Adult Dosing
Benzodiazepine reversal
- Initial dose 0.2 mg IV x 2; additional doses may be given at 1 min intervals until desired results are obtained
- Max total dose: 1 mg
- If resedation occurs, regimen may be repeated at 20-min intervals, not to exceed 3 mg/hr
Benzodiazepine overdosage
- 0.2 mg IV; additional 0.3 mg may be given 30 sec later if required
- Further doses of 0.5 mg may be given at 1-min intervals, if necessary
- Max total dose: 3 mg
- Usual dose required is 1-3 mg
- If resedation occurs, additional doses of 0.5 mg/min for 2 mins may be given at 20-min intervals (given no more than 1 mg at a time, not to exceed 3 mg per hour)
Pediatric Dosing
Benzodiazepine reversal
- >1yr: 0.01 mg/kg (up to 0.2 mg) IV (over 15 sec) x 1
- If the desired level of consciousness is not obtained after waiting an additional 45 sec, further injections of 0.01 mg/kg (up to 0.2 mg) can be administered and repeated at 60-sec intervals when necessary (up to a maximum of 4 additional times) to a maximum total dose of 0.05 mg/kg or 1 mg, whichever is lower
- Max: 0.2 mg/dose, 0.05 mg/kg upto 1 mg total dose
Benzodiazepine overdose (Non FDA approved)
- >1yr: 0.01 mg/kg IV (over 30 sec) qmin PRN
- Max: 0.2 mg/dose, 0.05 mg/kg upto 1 mg total dose
[Outline]
- The reversal of benzodiazepine effects may be associated with the onset of seizures in certain high-risk populations including the following: concurrent major sedative-hypnotic drug withdrawal, recent therapy w/ parenteral BZDs, seizure activity or myoclonic jerking in overdose cases, concurrent cyclic antidepressant poisoning
- Convulsions associated with flumazenil are successfully managed with BZDs, phenytoin or barbiturates
- Monitor patients for resedation, respiratory depression, or other residual benzodiazepine effects for up to 120 minute based on the dose and duration of effect of the benzodiazepine employed
- Overdose cases should always be monitored for resedation until the patients are stable and resedation is unlikely
- The effects of flumazenil may wear off before a long-acting BZD is completely cleared from the body
- Flumazenil may be associated with BZD withdrawal symptoms in patients who have taken BZDs for prolonged duration to have some degree of tolerance or physical dependence
- Use of flumazenil to diagnose benzodiazepine-induced sedation in the ICU is not recommended due to the risk of unrecognized benzodiazepine dependence
- Do not use flumazenil until effects of neuromuscular blocking agents have been fully reversed
- Flumazenil is intended as an adjunct to, not a substitute for, proper management of overdose patients (eg, airway maintenance, assisted breathing, circulatory support, decontamination)
- Use with caution in head injury patients due to risk of precipitation of convulsions, or alteration of cerebral blood flow
- Flumazenil may provoke panic attacks in patients with a history of panic disorder
Cautions: Use cautiously in
- Hepatic impairment
- Psychiatric disorder
- Hx of seizure disorder
- Risk of seizures
- Head injury
- Alcoholism
- Chronic BZD use for seizures
Pregnancy Category:C
Breastfeeding: Safety unknown, manufacturer advises caution.
