Fear of flying

ICD-10 F40.21 drug

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

FAlprazolamNot recommended · Benzodiazepines. Short-to-medium-acting anxiolyticsTaking alprazolam 'before a flight' is a common request, but in fear of flying it interferes with recovery. First-line treatment for a specific phobia is cognitive behavioural therapy with exposure. In a randomised trial (Wilhelm and Roth, 1997), 1 mg of alprazolam before a first flight reduced subjective anxiety but raised heart and respiratory rate. On a second flight, now without the drug, the alprazolam group was more anxious and had more panic attacks than placebo: the benzodiazepine undermines the therapeutic effect of exposure and reinforces avoidance. Added to this is the high dependence potential of a short-acting drug; it should be tapered gradually rather than stopped abruptly.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit