II. Indication
- Benzodiazepine sedation reversal
III. Contraindications
- Mixed drug Overdose with compounds that may cause Seizure (e.g. Tricyclic Antidepressants, Cocaine)
- Chronic Benzodiazepine use (dependence)
- Seizure Disorder
IV. Dosing: Adults
-
Benzodiazepine Sedation Reversal
- Initial: 0.2 mg IV over 15 seconds
- Titrate: 0.2 mg each minute to 1 mg total
-
Overdose Reversal
- Initial: 0.2 mg IV over 30 seconds to 2 minutes
- Titrate: 0.3-0.5 mg every 1 to 2 minutes to 3 mg total
- Repeat dosing protocol
- Repeat Dose: 0.005 mg/kg q1-2 minutes
- Maximum cumulative dose: 1 mg
- May repeat regimen every 20 minutes
V. Dosing: Children
-
Overdose Reversal
- Start: 0.01 mg/kg slow IV push over 1 to 2 minutes (maximum 0.2 mg)
- May repeat at 1 minute intervals up to 4 doses at 0.0005 to 0.01 mg/kg
- Maximum total 0.05 mg/kg (or 1 mg)
- Ttrate to effect
VI. Precautions
- Avoid in patients with chronic use (risks of severe withdrawal including Seizures)
- Most toxicology guidelines do not recommend Flumazenil in Overdose
- Potential harms appear to outweigh benefits in most cases
- Penningo (2016) Basic Clin Pharmacol Toxicol 118(1): 37-44 +PMID:26096314 [PubMed]
- May cause acute withdrawal if physically dependent
- Do not give routinely to comatose patients
- Only use if identity of drug is known, and certain that the patient has not used chronically
- Reverses Seizure protection of Benzodiazepines
- Increases risk of drugs that lower Seizure threshold (Cocaine, Tricyclic Antidepressants)
VII. Pharmacokinetics
- Onset: 1 to 2 minutes
- Peak: 6 to 10 minutes