Ask the doctor: I’m dreading a long haul flight — will Xanax help?

The fear of flying, known as aerophobia, is the extreme sense of fear and panic some people experience when flying and involves intense symptoms of anxiety. Photo: Getty Images

Jennifer Grant

March 14 2023 02:30 AM

Question: I’m going on a long haul flight soon and wanted to ask my GP for something to help with anxiety and restlessness on the flight. I took a Xanax someone gave me before and it worked wonders — is that the best thing to ask for?

Dr Grant replies: The trade name Xanax (drug name alprazolam) is one of the more commonly prescribed benzodiazepines (a type of sedative and anti-anxiety medication) to help relieve short-term anxiety prior to medical procedures or during long haul flights.

It should be taken in the longest possible effective dose for the shortest possible time. It should only be taken as prescribed by a doctor and not with alcohol- or opioid-containing painkillers. After taking the medication the peak blood concentration is reached within one to two hours, making you feel sleepy and relaxed usually within one hour. The fast-acting properties of Xanax makes it prone to being a drug of misuse. For this reason, doctors are often not keen to prescribe it. The duration of action is on average up to 11 hours.

Ideally, you should avoid taking medication unless it is completely necessary. What’s more, benzodiazepines are only advised for the short-term use during a crisis in a patient with a Generalised Anxiety Disorder (GAD). Fear of flying in isolation does not qualify as a GAD. Have you ever suffered a panic attack or any type of anxiety disorder? If you have a history of drug/alcohol misuse or are taking any other medication that may interact badly with a benzodiazepine, you need to consider alternative options.

Have you ever tried to seek help to improve your current coping strategies before a long haul flight? Often, a fear of flying is not due to flying itself but stems from related factors. One treatment approach is called controlled exposure-based therapy that works by gradually exposing the person to the object or situation that frightens them. Cognitive Behavioural Therapy is also a proven treatment option.

A few important and practical things to remember prior to flying include staying well-hydrated during the flight to help prevent developing clots, associated with long haul travel. Any kind of movement will improve the return of blood back to the heart and help prevent blood clots. Try to rotate your ankle in a circular motion and pump your calf muscles by pointing your toes up and down to help encourage blood flow.

If possible, try to book express lanes and early boarding options as this may help reduce some of the factors around your fear of flying. Noise-cancelling headphones may be helpful, particularly if you find music or listening to an audiobook soothing. Try to pack plenty of healthy snacks that are not high in sugar but that you enjoy and eat regularly. Restrict your caffeine intake (or any other potential stimulants) as they may increase your fear of flying.

In the few weeks prior to your flight, practice regular meditation and relaxation/breathing exercises as they can help reduce anxiety. Lastly, remember on any given flight there are plenty of people feeling anxious for a multitude of reasons, so ask for assistance if needed.

Dr Jennifer Grant is a GP with Beacon HealthCheck