Prescribing Sedatives for Procedures, Dental work or 'fear of flying' 

Sedatives for Radiological Procedures (CT/MRI Scans)

We understand that many patients feel anxious about undergoing radiological procedures such as CT or MRI scans, and may ask if we can prescribe sedatives beforehand.

However, for your safety, we do not prescribe sedatives for radiological procedures. This ensures that any sedation is managed by specialists with immediate access to monitoring and emergency support.

Why we do not prescribe sedatives for scans

• It is not safe for GP practices to prescribe sedatives for patients to use during these procedures.
• Safe and effective sedation requires:
  • A trained and credentialed team
  • Proper pre-procedure assessment
  • A clear sedation plan and checklist
  • Close monitoring throughout
  • Immediate access to resuscitation equipment and reversal agents

This is supported by guidance from the Royal College of Radiologists, which states:

“Safe and effective analgesia and sedation should be delivered by an appropriately trained and credentialed team with good access to anaesthetics, pre-procedure assessment, sedation plan and checklist, with appropriate monitoring and availability of resuscitation equipment and reversal agents.”

Important considerations

• Sedated patients must be carefully monitored. There have been serious incidents where sedatives prescribed outside hospital settings led to unmonitored respiratory arrest during scans.
• Practices are not required to prescribe sedatives for these procedures.
• Low doses (e.g. 2mg diazepam) are often ineffective, while even small amounts can cause unpredictable reactions, including increased agitation in some patients.
• Timing is difficult: a patient may take a sedative expecting an immediate scan, only to find the procedure is delayed, meaning the medication is no longer effective when needed.
• GPs are not regularly trained, skilled, or appraised in providing sedation.
• Hospital teams requesting or performing imaging have the same prescribing abilities as GPs, and are better placed to prescribe and manage sedation if required.

What if I’m anxious about my scan?

If anxiety is a concern:

• Discuss this with your hospital consultant or the radiology team. They can arrange appropriate support or sedation with full monitoring.
• If you are being referred for imaging, it may be helpful for us to note any concerns about anxiety on your referral, so the radiology team can plan accordingly.

Sedatives for ‘Fear of Flying” 

Avisford Medical Group has reviewed its diazepam prescribing for ‘fear of flying’ and based on current national guidelines will longer be prescribing diazepam or other sedatives for this reason.

Increasing concerns have risen regarding prescribing of diazepam. As safety issues have become better understood, it is clear diazepam has number of unwanted side effects and risks. This includes short-term memory impairment, co-ordination issues and reduced concentration and reaction times. There are also significant risks of addiction, unfortunately this has increased nationally over the past couple of decades, and it is historically prescribed for the fear of flying.

It is also a Class C/ Schedule IV drug in the U.K, which mean it has more prescribing restrictions compared to other prescription medicines.

Considering the information above, there are number of good reasons why we won’t be prescribing diazepam for fear of flying any longer:

• The use of diazepam can cause longer reaction times and slowed thinking, which during a flight will put the passenger at significant risk of not being able to act in a manner which could save their life in an event of critical incident. Incapacitation from this is a risk to all lives on board of the aircraft in an event of an emergency requiring evacuation. In fact there is a risk that you will be unarousable in case of an emergency.
• As it’s a sedative drug it can make you fall asleep anywhere, however it will be unnatural non-REM sleep, which means you won’t move around as much and can have increased risk of developing blood clots (DVT) in the leg or even lungs (Pulmonary embolism)which could be fatal. The risk is greater if your flight is greater than 4 hours.
• While most people find diazepam sedating, a small number of patients may develop paradoxical agitation and aggression. This can cause disinhibition and lead you to behave abnormally.
• In some countries it is illegal to import these drugs.
• Diazepam stays in your system for a long time, if your job requires to submit random drug testing, you may fail this if you have taken diazepam.
• Diazepam has been linked to onset of dementia.
• A study from Stanford University School of Medicine published in 1997 showed that there is evidence that use of diazepam (other benzodiazepines) stops the normal natural adjustment response that would gradually lessen anxiety over time and therefore perpetuates and may increase anxiety in the long term especially if used repeatedly. 

We understand although flying is safe it may be a source of concern for some. The aviation industry has recommended flight anxiety courses which are easily accessible for those who wish to fly. Treating the cause of the fear with one of these courses is much more favourable than simply masking the symptoms with risky medication.

We have included a list of resources below:

• Easy Jet
• British Airways
• Virgin 
• Hypnotherapy approach