We have reviewed our prescribing of diazepam and will no longer be prescribing diazepam for fear of flying or scan tests.
Diazepam in the UK is a Class C/Schedule IV controlled drug. We have outlined below the reasons we will no longer be prescribing it for fear of flying.
There are several important reasons why prescribing diazepam for fear of flying is not advised:
- Impaired Safety During Emergencies
Diazepam is a sedative, which can cause drowsiness, slowed thinking, and reduced alertness. In the event of an in-flight emergency, this could impair your ability to respond appropriately, potentially compromising your safety and that of others on board. - Increased Risk of Blood Clots (DVT)
While sedatives can help induce sleep, the sleep they produce is unnatural and lacks normal movement (non-REM sleep). This immobility, particularly on flights lasting longer than 4 hours, increases your risk of developing deep vein thrombosis (DVT) — a serious and potentially life-threatening condition. - Unpredictable Reactions
Although most individuals experience sedation with diazepam, a small number may have the opposite reaction — becoming agitated, disinhibited, or aggressive. Such behavior could pose a risk to yourself and other passengers, and may also result in legal consequences. - Not Clinically Appropriate for Phobias
According to national prescribing guidelines (e.g., the British National Formulary), diazepam is not indicated for phobic states or for short-term, mild anxiety. Prescribing it in such contexts would be contrary to established clinical guidance and could expose the prescriber to legal and professional risk. - Legal and Travel Implications
Diazepam is a Class C controlled drug in the UK and is similarly regulated or prohibited in many countries. Carrying it without appropriate documentation can result in legal issues, including confiscation or even arrest at international borders. - Long-Lasting Effects and Drug Testing
Diazepam has a long half-life, meaning it stays in the body for an extended period. This can lead to positive results on workplace drug screenings, even days after use, potentially affecting employment in safety-critical roles. - More Effective Alternatives Exist
We fully acknowledge that a fear of flying is real and distressing. However, more effective and safer interventions are available. Fear of flying courses, often run by airlines, have demonstrated excellent long-term outcomes and do not carry the risks associated with sedative medications.
Given the potential health, legal, and safety risks associated with diazepam, as well as its limited clinical appropriateness, we strongly advise against its use for flight-related anxiety. We recommend considering a structured fear of flying program instead, which offers a more sustainable and empowering solution.
Patients are welcome to seek the opinion of a private GP if they still wish to request a prescription for this purpose. We would also advise speaking to your pharmacist about alternatives that can be bought over-the-counter. We have outlined below the reasons we will no longer be prescribing it for fear of flying.
Further information and useful resources: