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Reversal for Benzodiazepines

 

Reversal for Benzodiazepines:  Flumazenil (Romazicon)

    

Route

Onset of Action

Peak Effect

Duration of Action

IV (bolus or infusion)

1-2 minutes

6-10 minutes (but 80% of the maximum response is seen within 3 minutes.)

 Call anesthesia if there is no desired clinical response with the administration of the initial 1 mg.

45-90 minutes

 

Specific benzodiazepine antagonist, used for complete or partial reversal of the sedative effects of benzodiazepines; management of benzodiazepine overdose

 

Administration Technique

IV bolus:

1)      Phase One:  Initially 0.2 mg IV over 15 seconds to one minute.  If patient does not reach desired level of consciousness after 45 seconds…

2)      Phase Two:  Repeat dose at one minute intervals until a cumulative dose of 1 mg has been administered (includes initial dose in phase one).  If no response to treatment is noted, call anesthesia for assistance.

IV infusion:

            30-60 ug/minute (0.5-1 ug/kg/min).  Total dose not to exceed 3 mg/hour.

 

Special considerations

  • Individualized dosage is required, manufacturer does not recommend the administration of flumazenil to patients under the age of 18.

 

  • Flumazenil- induced seizures have been reported in patients with chronic physical dependence to benzodiazepines or patients recently undergoing multiple procedures requiring multiple large doses of benzodiazepines.

 

  • Patients who have responded to flumazenil should be carefully monitored (up to 120 minutes) for resedation.

 

  • To avoid pain and inflammation at the site of injection, administration of flumazenil via a large vein is recommended.

 

  • Overdose:  Excessive doses result in anxiety, agitation, increased muscle tone, and possible convulsions.

Adverse effects

  • Respiratory – return of respiratory depression which has exceeded the therapeutic effects of flumazenil.

 

  • Cardiovascular – cutaneous vasodialation, sweating, and flushing, dysrhythmias, bradycardia, tachycardia, hypertension.

 

  • CNS – dizziness, headache, abnormal or blurred vision, confusion, and convulsions.

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