We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Flumazenil
From WikEM
Contents
Administration
- Type: Benzodiazepine Antidote
- Dosage Forms:
- Routes of Administration: IV
- Common Trade Names:
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
- Treat with phenobarbital or propofol; benzodiazepines will not work
