Reversal of benzodiazepine intoxication by flumazenil

Skielboe, Martin; Andersen, P.; Weber, Michael; Jarnvig, Inge-Lise; Sztuk, F.; Jørgensen, Ingrid Hals

doi:10.1016/0300-9572(91)90032-t

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…However, even when including the open phase of the trials, follow‐up was short in all included studies. In the literature, there are three case reports of aspiration pneumonia related to flumazenil use, and in all cases, assisted ventilation and prolonged hospitalisation were necessary .…”

Section: Discussionmentioning

confidence: 99%

Adverse Events Associated with Flumazenil Treatment for the Management of Suspected Benzodiazepine Intoxication – A Systematic Review with Meta‐Analyses of Randomised Trials

Penninga

Graudal

Ladekarl

et al. 2015

Basic Clin Pharma Tox

127

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Flumazenil is used for the reversal of benzodiazepine overdose. Serious adverse events (SAEs) including seizures and cardiac arrhythmias have been reported in patients treated with flumazenil, and the clinical advantage of flumazenil treatment has been questioned. The objective was to assess the risk of (S)AEs associated with the use of flumazenil in patients with impaired consciousness due to known or suspected benzodiazepine overdose. Studies included in the meta-analyses were identified by literature search in Medline, Cochrane Library and Embase using combinations of the words flumazenil, benzodiazepines, antianxiety agents, poisoning, toxicity and overdose. Randomised clinical trials (RCTs) in verified or suspected benzodiazepine overdose patients comparing treatment with flumazenil versus placebo were included. Pre-defined outcome measures were AEs, SAEs and mortality. Thirteen trials with a total of 994 randomised (990 evaluable) patients were included. AEs were significantly more common in the flumazenil group (138/498) compared with the placebo group (47/492) (risk ratio: 2.85; 95% confidence interval: 2.11-3.84; p < 0.00001). SAEs were also significantly more common in the flumazenil group compared with the placebo group (12/498 versus 2/492; risk ratio: 3.81; 95% CI: 1.28-11.39; p = 0.02). The most common AEs in the flumazenil group were agitation and gastrointestinal symptoms, whereas the most common SAEs were supraventricular arrhythmia and convulsions. No patients died during the blinded phase of the RCTs. The use of flumazenil in a population admitted at the emergency department with known or suspected benzodiazepine intoxication is associated with a significantly increased risk of (S)AEs compared with placebo. Flumazenil should not be used routinely, and the harms and benefits should be considered carefully in every patient.

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Section: Discussionmentioning

confidence: 99%

Adverse Events Associated with Flumazenil Treatment for the Management of Suspected Benzodiazepine Intoxication – A Systematic Review with Meta‐Analyses of Randomised Trials

Penninga

Graudal

Ladekarl

et al. 2015

Basic Clin Pharma Tox

127

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“…Flumazenil is an imidazobenzodiazepine that antagonizes the effects of benzodiazepine agonists by competitive interaction at the cerebral benzodiazepine receptor site [62]. It does not antagonize the effects of other drugs that do not affect benzodiazepine receptors, such as narcotics, barbiturates, cyclic antidepressants, and ethanol.…”

Section: Flumazenil: Titrating Sedation At the Level Of Neurotransmismentioning

confidence: 99%

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2000

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The modern intensive care unit (ICU) has evolved into an area where mortality and morbidity can be reduced by identification of unexpected hemodynamic and ventilatory decompensations before long-term problems result. Because intensive care physicians are caring for an increasingly heterogeneous population of patients, the indications for aggressive monitoring and close titration of care have expanded. Agitated patients are proving difficult to deal with in nonmonitored environments because of the unpredictable consequences of the agitated state on organ systems. The severe agitation state that is associated with ethanol withdrawal and delirium tremens (DT) is examined as a model for evaluating the efficacy of the ICU environment to ensure consistent stabilization of potentially life-threatening agitation and delirium.

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