While it may be true that flumazenil is relatively safe, I am not impressed with the benefit that it is likely to offer benzodiazepine overdose patients.įirstly, in the 10-year study by the poison center, only half of the patients who received flumazenil woke up afterward. Given this more recent data, it seems unlikely that flumazenil would be harmful when given to overdose patients, and that patients with pro-convulsant co-ingestion might be the only group to be concerned about. 8 of the 13 patients who seized had also taken pro-convulsant medications. Out of 904 patients, there were 13 patients with seizures and 1 death following flumazenil administration. In the present decade, some slightly more robust data has been presented suggesting the risk of seizure from flumazenil in benzodiazepine toxicity may be overstated.Ī single-center retrospective observational study of 23 adult patients administered flumazenil for known or suspected benzodiazepine overdose in the ED, revealed that no patient experienced a seizure.Ī poison center published 10 years of data on flumazenil administration in acutely poisoned adults. In addition to these human case reports, rat and dog data suggest the increased risk of seizure when flumazenil is given. Lorazepam, phenytoin, and phenobarbital were administered however, seizures persisted for 4 hours, resulting in rhabdomyolysis, acute renal failure, severe brain damage, and death.Īnother set of authors reported the occurrence of a generalized tonic-clonic seizure in a pediatric patient following the administration of flumazenil.Ī review of 43 seizures reported with flumazenil identified that almost half of the cases involved co-ingestion of a pro-convulsant agent (such as a tricyclic antidepressant). The patient developed refractory seizures. This risk was described in case reports in the early 1990’s.Ī 39-year-old woman who overdosed on benzodiazepines and tricyclic antidepressants was treated with flumazenil. Many providers insist on not using flumazenil in benzodiazepine overdose scenarios due to the risk of precipitating acute benzodiazepine withdrawal and seizures. The onset of action is 1-2 minutes and the effect lasts for about 1 hour. The usual dose is 0.2 mg over 15-30 seconds, repeated every minute if needed. – Reversal of conscious sedation and general anesthesia The approved indications for flumazenil are: It is classified as an antidote to benzodiazepines. Flumazenil is a competitive benzodiazepine receptor inhibitor.
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