GP refused me Valium for a long flight

[MinesaBottle]

DH and I are flying to Australia next week for a family funeral. I don’t cope well with flying at all, and for the last few years I’ve gone to the GP and been prescribed a few 2mg Valium for the flights (we’ve already been to NZ this year - another funeral) and last year (dsd’s wedding). Which is a way of saying I’ve taken it on long flights before with no issues. I don’t drink alcohol on flights either.

I went to the GP today to ask for some Valium or similar and she flat out refused! She said she won’t prescribe Valium for flights because ‘you won’t move around and you’ll be at risk of DVT’. How much did she think I’d take?! I’ve flown on it before and always been conscious (I can’t sleep on planes anyway) and moved around; I always get an aisle seat so I can get up. She prescribed propranolol instead; I’ve never had it and it only calms physical symptoms of anxiety, not mental ones (is what she said). I’m also worried it might interact with paroxetine; she said not but didn’t actually look it up!

Weirdly I was in tears when I got in—I think because of the disruption to my usual routine when flying. I feel like she was judging me too. But regardless, should I see a private GP (there’s one near work) and see if they would prescribe five or six Valium or similar? I need the mental calming too. I have ADHD and my thoughts race at the best of times, never mind on a long flight heading to a funeral!

I take hay-fever tablets instead. A couple knock me out for a good few hours.

@gerrytrude diazepam are generic so should hardly cost anything at all.

I’ve been a GP for over 20 years, and I’ve prescribed diazepam many times for flights. However, in the last year or so the British Aviation Authority began to advise against it. I’m not completely sure why, but I think it’s to do with being sedated and the risks that can pose.

Now I’m not stupid, and I know that patients who’ve taken tiny doses of diazepam for flights for years, with no problems, are not going to be wiped out by a small dose of diazepam. But we live in an age of litigation, and most doctors now practice very defensively, because otherwise we can find ourselves in trouble. So we made a decision as a practice that we would no longer prescribe diazepam for flights. Many GP surgeries have taken the same approach. The ones that don’t are braver than we are!

Please could someone tell me how you find a private GP?

Do you have to join a private GP practice?
Or are you talking about a private walk in?
Or asking your NHS GP to do a private prescription?

How does it work?

I get anxious on flights and find alcohol works well! I have had diazepam as well (not with alcohol, on its own). And honestly 2 glasses of wine works better for me.
I appreciate it's not the healthiest but it's meant I can fly and my world isnt restricted anymore

I was given propranolol for flight anxiety whilst on anti-depressants. Absolute game-changer. No racing thoughts/sweaty palms/galloping heartrate/feelings of imminent doom. Just calm and clarity. Best flight ever. I hope it works for you too.

My DH has not been able to get a doctors appointment for severe eczema (his skin is splitting open, the longest split is nearly 7cm), my DM can't get an appointment with her GP for severe arthritis. So glad all these people running for drugs because they have to get a flight are getting appointments!

Don't worry about politicians and the NHS - the British people will kill it off first.

And just incase you still haven't got it; OP YABU!

In the past for flights I've used co-codamol and I find that it reduces my anxiety. I used to take Solpadine max before a flight. I know that's not how it's meant to be used. Or you could try CBD, I stopped using codeine and use CBD when my meds aren't cutting it. You can get it in many forms, the tea is nice and the sweets are good.

I am on propranolol for migraines and anxiety and it helps alot. I take it with my SSRIs and it works fine.

I guess I was lucky to get the appointment then. It’s not always so easy.

I don’t take meds for the ADHD any more as I never felt comfortable taking them; I (usually) have coping strategies. Maybe I should start again before the flight!

I’d just like to point out again that I don’t take Valium often. Two long hauls in a year is really unusual for us and it’s only due to family stuff. I’ve never been given more than six pills at a time. I’ve also calmed down a bit now - due to my anxiety I was really keyed up and upset.

Dorothyparkerscat in my case it’s a private walk in. They’re at or near a few of the main stations in London. I googled it.

Just be aware of propanolol if you have asthma.

I was taking it earlier this year, and it interacted with my asthma to give me a serious attack. I lost consciousness when I stopped breathing. It could have been much worse.

Nope, not asthmatic. The GP also checked my breathing with her stethoscope to make sure (and help calm me I think!)

@DorothyParkersCat just google private GPs in your area. You don't need to register as such. You just fill in a form at your initial appointment (if I remember correctly) and maybe your first appointment is longer/more expensive that subsequent ones, or it might just be a standard fee, I can't recall.

At my private GP an appointment costs £120 and you also have to pay the full cost for any prescription they write (not the NHS subsidised cost). That varies wildly depending on the drug.

I have private health insurance which covers both, but think it's not so common to have prescriptions covered, most insurers just cover the cost of the appointment.

Benzos are increasingly known to be problematic even in low doses and the information from the aviation industry does indeed advise against it. It CAN cause problems. It's usually doesn't but if it were to and no one knows when and to whom it will effect adversely (even if taken previously) a GP who prescribed it would have no legal defense at all. That is not a rap over the knuckles. That is losing your career, credibility, and sadly in quite a few cases of litigation, life, as suicide in drs facing litigation is well documented. Patient choice does NOT mean having whatever you fancy especially when it is explicitly advised against... also with regard to pain meds it's a similar situation. On the one hand GPs are being absolutely demonized for prescribing these 'dreadful addictive medications' on the other hand they are 'denying patients pain relief and ignoring their pain'.... there is NO way of meeting both needs. There is no fairy dust. There are no 'safe' medications that are being withheld. Strong drugs have potentially dangerous side effects and are addictive but work for a while. Weaker safer (but not safe - all drugs carry risk) may be less effective. This is not the fault of the doctors. They cannot magic up completely safe and strong medication. It doesn't exist. In this case it is the very nature and effect of the diazepam that helps that causes the risk. Doctors balance difficult risk vs benefit decisions day in day out. You cannot demand they work outside of their professional judgement and advisory evidence based guidelines.

Just out of interest, are alcoholics still prescribed benzos for the withdrawal?

Yes, they do

OP unless you are medically qualified, you would be best following the advice of the GP (who is).

Also from a selfish point of view if you’ve prescribed something against guidelines your insurance doesn’t cover you. I don’t know what would happen if someone got a clot and the plane had to be diverted in these circumstances but even if the patient / their family didn’t sue you I wouldn’t put it past an airline to take legal action against the prescriber - proving that the low dose diazepam didn’t contribute would be impossible confused

I don’t even know where to start unpicking the wrongness of the assumptions here,

1. taking medication prescribed by your go will not vitiate your insurance

2. the burden of proof if an airline brought a claim against the prescriber - the burden of proof would be on the airline, not on the prescriber to prove diazepam didn’t contribute !

I have done lots of long haul flights over the last 2 years and my GP has prescribed Valium (diazepam) for each one. Think it varies from GP to GP.

OP I feel your pain
I'm not a great flyer but fly a lot
I managed to get 8 x 2mg diazepam off my GP before my last flight a few weeks ago

I take propranolol as I get to the airport, then I drink a lot and take some diazepam.
To be honest if you're anxiety is ++++ you'll find it very difficult to be sedated by diazepam

You can buy it over the counter in some pharmacies in Thailand and Cambodia

I've recent bought zopiclone for flights which had knocked me out for 7 hours both ways and the best flights I've ever had

Disclaimer - I'm a nurse! We take anything and everything

I take both propranolol (for high B.P. and tremor) and alprazolam (similar to Valium - I'm not in the U.K. and my psychiatrist has no problem prescribing it).

I did ask her but she wasn’t very forthcoming about what to expect and how long it lasts. I know I’m a layperson but I’m capable of understanding that much.

Propranolol only lasts about 4-5 hours, though larger doses (above 40mg) can take longer to wear off. How many did you get? I honestly don't think 10mg will do much if you're very anxious. I find 40mg makes me quite tired and I feel a bit like I'm wading through treacle. Pretty sure that in order to overcome your anxiety with propranolol, you'd need a dose that's more incapacitating than a couple of mg of Valium.

Also surely it's safer for you to take a medication you've taken before, knowing how it affects you, than taking a brand-new-to-you medication for the first time on s long haul flight?

@Aridane

That poster is a GP talking about her own medical indemnity insurance - you know, the insurance GPs have to spend c.£8,000 on every year in order to be able to practise...

If a GP prescribes something not in accordance with the guidelines, and something goes wrong (e.g. DVT on plane), then we will not be covered by our medical indemnity insurance, and will be bankrupted if the patient’s family sues.

@Aridane

She wasn’t talking about the OP’s travel insurance...

I wonder if my friend knows this, she normally takes 20mg to get on a plane shock

I take it your friend has some sort of long term anxiety disorder and has been taken diazepam a long time??? Becasue 20mg is by far in excess of starting doses. I have patients who dont even get doses that big for severe acute anxiety and agitation alongside chronic psychosis.

I have pericyazine for anxiety it is an old anti psychotic used in a tiny amount for anxiety

Not travel insurance, doctors' insurance to practice. We are not 'indemnified' to practice against guidelines.