Flumazenil

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Administration

Adult Dosing

  • 0.2 mg IV; if inadequate response after 30s, give additional 0.3 mg IV; if inadequate, repeat doses of 0.5 mg IV q1 min to MAX total dose of 3 mg
  • If only partial response to 3mg, may slowly titrate to 5mg

Pediatric Dosing

  • >1 year old: 0.01 mg/kg (up to 0.2 mg) IV; if inadequate after 45s, repeat 0.01mg/kg (up to 0.2mg) q1 min up to 4 times. Max total dose 0.05mg/kg or 1mg (whichever is lower)

Special Populations

  • Pregnancy Rating: C
  • Lactation risk: Infant risk cannot be ruled out
  • Renal dosing: No adjustment
  • Hepatic dosing: no change to initial dose, reduce dose or frequency of subsequent doses

Contraindications

  • Allergy to class/drug
  • Need for benzodiazepine to control potentially life-threatening condition (e.g. seizures in raised ICP, status epilepticus)
  • Suspected or known physical dependence on benzodiazepines
  • Suspected TCA overdose
  • Co-ingestion of seizure-inducing agents
  • Known seizure disorder
  • Suspected increased intracranial pressure

Adverse Reactions

Serious

  • Cardiac dysrhythmias
  • Seizure in patients relying on benzodiazepines for seizure control or who are physically dependent on benzos, or who have ingested large doses of other drugs
  • Death (in same patients as above)

Common

  • Dizziness, headache, visual changes
  • Agitation
  • Diaphoresis

Pharmacology

  • Half-life: 40-80 min
  • Metabolism: Hepatic
  • Excretion: Mostly renal

Mechanism of Action

  • Competitive GABA antagonist

Comments

  • Really only safe for use in benzo-naive patients who have had known benzo-only overdose (e.g. pediatric patient who was given too much for sedation)
  • Flumazenil-Induced Seizure

See Also

References