Use of sedatives for Benzodiazepines (and related medications) for flying, hospital and dental procedures

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For the following reasons we will no longer be providing Diazepam or similar drugs for flight anxiety, hospital or dental procedures.

Flying

People often come to us requesting the doctor or nurse to prescribe diazepam for fear of flying or assist with sleep during flights. Diazepam is a sedative, which means it makes you sleepy. There are several reasons why prescribing this drug is not recommended:

· According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) in treating phobic states. Your doctor would be taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis in generalised anxiety · NICE guidelines suggest that medication should not be used for mild and self-limiting mental health disorders. In more significant anxiety related states, benzodiazepines, sedating antihistamines or antipsychotics should not be prescribed. Benzodiazepines are only advised for the short-term use for a crisis in generalised anxiety disorder in which case they are not fit to fly. Fear of flying in isolation is not a generalised anxiety disorder.

· Although plane emergencies are a rare occurrence there are concerns about reduced awareness and reaction times for patients taking Diazepam which could pose a significant risk of not being able to react in a manner which could save their life in the event of an emergency.

· Sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. This can cause you to be at an increased risk of developing a blood clot (Deep Vein Thrombosis – DVT) in the leg or even the lungs. This risk is even greater if your flight is more than 4 hours.

· Whilst most people find Diazepam sedating, a small number have paradoxical agitation and aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally which can pose a risk on the plane. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law. · Diazepam and similar controlled drugs are illegal in a number of countries. The passenger may also need to use a different strategy for the homeward bound journey and/or other legs of the journey.

· It is important to declare all medical conditions and medications you take to your travel insurer. If not, there is a risk of nullifying any insurance policy you may have.

· Flight anxiety does not come under the remit of General Medical Services as defined in the GP contract and so we are not obliged to prescribe for this. Patients who still wish to take benzodiazepines for flight anxiety are advised to consult with a private GP or travel clinic.

If you wish to discuss this further you may book a routine telephone call with Dr Beanland and such queries will not be treated as urgent.

https://www.fearlessflyer.easyjet.com

https://www.britishairways.com/content/information/travel-assistance/flying-with-confidence

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Hospital and Dental procedures including imaging

In addition to the points made above it is important to remember that when requesting sedation for a hospital or dental procedure:

· GPs are not trained to provide the correct level of sedation for a procedure / scan.

· Providing too little sedation will not help you, providing too much sedation can make you too sleepy, which could lead to the procedure being cancelled.

· Too much sedation can dangerously affect your breathing. After taking a sedative for a procedure or scan, you will need to be closely monitored to keep you safe.

· Sedation will affect your ability to travel to or home from an appointment

· GPs do not prescribe for Dental issues

Please see the below information from the UK Radiology guidelines regarding this matter. The link to the full guidelines is below but we have highlighted the relevant information for your ease:

3.3.3 Most patients are anxious before a diagnostic or interventional procedure particularly if they are in pain. A pre-procedure visit with friendly support and explanation in the radiology department reduces the need for sedation. Sedatives should be offered if anxiety persists or if the patient would feel more comfortable during a procedure. 3.3.4 If the procedure is being done on a day case or outpatient basis sedatives can be prescribed at the pre-assessment visit, to be taken on the day of the examination.

Therefore, if requesting sedation for the purpose of a scan or procedure at the hospital this should be discussed with your hospital team directly.

Reference: Safe Sedation, Analgesia and Anaesthesia within the Radiology Department (rcr.ac.uk) [https://www.rcr.ac.uk/sites/default/files/publication/Safe_Sedation.pdf]