Why Diazepam Is Not Recommended
1. It can cause unexpected (“paradoxical”) reactions
Diazepam is sometimes thought of as a calming medication, but in a small number of people it can have the opposite effect. This is called a paradoxical reaction. Instead of reducing anxiety, it can cause:
· Agitation
· Aggression
· Restlessness
· Confusion
These reactions can be particularly dangerous if they occur during a flight or inside an MRI scanner, where movement must be kept to a minimum.
2. It can slow breathing
Diazepam is a sedative and can cause respiratory depression (slowed or shallow breathing). This risk increases if the person is:
· Unwell
· Elderly
· Taking other sedative medications
· Drinking alcohol
Air travel is already a physiologically stressful environment; combining this with a medication that affects breathing can pose additional risks.
3. It can impair judgment during an emergency
Airlines require all passengers to be able to:
· Understand safety instructions
· Follow directions from cabin crew
· Act quickly during an emergency
Diazepam can impair coordination, reaction time, memory, and judgment. If an emergency occurs, a sedated passenger may struggle to react appropriately or may put themselves and others at risk.
4. It can interact dangerously with other medicines and alcohol
When diazepam is combined with alcohol or other common medications, such as painkillers, sleeping tablets, antihistamines, or antidepressants, the sedative effect can be stronger than expected. This increases the risk of excessive drowsiness, breathing problems, falls, and confusion.
5. It is not recommended for phobic states
According to the British National Formulary (BNF), the prescribing guideline used by all UK doctors, diazepam is contraindicated in the treatment of phobic states, including severe fear or panic related to flying or enclosed spaces.
6. Diazepam is illegal in some countries
Some countries classify diazepam as a controlled or illegal substance. This means:
· You may be refused entry
· The medication may be confiscated
· You could potentially face legal consequences
As doctors, we cannot prescribe a medication that may place a patient at risk when travelling internationally.
So What Can Help Instead?
We recognise that flight anxiety and claustrophobia are very real issues. Although we cannot prescribe diazepam, there are safe and effective alternatives:
‘Fearless flyer’ courses and additional support · https://www.fearlessflyer.easyjet.com/ · https://www.britishairways.com/content/information/travel-assistance/flying-with-confidence · https://patient.info/features/mental-health/how-to-manage-flight-anxiety
• MRI support strategies
Radiology departments can offer:
· Extra time to prepare
· Calming music
· Communication throughout the scan
· The option to stop the scan at any time
Many patients find these measures enough to complete the scan comfortably.