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Elliott Hall Medical Centre

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Fear of Flying

Patients sometimes contact us asking us to prescribe sedative medication for fear of flying; this includes but is not limited to: diazepam (and other benzodiazepines), zopiclone and valium. At Elliott Hall Medical Centre we appreciate that fear of flying can be very frightening but there are many reasons why the prescription of these medications in this circumstance is not recommended – please see these outline below – as such our policy has been updated in keeping with current medical guidance and we will no longer be providing such prescriptions.

  1. These medications are sedatives. This means they make you sleepy and more relaxed, cause longer reaction times and slowed thinking. In the event of a critical incident or emergency during a flight it may impair your ability to concentrate, follow instructions and react to the situation. This would put you at significant risk of not being able to act in a manner which could save your life. Incapacitation from these medications is a risk to the lives of all onboard the aircraft in the event of an emergency requiring evacuation.
  2. Any sedating drugs induce non-REM sleep, which tends to be of a type where the person does not move in their sleep. This therefore increases the possibility of sitting without moving for several hours. If this is more than 4 hours (the amount of time shown to increase the risk of developing a DVT whether in an aeroplane or elsewhere) the risk of DVT or PE is further increased. These conditions are potentially fatal.
  3. Sedative effects can also affect breathing and cause low oxygen levels, which again could be life threatening. This is further exacerbated with the lower circulating oxygen levels on an aeroplane (normal Oxygen saturations for a healthy person at 8000ft are around 90% whereas normal oxygen saturations at ground level are between 94-100%) and furthermore in those with underlying lung disease. With the two affects added together this may become significant.
  4. Some people may have a paradoxical effect from these medications shown by an increase in agitation, aggression and/or confused behaviour. They can also cause disinhibition and lead to abnormal behaviours. These behaviours could impact on your safety as well as that of the people around you.
  5. If taken in addition to alcohol consumption, there is an increase of all the risks mentioned above – many nervous flyers will consume alcohol in the terminal before flying and during the flight despite any advice otherwise.
  6. For some countries it is illegal to import these drugs e.g. in the Middle East.
  7. Diazepam stays in your system for some time, if you have to take a drugs test for employment purposes you may fail this.
  8. According to the prescribing guidelines that UK doctors follow (the British National Formulary), diazepam is not recommende in treating phobic states. It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.” NICE guidelines suggest that these medications are only advised for the short term use for a crisis in generalised anxiety disorder in which case a person would not be fit to fy. Fear of flying in isolation is not a generalised anxiety disorder.
  9. These medications are highly addictive in their nature even with short term use.

We appreciate that fear of flying is very real and frightening, however we would recommend tackling the phobia in an appropriate way by using self-help resources or a fear of flying course. Whilst we do not recommend any specific course, you may find the following links useful:

  1. Fear of flying course | Fearless Flyer (easyjet.com)
  2. Our course venues | Flying With Confidence (British Airways)
  3. Collections | flyingwithoutfear (Virgin)

If you still feel you need these medications please contact a travel clinic or aviation medicine specialist.