Prescribing Policy-Diazepam and Other Benzodiazepines for Fear of Flying
Purpose
This policy sets out the practice approach to requests for diazepam or other benzodiazepines for fear of flying, flight-related anxiety or to help patients sleep during a flight.
Fear of flying can be very distressing and can have a significant impact on patients. However, benzodiazepines are not considered an appropriate routine treatment for this problem.
Practice policy:
The practice does not routinely prescribe diazepam or other benzodiazepines for fear of flying, flight-related anxiety or to help patients sleep during flights.
This does not prevent benzodiazepines being prescribed where there is a separate, appropriate clinical indication.
Scope
This policy applies to all prescribers working within the practice, including GPs, advanced practitioners and other authorised prescribers.
It covers requests for:
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diazepam, lorazepam, clonazepam, temazepam, other benzodiazepines requested specifically for flying or requested to help patients sleep during a flight
The policy does not apply to patients who are already taking a benzodiazepine for an established medical indication. Such patients should be managed on an individual basis.
Clinical and prescribing rationale
Fear of flying is not a routine indication for diazepam
Fear of flying may occur as a specific phobia or as part of a wider anxiety disorder. The appropriate management depends on the individual patient and the underlying problem.
Benzodiazepines are not generally recommended for phobic states or for the routine management of mild anxiety.
A request for diazepam simply because a patient is due to fly does not, on its own, provide a sufficient clinical indication for prescribing.
NICE guidance
NICE guidance does not recommend routine benzodiazepine treatment for anxiety disorders.
For generalised anxiety disorder, benzodiazepines should not normally be offered except as a short-term measure during a crisis. Benzodiazepines are also not recommended for the treatment of panic disorder because of concerns about poorer long-term outcomes.
Fear of flying should therefore not normally be managed by providing a short course of diazepam for an upcoming flight.
Safety considerations
There are a number of practical safety concerns with taking diazepam before or during a flight.
Sedation and impaired reactions
Diazepam can cause drowsiness and impair concentration, coordination, judgement and reaction time. This may affect a person's ability to respond appropriately to instructions or an unexpected situation during a flight.
Reduced mobility
Sedation may make patients less active during a flight. Long periods of immobility are already associated with an increased risk of venous thromboembolism during air travel.
The practice therefore does not recommend using sedative medication simply to enable a patient to sleep through a flight.
Alcohol and other sedatives
Patients may drink alcohol while travelling. Alcohol and benzodiazepines can have additive sedative effects and the combination should be avoided.
Other medicines or substances that cause sedation can also increase the risks.
Respiratory problems
Benzodiazepines can depress respiration. Extra caution is required in patients with respiratory disease, sleep-disordered breathing and other conditions where sedation may present an increased risk.
Paradoxical reactions
Although uncommon, benzodiazepines can occasionally cause agitation, disinhibition, confusion or increased anxiety rather than calming the patient.
This could be particularly difficult to manage in an aircraft.
Dependence and withdrawal
Benzodiazepines carry a risk of tolerance and dependence.
They should generally be used for as short a period as possible and, when prescribed for anxiety or insomnia, treatment should normally be limited to a short period.
There is therefore little justification for exposing a patient to these risks where the only reason for prescribing is an anticipated flight and there are other ways of managing the anxiety.
Patients who are already taking benzodiazepines regularly should not be advised to stop them suddenly. Withdrawal can be significant and, in some circumstances, serious. Any reduction should be planned and undertaken gradually where clinically appropriate.
Alternatives to prescribing
Patients should be offered advice and support rather than simply being told that diazepam cannot be prescribed.
Depending on the circumstances, this may include:
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self-help information about fear of flying;
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cognitive behavioural therapy (CBT);
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NHS Talking Therapies where appropriate;
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assessment for an underlying anxiety disorder;
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recognised fear-of-flying courses or programmes offered by airlines or other providers.[Text Wrapping Break]
If the assessment identifies an anxiety disorder, this should be managed appropriately rather than prescribing diazepam specifically for the flight
Patients already taking benzodiazepines
This policy relates to new prescribing for flight anxiety.
It should not be interpreted as advice for patients to stop established benzodiazepine treatment.
Patients taking benzodiazepines regularly should have their medication reviewed where appropriate. If treatment is to be reduced or stopped, this should normally be done gradually and with appropriate support.
Policy reviewed: 12/08/2026