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Benzodiazepine Prescribing 

 

We will no longer prescribe medications such as diazepam, temazepam, lorazepam, clonazepam and zopiclone(z-drugs) for fearing of flying or to aid sleep on long haul flights (see separate policy).

Prescribing Policy for Hypnotics, Anxiolytics and Z-drugs

In line with national and local and national first line treatment should be non-pharmacological measures and if not successful consider prescribing if other interventions have not been successful consider prescribing hypnotics and anxiolytics where indicated, first line options should be as follows: 

  • Anxiolytic – diazepam
  • Hypnotic – temazepam or zopiclone

Initial prescribing, document the following: 

  • Maximum of 14 days’ supply and at lowest effective dose (acute prescription)
  • Document indication
  • Other possible causes of sleep disturbances (examples; pain, dyspnoea, depression) and treat appropriately 
  • Follow-up with clinician (after 2 weeks – please note should not be prescribed for more than 2 to 4 weeks including tapering off) 
  • Advised patients on risks of taking medication, dependency, tolerance and addiction
  • Those on regular benzodiazepines or z drugs, if appropriate, counselled for a withdrawal scheme with aim to gradually reduce drug dosage to zero. NICE recommendation: reduction of 5-10% every 1-2 weeks, or an eighth of the daily dose every 2 weeks. 
  • Patients who are unable or unwilling to reduce drug dosage or who use more than one drug of abuse potential, or dependent on alcohol may be referred to substance misuse service as appropriate
  • Advised patients on other non-pharmacological therapies alongside such talk changes, physio, sleep hygiene etc. 
  • Should only be on repeats if under severe mental health problems under care of psychiatrist, benzodiazepine in epilepsy or terminally unwell.

Resources

Claustrophobia and refusal to have MRI scans

It’s estimated that every year, approximately two million MRI scans worldwide are not performed because of patients refusing to be scanned or terminating the scan early due to claustrophobia. 

There are many resources online that can help prepare patients on what to expect during a scan including step by step explanations and videos of MRIs being performed.  In more severe cases, the NHS website suggests that mild sedatives are an option for people with severe MRI anxiety. 

The 2018 Royal College of Radiologists' guidance quoted in this article in 2018 indicated that it was not appropriate for GPs to prescribe sedatives for patients receiving a scan due to the need for pre and post assessment and monitoring by trained practitioners. This guidance was updated in October 2024, and now includes the following line:

"Patients undergoing outpatient investigations such as CT and MRI may require premedication with standard oral anxiolytics prior to attendance for the examination. These may be prescribed by the referring clinical team or general practitioner and these patients do not require any specific recovery or assessment before discharge."

Of course, individual prescribers will still need to consider the GMC prescribing guidance with regard to doctors being responsible for their decisions and actions, and ensuring that prescriptions are appropriate, necessary and safe.

We would therefore suggest that if we are referring for the scan and the patient requires sedation that we consider prescribing taking full account of the risks and counselling the patient accordingly. If the scan is requested by secondary care prescribing any such sedatives should be their responsibility.