What is the best medication for managing airplane anxiety?

Best Medication for Airplane Anxiety

Benzodiazepines, particularly alprazolam or diazepam, are the most effective medications for managing airplane anxiety when used appropriately for short-term relief.

First-Line Medication Options

Benzodiazepines

Benzodiazepines are the drugs of first choice for situational anxiety like airplane travel due to their rapid onset and effectiveness 1:

• Alprazolam (Xanax):

  • Indicated for anxiety disorders and short-term relief of anxiety symptoms 2
  • Dosing: 0.25-0.5mg taken 30-60 minutes before flight
  • Benefits: Rapid onset, effective for panic symptoms that can occur during flights
  • Duration: 4-6 hours, appropriate for most flights

• Diazepam (Valium):

  • Dosing: 2-10mg (0.1-0.8mg/kg) as a single oral dose 30-60 minutes before flight 1
  • Benefits: Longer duration of action (6-8 hours), good for longer flights
  • Less likely to cause rebound anxiety between doses

Important Considerations

1. Timing is critical: Medication should be taken 30-60 minutes before boarding to ensure peak effect during the flight 1

2. Trial before travel: If possible, try the medication before your trip to assess your individual response and appropriate dosage

3. Avoid alcohol: During the flight, alcohol consumption should be avoided as it may alter cognitive function and trigger anxious states 3

4. Avoid caffeine: Excessive consumption of caffeine should be avoided as it can have diuretic effects and may increase anxiety 3

Special Populations and Precautions

• Elderly patients: Should use lower doses of benzodiazepines (reduced by 50%) due to increased sensitivity 1

• Patients with substance abuse history: Require careful assessment for signs of misuse 1

• Driving restrictions: Patients must not drive after receiving benzodiazepines 1

Potential Drawbacks of Benzodiazepines

Research has shown some important limitations to consider:

• A study of flight phobics found that while alprazolam reduced self-reported anxiety during initial exposure, it was associated with increased anxiety during subsequent flights and hindered therapeutic effects of exposure therapy 4

• Risk of dependence with regular use, which is why they should be limited to short-term, situational use 1

Alternative Medications

If benzodiazepines are contraindicated or not preferred:

• Buspirone: Indicated for anxiety disorders 5, but has slower onset (2-3 weeks) making it less suitable for situational anxiety like air travel

• SSRIs: May be beneficial for those with chronic flight anxiety who travel frequently, but require weeks of treatment before effects are seen 6, 7

Non-Pharmacological Approaches

These should be used alongside medication for optimal results:

• Use earplugs or eye shades during the flight 3
• Practice relaxation techniques and deep breathing exercises
• Book a flight time in late morning or early afternoon 3
• Consider requesting early boarding to reduce stress 3
• Whenever possible, book direct flights 3

Conclusion

For most travelers with airplane anxiety, a short-acting benzodiazepine like alprazolam or diazepam taken 30-60 minutes before the flight provides the most effective relief. For frequent flyers, consider cognitive behavioral therapy for long-term management, as medication alone may lead to dependence or diminished effectiveness over time.