FLUMAZENIL

Antidote for benzodiazepine poisoning with antagonistic activity on benzodiazepine receptors

Dosage Forms

Solution for Injection

0.1 mg/ml

Uses

  • Management of benzodiazepine toxicity in anaesthesia, intensive care, and clinical procedures

Dose and Duration

Anaesthesia and clinical procedures
By IV injection
Adult: 0.2 mg over 15 seconds, then 0.1 mg at 60 second intervals if required. Usual dose range, 0.3–0.6 mg (maximum total dose, 1 mg)
Child 1 month–18 years: 0.01 mg/kg (max 0.2 mg). Repeated at 1 minute intervals if required. Maximum total dose of 0.05 mg/kg
Neonate: 0.001 mg/kg repeated at 1 minute intervals if required
If drowsiness recurs after injection, by IV infusion,
Child 1 month–18 years: 0.002- 0.01 mg/kg/hour, adjusted according to response. Maximum dose 0.4 mg/hour
Neonate: 0.002- 0.01 mg/kg/hour, adjusted according to response
Intensive care
Adult: by IV injection, 0.3 mg over 15 seconds, then 0.1 mg at 60 second intervals if required (maximum total dose 2 mg) if drowsiness recurs either, by IV injection, 0.3 mg; or by IV infusion of 0.1–0.4 mg/hour adjusted according to response
Child and neonate: dose same as for anaesthesia

Preparation

  • Can be used without dilution. For continuous IV infusion, dilute with Glucose 5% or Sodium Chloride 0.9%

Contraindications

  • Hypersensitivity to flumazenil
  • Where benzodiazepine used for treatment of a life-threatening condition such as status epilepticus, increased intracranial pressure

Side Effects

  • Nausea, vomiting
  • Increased risk of panic disorders in patients with history

Pregnancy

  • Can be used

Breast-feeding

  • Can be used

⚠️ Caution

  • Avoid breast-feeding for 24 hours after treatment with flumazenil
  • Repeat doses often required since half-life of most benzodiazepines is longer than half-life of flumazenil
  • Benzodiazepine dependence may precipitate withdrawal symptoms
  • Risk of convulsions when flumazenil is given to patients on prolonged benzodiazepine therapy for epilepsy
  • Ensure neuromuscular blockade has cleared before giving
  • Avoid rapid injection in high-risk or anxious patients and following major surgery
  • Use cautiously in patients with head injury since rapid reversal of benzodiazepine sedation may cause convulsions
  • Carefully titrate dose in hepatic failure