Pharm
Benzodiazepine antagonist
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Benzodiazepine antagonist
, Flumazenil, Romazicon
Indication
Benzodiazepine
sedation reversal
Contraindications
Mixed drug
Overdose
with compounds that may cause
Seizure
(e.g.
Tricyclic Antidepressant
s,
Cocaine
)
Chronic
Benzodiazepine
use (dependence)
Seizure Disorder
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
Titrate: 0.3-0.5 mg q30 seconds 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
Dosing
Children
Initial: 0.005 to 0.2 mg IV over 3-5 minutes, titrating to effect
Precautions
Avoid in patients with chronic use (risks of severe withdrawal including
Seizure
s)
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
Benzodiazepine
s
Increases risk of drugs that lower
Seizure
threshold (
Cocaine
,
Tricyclic Antidepressant
s)
Pharmacokinetics
Onset: 1 to 2 minutes
Peak: 6 to 10 minutes
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