Flumazenil

Flumazenil - a competitive antagonist at the benzodiazepine receptor. It has a short duration of action (20 min).

Uses
To facilitate weaning from ventilation in patients sedated with benzodiazepine
In the management of benzodiazepine overdose
As a diagnostic test for the cause of prolonged sedation

Contraindications
Tricyclic antidepressant and mixed-drug overdose (fits)
Patients on long-term benzodiazepine therapy (withdrawal)
Epileptic patients on benzodiazepines (fits)
Patients with raised ICP (further increase in ICP)

Administration
• IV bolus: 200 μg, repeat at 1-min intervals until desired response, up to a total dose of 2mg
If re-sedation occurs, repeat dose every 20 min

How not to use flumazenil
Ensure effects of neuromuscular blockade reversed before using flumazenil

Adverse effects
Dizziness
Agitation
Arrhythmias
Hypertension
Epileptic fits

Cautions
Re-sedation – requires prolonged monitoring if long-acting benzodiazepines have been taken

Organ failure
Hepatic: reduced elimination