Dental Procedures
GPs will not issue prescriptions for sedating medications (such as diazepam) prior to dental procedures.
Dentists should not direct patients to GPs requesting they prescribes sedating medications, such as diazepam.
If a dentist wishes to prescribe sedating medications for anxious patients that dentist should be responsible for issuing the prescription. The dental practitioner’s formulary, which is the list of drugs a dentist can prescribe, is found on the BNF dental practitioners formulary and includes Diazepam Tablets and Oral Solution.
If the dentist is treating a patient within their practice NHS contract, then the prescription should be on a FP14D form.
If the dentist is treating a patient privately, they should issue a private prescription.
Dentists may contact a GP for information or advice, if, for example the patient has a complex medical history.
Claustrophobia and MRI scans
GPs will not issue prescriptions for sedating medications (such as diazepam) prior to MRI scans.
It’s estimated that every year, approximately two million MRI scans worldwide are not performed because of patients refusing to be scanned or terminating the scan early due to claustrophobia.
There are many resources online that can help prepare patients on what to expect during a scan including step by step explanations and videos of MRIs being performed. In more severe cases, the NHS website suggests that mild sedatives are an option for people with severe MRI anxiety. However, guidance from The Royal College of Radiologists states that a ‘trained and credentialed team should administer sedation and analgesia’, that ‘patients requiring sedation should undergo pre-procedure assessment and have a sedation plan’ and that ‘sedated patients should be appropriately monitored’.
This means that GPs are not in a position to prescribe these medications for MRI scans.
If you think you need sedation for an MRI scan, this needs to be discussed with the radiology team.
Flight anxiety and prescribing of medications for flying
For the following reasons we will no longer be providing Diazepam or similar drugs for flight anxiety:
- Flight anxiety does not come under the remit of General Medical Services as defined in the GP contract. Patients who still wish to take benzodiazepines for flight anxiety may, if they wish, consult with a private GP or travel clinic.
- Benzodiazepines, including the well-known Diazepam also known as ‘Valium’, as well as having short term deleterious effects on memory, co-ordination, concentration and reaction times, are also addictive if used for a moderate time, with withdrawal leading to fits, hallucinations, agitation and confusion, with possible long-term effects on cognition and balance. Unfortunately, benzodiazepines have also become a widely used drug of abuse since they first came on the market. Because of this Diazepam in the UK is a Class C/Schedule IV controlled drug.
- According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) in treating phobic states. It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.” Your doctor would be taking a significant legal risk by prescribing against these guidelines. Diazepam is only licensed short term for a crisis in generalised anxiety. Fear of flying on its own is not a generalised anxiety disorder.
- Our contract with the NHS advises that an NHS prescription should not be provided for medication which is requested solely in anticipation of the onset of an ailment whilst outside the UK, but for which treatment is not required at the time of prescribing. It is therefore recommended that an NHS prescription is not provided for fear of flying.
Below are some of the issues specific to the use of Diazepam during flights:
- Diazepam is a sedative, which means it makes you sleepy and more relaxed. Although emergencies during aeroplane flights are a rare occurrence, there are concerns about reduced awareness and reaction times for patients taking Diazepam which could pose a significant risk of them not being able to react in a manner which could save their life in the event of an emergency.
- The use of such 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. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is longer than 4 hours, the amount of time which has been shown to increase the risk of developing DVT whether in an airplane or elsewhere.
- 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. A similar effect can be seen with alcohol, which has led to people being removed from flights.
- A study published in 1997 from the Stanford University School of Medicine showed that there is evidence use of Benzodiazepines stops the normal adjustment response that would gradually lessen anxiety over time and therefore perpetuates and may increase anxiety in the long term, especially if used repeatedly.
- Diazepam and similar controlled drugs are illegal in several countries. They may be confiscated, or you may find yourself in trouble with the police.
- Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testing, you may fail this having taken diazepam. Your driving may be impaired after your flight which may mean that you would 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.
You can find further information and useful courses in the links below.
How to manage a fear of flying and flying anxiety | Patient
Fear of flying course | Fearless Flyer
Flying with confidence | Information | British Airways
https://www.flyingwithoutfear.com/Air Travel – Fit for Travel