Important update
After careful consideration, St George’s Surgery no longer prescribes benzodiazepines (e.g. diazepam) for fear of flying or to help with sleep during flights.
These medicines were widely used in the past but are now more strictly controlled due to safety concerns.
Our position
We understand that fear of flying is very real and can be very distressing.
However, for reasons listed below, we will not prescribe diazepam or similar sedatives for this purpose as it is no longer considered safe or appropriate.
Many GP practices across the UK have adopted similar policies in line with national prescribing guidance and patient safety recommendations.
We strongly encourage structured anxiety support instead.
Why we do not prescribe Diazepam for flying
1. Safety in emergencies
Diazepam slows thinking and reaction times. In the unlikely event of an in-flight emergency, this could impair your ability to follow instructions and react appropriately, putting yourself and others at risk.
2. Breathing and oxygen levels
Sedatives can suppress breathing. Cabin oxygen levels are lower than at sea level. Combining this with alcohol or underlying respiratory conditions increases risk.
3. Risk of blood clots (DVT)
Sedatives cause unnatural, non-REM sleep and reduce movement. This increases the risk of deep vein thrombosis (DVT), especially on flights over four hours. Blood clots can be life-threatening.
4. Paradoxical reactions
A small number of people experience agitation, aggression, confusion or disinhibition instead of sedation. This can create serious safety and legal consequences during a flight.
5. Alcohol interaction
Combining benzodiazepines with alcohol significantly increases sedation, breathing suppression, and behavioural risks.
6. Prescribing guidelines
The British National Formulary (BNF) states that:
- Diazepam is not recommended for phobic states.
- Benzodiazepines should not be used for short-term mild anxiety.
The National Institute for Health and Care Excellence (NICE) advises:
- Medication should not be used for mild, self-limiting anxiety disorders.
- Benzodiazepines are only appropriate short-term during a crisis in generalised anxiety disorder — in which case a person would not be fit to fly.
Prescribing outside of these guidelines places clinicians at medico-legal risk.
7. Legal issues abroad
Some countries (including parts of the Middle East) prohibit importation of benzodiazepines. Medication may be confiscated and legal consequences could follow.
8. Workplace drug testing
Diazepam remains detectable in the body for an extended period and may result in a positive workplace drug test.
9. Link to dementia
Long-term benzodiazepine use has been associated with an increased risk of developing dementia.
10. NHS contractual position
Fear of flying is not covered under General Medical Services as defined by the NHS GP contract. Therefore, GP practices are not obligated to prescribe medication for this condition. Patients who still wish to take benzodiazepines for flight anxiety despite the risks involved are advised to consult with a private GP.
Alternatives that can help
NHS Talking Therapies
Self-refer for CBT and anxiety support:
Talking Therapies > Glos Health & Care NHS Foundation Trust
Airline Fear of Flying Courses
EasyJet – Fearless Flyer
- www.fearlessflyer.easyjet.com
- 0203 813 1644
British Airways – Flying With Confidence
- www.flyingwithconfidence.com
- 01252 793250
Sedatives for scans and procedures
We also do not prescribe sedatives for:
- MRI or CT scans
- Dental procedures
- Minor surgery
Prescribing sedative medication for these purposes are no longer considered safe or appropriate for the following reasons:
1. Sedation safety
GPs are not trained or equipped to provide procedural sedation. Too little sedation may not work, while too much can dangerously suppress breathing or consciousness. Safe sedation requires appropriate monitoring, which cannot be provided in general practice.
2. Unexpected reactions
Although diazepam is usually calming, some people experience the opposite effect, such as agitation or confusion, which may increase risks during procedures.
3. Timing of medication
Hospital appointments are often delayed. Any sedation needs to be given at the correct time by the clinical team performing the procedure to ensure it is safe and effective.
4. Radiology guidelines
The Royal College of Radiologists sets strict safety standards for sedating patients undergoing CT or MRI scans. If you are anxious about a scan or procedure, please contact the hospital department directly. Taking a sedative without the knowledge and monitoring of the radiology team is considered unsafe and could be dangerous if complications occur.
5. Responsibility of the treating clinician
If sedation is required for dental treatment or surgery, it is the responsibility of the dentist or surgeon to provide and monitor it. GP practices do not prescribe sedatives for these purposes.
If you are concerned about undergoing a scan or procedure due to anxiety or claustrophobia, please contact the requesting department or radiology service directly.