INTRODUCTION
We understand that some patients experience anxiety related to medical tests or procedures, travel, or dental treatment. This policy explains our practices position on prescribing sedative or anxiolytic medication (such as diazepam or lorazepam) for situations that are not part of NHS medical treatment provided by this practice.
General position
As a GP practice, we do not routineyl prescribe sedative medication for situational anxiety related to non-medical or externally arrasnged procedures.
This includes, but is not limited to:
- MRI or dental scans
- Dental procedure
- Fear of flying or travel related anxiety
- Claustrophobia associated with private tests or procedures
WHY WE DO NOT PRESCRIBE IN THESE CIRCUMSTANCES
Prescribing responsibility:
Hospital consultants, who request and perform imaging, have the same prescribing capabilities as GP s if a patient requires medication to process with an investigation, the consultant is better positioned to prescribe it, either through the hospital pharmacy or a hospital prescription. GPs are not regularly trained or appraised in sedation techniques.
Ineffective sedation
A 2mg dose of diazepam (benzodiazepine) is typically sub therapeutic for most adults and may not effectively sedate the patient. Furthermore, anxiolytics can have idiosyncratic responses in patients, and even small doses may cause agitation in certain individuals.
Timing issues
Patients might take a sedative an hour before the procedures only to find that the procedure has been delayed, making the sedative timing less effective.
Patient safety
Sedative medications can cause side effects such as drowsiness, imapired coordination, breathing difficulties and confusion. they may also interact with other prescribed medicines or alcohol.
Regulatory guidance
National guidance advises that benzodiazepines and similar medications should:
- Be prescribed for short-term, clinically appropriate indications only
- Not to be used for situational anxiety
- Be avoided where risks outweigh potential benefits
Medico-legal considerations
Prescribing sedation without direct responsibility for the procedures exposes patients to risk and falls outside the scope of safe general practice prescribing.
MRI AND CT SCANS
If a patient requires sedation for an MRI or CT scan due to anxiety or claustrophobia:
Please ask them to discuss this with the imaging provider or hospital department
Many radiology services offer:
- Open or wide-bore scanners
- Support during the scan
- Sedation arranged and supervised by their own clinical team where appropriate
The royal college of radiologists makes no mention of GP involvement in the provision of low-dose anxiolytics. The college stresses the importance of well-trained staff and proper patient monitoring as detailed in their guidelines:
“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.”
DENTAL PROCEDURES
For anxiety related to dental treatment:
- Your dentist is responsible for assessing and arranging sedation if required
- Dentists can offer local anaesthesia, conscious sedation, or refer to specialist services if needed
- We are unable to prescribe sedatives for dental procedures
FEAR OF FLYING OR TRAVEL ANXIETY
We do not prescribe sedatives for fear of flying or travel related anxiety because:
- Sedatives may impair awareness and reaction times in emergency situations
- They increase the risk of blood clots during long periods of immobility
- They may cause paradoxical agitation or disinhibition
- Airlines and insurers may advise against their use
We recommend:
- Non-medication approaches such as anxiety management courses, fear of flying programmes, or talking therapies
- Cognitive behaviour therapy (CBT) which has good evidence for managing phobias
WHAT WE CAN HELP WITH
We are happy to:
- Discuss anxiety symptoms in a routine appointment
- Explore non-medication strategies for managing anxiety
- Refer to talking therapies such as NHS talking therapies (IAPT), where approriate
- Review long term anxiety conditions and ongoing treatment plans