7/28/2023 0 Comments Flumazenil antidote dose![]() ![]() In such cases, withhold flumazenil and allow the patient to remain sedated (with ventilatory and circulatory support as needed) until the signs of cyclic antidepressant toxicity have subsided. Flumazenil is contraindicated in the presence of serious concurrent cyclic antidepressant overdose or poisoning as manifested by motor abnormalities (twitching, rigidity, focal seizure), dysrhythmia (wide QRS, ventricular dysrhythmia, heart block), anticholinergic signs and symptoms, and cardiovascular collapse at presentation. Possible risk factors for seizures include: concurrent major sedative-hypnotic drug withdrawal, recent therapy with repeated doses of parenteral benzodiazepines, and myoclonic jerking or seizure activity prior to flumazenil administration in overdose cases. It should be used only by practitioners prepared to manage such complications should they occur. Use flumazenil with caution in patients with head trauma as it may be capable of precipitating convulsions or altering cerebral blood flow in patients receiving benzodiazepines. Flumazenil is contraindicated in patients who have received a benzodiazepine for the control of life-threatening conditions such as the control of increased intracranial pressure and status epilepticus. Use of flumazenil can precipitate signs of benzodiazepine withdrawal, which may precipitate seizures. Seizures are most frequent in patients receiving long-term benzodiazepine therapy (benzodiazepine dependence). Journal of Toxicology-Clinical Toxicology 2004 42(2):209-216.Alcoholism, benzodiazepine dependence, head trauma, increased intracranial pressure, overdose, seizure disorder, seizures, status epilepticus, substance abuseįlumazenil therapy has been associated with seizures. Should a benzodiazepine antagonist be used in unconscious patients presenting to the emergency department? Resuscitation 2007 74(1):27-37. Treatment of benzodiazepine overdose with flumazenil. The flumazenil in benzodiazepine intoxication multicenter study group.QRS prolongation on the ECG to suggest a possible co-ingestion with a sodium channel blocking drug (i.e.Known or suspected benzodiazepine dependance.Known or suspected co-ingestion of a pro-convulsant.This decision needs to be weighed up with the ability for a ward to manage an infusion and with large adult ingestions it can be easier, quicker and potentially safer to intubate and transfer to ICU ![]() Sometimes a flumazenil infusion is warranted.Re-sedation is likely to occur at 90 minutes whereupon further doses will be required.Paediatric dose = 0.01 – 0.02 mg/kg, repeat every minute.Adult dose = 0.1 – 0.2 mg IV and repeat every minute until there is reversal (max dose not exceeding 2mg).Only administer in an area that can manage potential seizures.The main hesitation for its use relates to dependency of benzodiazepines and mixed overdoses which if the benzodiazepine is reversed my precipitate seizures which will be difficult to control. Usually to reverse procedural sedation, accidental paediatric ingestion with compromise, and rarely to help make a diagnosis of benzodiazepine overdose or if a patient’s airway is compromised without quick access to intubation equipment. Flumazenil is a competitive benzodiazepine antagonist with a limited role in the management of benzodiazepine poisoning.
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