Advice for patients on requests to prescribe sedating medications
Advice for patients requesting sedatives
Dental procedures and anxiety
GPs will not issue prescriptions for sedating medications (such as diazepam) prior to dental procedures.
Dentists should not direct patients to their GP to request sedating medications. If a dentist considers sedation clinically appropriate for an anxious patient, responsibility for prescribing rests with the dentist providing the treatment.
The dental practitioners’ formulary (BNF dental practitioners formulary) includes diazepam tablets and oral solution.
- If the dentist is treating the patient under their NHS contract, the prescription should be issued on an FP14D form.
- If the dentist is treating the patient privately, they should issue a private prescription.
Dentists can access a patient’s Summary Care Record via the DERs/Rego electronic referral system for NHS England dental referrals. Dentists may contact a GP for clinical information or advice where a patient has a complex medical history, but not to transfer prescribing responsibility.
Claustrophobia and MRI scans
GPs will not issue prescriptions for sedating medications (such as diazepam) prior to MRI scans.
Claustrophobia is a common reason for patients declining or terminating MRI scans early.
Many resources are available online to help patients prepare, including step-by-step explanations and videos demonstrating MRI procedures.
In more severe cases, the NHS website notes that sedation may be an option. However, medico-legal advice (including the Royal College of Radiologists’ guidance Sedation, analgesia and anesthesia in the radiology department, 2018) makes clear that sedation should only be administered by a trained and credentialed team, with appropriate pre-assessment, monitoring and aftercare.
For this reason, the GP is not the appropriate clinician to prescribe sedating medication for MRI anxiety. Where sedation is required, this should be discussed directly with the radiology team, who are responsible for the procedure and the patient’s safety.
Flight anxiety and prescribing for flying
For the reasons outlined below, the practice will no longer prescribe diazepam or similar medications for flight anxiety. Instead, patients are signposted to aviation-industry-approved fear-of-flying courses (link provided below).
Flight anxiety does not fall within the remit of core General Medical Services (GMS) as defined in the GP contract. The practice is therefore not commissioned or insured to prescribe for this purpose. Patients who wish to pursue medication for flight anxiety are advised to consult a private GP or travel clinic.
Benzodiazepines, including diazepam (Valium), were historically prescribed more widely. Over time, it has become clear that they carry significant risks, including:
- impairment of memory, coordination, concentration and reaction times
- dependence and withdrawal symptoms (including agitation, hallucinations and seizures)
- long-term effects on cognition and balance
- misuse and diversion
Diazepam is a Class C / Schedule IV controlled drug in the UK, and its prescribing is now tightly regulated.
Prescribing guidance (British National Formulary) states that diazepam is contraindicated in phobic states and that benzodiazepines should not be used to treat short-term or mild anxiety. NICE guidance also advises against medication for mild or self-limiting anxiety disorders.
Fear of flying alone does not constitute a generalised anxiety disorder. Where anxiety is severe enough to warrant medication, this requires appropriate mental health assessment and support rather than short-term sedative prescribing.
Additional risks of benzodiazepine use when flying include:
- reduced awareness and reaction time in the event of an in-flight emergency
- increased risk of deep vein thrombosis due to reduced movement during unnatural (non-REM) sleep
- paradoxical agitation, disinhibition or aggression in some individuals
- legal issues in countries where benzodiazepines are restricted or illegal
- prolonged impairment affecting driving or safety-critical work
- potential invalidation of travel insurance if medications are not declared
Evidence also suggests that repeated benzodiazepine use can perpetuate or worsen anxiety over time, rather than resolving it.
For further information, please click on the link below:
Final statement
We recognise that some patients may have received these medications in the past and may feel disappointed by this change. However, this policy reflects current national guidance, medico-legal advice and patient safety considerations, and is applicable to all patients going forward.
While we regret any inconvenience this may cause, this approach ensures that care is provided by the most appropriate service and protects both patients and GPs from avoidable risk.