information:

[i] British National Formulary; Diazepam – bnf.nice.org.uk/drug/diazepam.html

[ii] British National Formulary; Hypnotics and anxiolytics – bnf.nice.org.uk/treatment-summary/hypnotics-and-anxiolytics.html

[iii] Generalised anxiety disorder and panic disorder in adults: management. NICE Clinical guideline [CG113] Published date: January 2011 Last updated: July 2019 www.nice.org.uk/guidance/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 – travelhealthpro.org.uk/factsheet/43/medicines-abroad