1. Fear of Flying
Diazepam is not licensed as a sedative for aircraft flights and will not be prescribed for this purpose. Diazepam is a sedative, which means it makes most patients sleepy and more relaxed. If there is an emergency during the flight, it may impair ability to concentrate, follow instructions and react to the situation. This could have serious safety consequences for the patient and those around them.
Sedative drugs can make patients fall asleep. However, it is an unnatural non-REM sleep. This means the sedated person won’t move around as much as during natural sleep. This increases the risk of developing a blood clot (DVT) in the leg or even the lung. DVT is a serious (sometimes life-threatening) medical condition and risk of a DVT increases with longer flights.
Whilst most people find benzodiazepines sedating, a small number experience paradoxical agitation and aggression. They can also cause disinhibition and lead patients to behave in a way that they would not normally. This could impact on the safety of other passengers as well as the patient and could also precipitate trouble with the law. This is particularly likely if diazepam is combined with alcohol.
For all of the reasons above, patients who experience fear of flying are recommended to address it with a Fear of Flying course run by the airlines.
2. Sedation for Radiological Procedures
Anxiolytics will not be prescribed by the practice for patients undergoing radiological procedures (e.g. MRI scans) in secondary care, in keeping with Local Medical Committee (LMC) advice.
The Royal College of Radiologists has published detailed guidance which states “Safe and effective analgesia and sedation should be delivered by an appropriately trained and credentialed team with good access to anaesthetics, pre-procedural assessment, sedation plan and checklist, with appropriate monitoring and availability of resuscitation equipment and reversal agents.” We therefore expect the Radiology or Anaesthetics Teams to arrange sedation according to the hospital’s in-house policy.
3. Advice for GPs for requests to prescribe sedative 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, 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. Dentists do not have EPS.
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.
4. Temporary Residents
Temporary residents should contact their existing surgery to arrange electronic transfer of a prescription for their regular medicines to a local pharmacy wherever practicable.
Temporary residents not currently on a benzodiazepine or Z-drug will be treated according to NICE guidelines and this practice policy.
Temporary residents who are regular users of benzodiazepines or Z-drugs will not receive prescriptions without proof of dosage, frequency and date of last prescription. This information can be obtained from the patient’s surgery or from their Summary Care Record.