flumazenil (Romazicon®)
Benzodiazepine receptor antagonist
Flumazenil antagonizes the actions of benzodiazepines on the central nervous system. It has been shown to antagonize sedation, impairment of recall, and psychomotor impairment produced by benzodiazepines. Flumazenil does not antagonize CNS effects of ethanol, barbiturates or opioids.
1-2 minutes.
Generally less than that of the benzodiazepine
Reversal of benzodiazepine sedation
Overdose of unknown substances
Underlying dependence upon benzodiazepines.
Hypersensitivity to flumazenil or to benzodiazepines.
Cyclic antidepressant overdose
Nausea and vomiting, dizziness, agitation
Injection-site pain, cutaneous vasodilation
Abnormal vision, seizures
Toxic effects of mixed drug overdose (especially cyclic antidepressants) may emerge with the reversal of the benzodiazepine effects.
5 and 10 ml vials (0.1mg/ml)
0.2 mg IV over 30 seconds; and additional dose of 0.3 mg may be given in 30 seconds, followed by 0.5 mg at 1 minute intervals (maximum dose 3 mg)
Not recommended
Pregnancy Safety: Category C
To minimize the likelihood of injection-site pain, administer through an IV infusion established in a large vein.
Be prepared to manage seizures in patients who are physically dependent on benzodiazepines to control seizures or who have ingested large doses of other drugs.
Flumazenil may precipitate withdrawal syndromes in patients who are dependent on benzodizepines.
Patients should be monitored for possible resedation, respiratory depression, or other residual benzodiazepine effects.
Be prepared to establish and assist ventilations.