Introduction:
Flumazenil is a well recognised antidote for benzodiazepines. It is a competitve benzodiazepine receptor antagonist. It’s use in clinical practise is common for iatrogenic benzodiazepine toxicity. Flumazenil is an effective antidote in situations where clinicians have overestimated the dose and effect of benzodiazepines used in procedural sedation. Flumazenil immediately restores the patient’s conscious level to pre-sedation level when there are concerns of airway and respiratory compromise.
In recent years, the use of flumazenil as an antidote in situations where patients have intentionally or unintentionally overdosed on benzodiazepines has become controversial. The incidence of patients developing seizures or dysrhytmias after administration of flumazenil has lead to a change in how the antidote is used in clinical practise.
Discussion:
Can flumazenil be administered safely when dealing with unknown drug toxicity? Should clinicians continue to use flumazenil when managing suspected benzodiazepine overdose outside of clinical practise? What precautions should the clinician take when using the antidote?
Understanding how benzodiazepines can help to reduce the toxic effect of other co-ingestions is important. In certain situations removing the therapeutic effects of benzodiazepines may cause more harm. Benzodiazepine dependence is also an important factor to consider before administered flumazenil. Navigating the do’s and don’ts when considering the use of flumazenil in a possible benzodiazepine overdose will be elaborated in this presentation.
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