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Medication for fear of flying or investigative procedures
We do not prescribe diazepam (Valium) for either fear of flying or for patients having MRI scans or other procedures.
Diazepam in the UK is a Class C / Schedule IV controlled drug and is only licensed for short term use for a crisis in generalised anxiety and the prescribing guidelines doctors follow (from the British National Formulary) advise that ‘the use of benzodiazepines (diazepam) to treat short-term ‘mild’ anxiety is inappropriate’ and ‘benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress.’ As GPs we would be taking a significant legal risk prescribing against these guidelines as neither fear of flying, nor anxiety around a medical procedure, are generalised anxiety disorders.
Introduced in the 1960’s, benzodiazepines including diazepam were hailed as wonder drugs; however, it became increasingly clear that, as well as having short term deleterious effects on memory, co-ordination, concentration and reaction times, they were also addictive, with withdrawal leading to fits, hallucinations, agitation and confusion. They were also found to have long-term effects on cognition and balance and have also become a widely used drug of abuse since they first came on the market and as a result have become fair more controlled since the 1990’s.
Investigative procedures or MRIs
In reaching our decision not to prescribe for investigative procedures, we have taken the following into consideration:
Small doses of benzodiazepines such as 2mg diazepam are sub-therapeutic for most adults for effective sedation, however, they can have an idiosyncratic response in some patients and even very small doses can cause increased agitation in some people.
A patient may take a sedative ‘an hour’ before their assumed procedure, to then attend the hospital to find their procedure has been delayed.
GPs are not regularly involved, skilled, trained or appraised in sedation skills, but all hospital consultants, both those requesting imaging and those providing it, have access to the same prescribing abilities as GPs. If a patient needs a certain medication to enable an investigation to go ahead, they are better positioned to provide a prescription.
Sedated patients should be regularly monitored, and it’s important that the team monitoring you throughout your procedure are aware of all medications you’ve taken.
Fear of flying
Diazepam is a sedative and so can cause drowsiness, and impair concentration and decision making, it should therefore not be taken by individuals who may be called on to make important decisions (for example in case of an in-flight emergency).
Further support
There are several aviation industry recommended flight anxiety courses
Providing NHS Services