Prescribing of Diazepam

General Practitioners (GPs) in the UK typically do not prescribe diazepam for common issues like fear of flying or for routine medical or dental procedures, as this practice does not align with national prescribing guidelines. These guidelines, including those in the British National Formulary (BNF),  state that diazepam—a benzodiazepine—is contraindicated for phobias and is inappropriate for short-term anxiety in non-crisis situations.

Furthermore, GPs are generally not the professionals responsible for administering or monitoring sedation for procedures such as scans or dental work,  and they may not be familiar with the specific protocols required in such circumstances.

Reasons for the Policy

• Contraindicated for phobias: The BNF explicitly states that benzodiazepines like diazepam are not recommended for treating phobias and not for routine issues like flying or dental procedures.
• Legal and ethical considerations: Prescribing against national guidelines carries potential legal and professional risks for GPs.
• Potential side effects: Diazepam can cause drowsiness, impair cognitive function, and in rare cases, lead to paradoxical reactions like aggression.
• Risk of blood clots: Sedatives may increase the risk of blood clots during long periods of inactivity, such as on long-haul flights.
• Unnatural sleep: Diazepam can induce non-REM sleep, which differs from natural sleep and may contribute to health risks.
• Long half-life: Diazepam remains in the body for a significant time, which can be problematic, including implications for drug testing.
• Lack of monitoring by GP: GPs do not typically monitor sedation during procedures and are not best placed to manage the associated risks.

Alternatives and Recommendations

• Fear of flying courses:Airlines and organizations offer courses to help manage fear of flying without medication.
• Consult with specialists: For sedation during procedures, consult with the appropriate specialist such as a dentist or radiologist.
• Proper mental health support: Anxiety disorders should be addressed through appropriate mental health support, not medication alone.