“I’ve got a long-haul flight on Saturday and I can’t do it without a few diazepam — my old GP always gave them”

Requests for benzodiazepines for flight anxiety are common. Many GPs decline them because of sedation and paradoxical reactions, impaired ability to respond in an emergency, increased risk of venous thromboembolism from prolonged immobility while sedated, legal restrictions in some countries, and because they do not treat the phobia. Pregnancy adds weight: benzodiazepines are avoided where possible in pregnancy (check the SPC), and pregnancy itself raises VTE risk. RCOG guidance on reducing the risk of VTE in pregnancy treats long-distance travel (over 4 hours) as a transient risk factor; with additional risk factors such as age over 35, BMI 30 or more, an IVF pregnancy or a family history of VTE, an individual assessment is needed and thromboprophylaxis may be advised by the maternity team. General travel advice in pregnancy: mobilise and do calf exercises, stay hydrated, avoid alcohol, wear well-fitted graduated compression stockings, choose an aisle seat, carry maternity notes, and check that travel insurance covers pregnancy; airlines may ask for a letter later in pregnancy (often after 28 weeks). Non-drug approaches to flight anxiety include slow breathing, grounding, distraction, telling the crew and, longer term, CBT-based courses. The hidden agenda is acute grief complicated by guilt after an estranged parent’s sudden death, with panic attacks: acknowledge it, assess mood and risk, offer bereavement support and NHS Talking Therapies, and follow up on return. Holding a prescribing boundary is easier when the patient feels heard and leaves with a better plan than the one she came for.