You are discussing with your junoir the below medication
Q1.What are the indications and contraindications?
Q2.What are the expected adverse events?
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You are discussing with your junoir the below medication
Q1.What are the indications and contraindications?
Q2.What are the expected adverse events?
Medication Round
Flumazenil is the antidote for benzodiazepines
Indications:
1.rapid reversal of acute benzodiazepines overdose induced coma and respiratory deepression ( routine use in benzodiazepines overdoseis not recommended)
2.reversal of post op or post procedure benzodiazepines sedation
3.can be used to reverse CNS depression from non benzodiazepines sedatives like zolpidem
Contraindications:
1.known hypersensitivity
2. Suspected serious TCA or proconvlusant overdose
3. Benzodiazepines use for control of status epileptic
Adverse effects
Anxiety ,agitation,GI symptoms,headache,tremor
Acute withdrawal in chronic benzodiazepines users which can cause life threatening seizure not responding to benzodiazepines
Can precipitate arrhythmia in mixed overdose
References
Olsen,Poisoning and drug overdose 6th edition
Medication Round
Thank you all for the excellent comments
Flumazenil is the antidote for benzodiazepines
Indications:
1.rapid reversal of acute benzodiazepines overdose induced coma and respiratory deepression ( routine use in benzodiazepines overdoseis not recommended)
2.reversal of post op or post procedure benzodiazepines sedation
3.can be used to reverse CNS depression from non benzodiazepines sedatives like zolpidem
Contraindications:
1.known hypersensitivity
2. Suspected serious TCA or proconvlusant overdose
3. Benzodiazepines use for control of status epileptic
Adverse effects
Anxiety ,agitation,GI symptoms,headache,tremor
Acute withdrawal in chronic benzodiazepines users which can cause life threatening seizure not responding to benzodiazepines
Can precipitate arrhythmia in mixed overdose
References
Olsen,Poisoning and drug overdose 6th edition
1. Competitive BZD-receptor inhibitor
2. Rapidly reverses BZD-induced coma
3. Onset within 1–2 min; peak at 6–10 min; duration 1–2 hr (repeated dosing may be indicated)
4. Efficacy dependent on dose of BZD being antagonized and dose of FZ used
5. Do not administer empirically as part of “coma cocktail” or unknown ingestion
6. May help avert need of airway intubation but has not consistently reversed respiratory depression
7. May be beneficial in shortening hospital stay or as diagnostic maneuver Indications include isolated BZD overdose in nonhabituated user with CNS depression, normal EKG, normal vital signs, and normal neurologic exam.
8. Most useful to reverse iatrogenic poisoning (conscious sedation) Contraindications include: Coingestions that might lower seizure threshold (tricyclic antidepressants [TCAs]) Seizure history or activity Allergy Neuromuscular blockade
9. Do not use if hypotension, hypoxia, dysrhythmias, or increased intracranial pressure is present.
10. May precipitate withdrawal state including seizures, for which BZDs can no longer be used to treat
11. FZ (Romazicon): Initial: 0.2 mg IV over 30 sec (adult) If no response: 0.3 mg IV after 30 sec If still no response: 0.5 mg IV and repeat q1min if needed, to max. dose of 3 mg Continuous infusion at 0.1–1 mg/h if multiple repeated doses required to maintain response. Continuous infusion not FDA approved
12. Pediatric dosing: Titrate to max. cumulative dose of 0.05 mg/kg/d. Continuous infusion at 0.005–0.01 mg/kg/h has been used. Only use in selected patients as may precipitate seizures or dysrhythmias Monitor after use for resedation (occurs between 20 and 120 min after use)
- used in cases of pediatric cases of benzodiazepines ingestion..
- I think it should be avoided in cases of benzodiazepines dependence, because it may lead to convulsions.
Thank you!
I have question dr Suad if u have time to answer it
initial adult dose is 0.2mg
in ampule of antidote why they keep 0.5mg ?
Flumazenil is antidote of benzo group
Indication : usually uses in pure toxicity of benzo to avoid side effect seizure of other toxicity
CI: pt is known to have seizure , or taking other medication causing seizure or in toxicity of TCA , in cases of low threshold of seizure ( head injury ), dependence to benzo ( risk of complication from withdrawal sx )
SE: agitation and headache mainly , if causing seizure will be difficult to reverse back because all receptors blocked and may cause death if not able to control it, may cause arrhythmia
Thank you Dr.Suad for sharing this post
- it is used for benzodiazepine antidote mainly , CI: allergy / if the patient known to have sezuire , or dependent on benzo, or if he needs benzodiazepine to control sezuire
- S.E:
cardic dysrhythmia , sezuire in patient who are dependent on benzo, dizzness, headache , visual change , agitation