Toxicology 8: Bendodiazepine Overdose Portal
| Pharmacology: | Flumazenil (Romazicon) antagonizes the action of benzodiazepines via competitive inhibition at the GABA receptor. |
| Pharmacokinetics: | Onset of action = 1 to 3 minutes; Peak effect = 6 to 10
minutes Distribution t ½ = 7 to 15 minutes; Terminal t ½ = 41 to 79 minutes Cleared by the liver; clearance altered in liver disease |
| Indications: |
NOTE: The use of Romazicon does not diminish the need for prompt detection of hypoventilation nor for effective intervention by establishing an airway and assisted ventilation. |
| Dosing: |
Initial dose is 0.2 mg IV over 30 seconds. Wait an
additional 30 to 60 seconds and, if there is no response, give 0.3 mg
over 30 seconds.
Can give additional dose of 0.5 mg over 30 seconds at
60-second intervals up to 3.0 mg. Patients who respond at 3.0 mg can be
titrated up to 5.0 mg. May repeat treatment at 20-minute intervals if sedation occurs (should monitor for sedation for at least 2 to 3 hours). Can give up to 1 mg at any time and up to 3 mg per hour. Flag syringes/bags should be flagged (as is often done with Narcan) to make personnel aware of contents. Continuous infusion is rarely needed but can use 15 to 25 µg/min |
| Pediatric Dosing: | PEDS: Start with smaller doses 0.01 to 0.02 mg/kg initially and can increase to adult dosing. |
| Precautions: |
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| Contraindications: |
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| Side Effects: | Nausea/vomiting, dizziness, agitation, headache, paresthesia, fatigue, cutaneous vasodilation, abnormal vision |