Slow subcutaneous infusion of flumazenil for the treatment of long-term, high-dose benzodiazepine users: a review of 214 cases

Abstract

Despite the first reports concerning benzodiazepine dependence being published in the early 1960s literature, the risk of benzodiazepine addiction is still greatly debated. The severe discomfort and life threatening complications usually experienced by long-term benzodiazepine users who suddenly interrupt benzodiazepine intake have led to the development of several detoxification protocols. A successful strategy used by our Addiction Unit is abrupt benzodiazepine cessation by administering flumazenil slow subcutaneous infusion (FLU-SSI) with an elastomeric pump. Although some studies proved the efficacy of flumazenil infusion more than 20 years ago, only a few centres in the world offer this method to their patients. This paper reports the data related to 214 subjects addicted to high doses of benzodiazepine and treated with the FLU-SSI method between 2012 and 2014. This technique is less invasive and requires less nursing intervention than intravenous infusion. Our data support FLU-SSI as a possible efficient strategy for the treatment of patients with long-term, high-dose benzodiazepine addiction, and could become a routine therapy as long as the necessary further studies on dose, duration of infusion and safety issues are carried out.

Benzodiazepine abuse among athletes: Pain relief or just a weapon against insomnia? A clinical case study

“…Interestingly, the dosage of the various benzodiazepines is convertible into therapeutic daily dose using one of the most accepted conversion tables, in which 2 mg of lormetazepam is equal to 10 mg of diazepam. 10 Therefore, this 900 mg of lormetazepam is comparable to 4500 mg of diazepam. She had tried using melatonin in place of lormetazepam, but had found it ineffective.…”

“…As a result, her intake of lormetazepam had increased to a maximum daily dose of 18 vials (20 ml (50 mg) × 18, amounting to a total of 360 ml (900 mg) per day). Interestingly, the dosage of the various benzodiazepines is convertible into therapeutic daily dose using one of the most accepted conversion tables, in which 2 mg of lormetazepam is equal to 10 mg of diazepam . Therefore, this 900 mg of lormetazepam is comparable to 4500 mg of diazepam.…”

“…Recent case reports on high levels of benzodiazepine use among athletes have underlined the lack of scientific data in this research field . Long‐term benzodiazepine use is generally avoided due to the risk of adverse reactions (eg, impaired psychomotor and cognitive functioning) and the potential to develop addiction . Even though levels of benzodiazepine consumption and abuse are increasing in Europe, somewhat surprisingly scientific research seems to overlook this issue .…”

“…8,9 Long-term benzodiazepine use is generally avoided due to the risk of adverse reactions (eg, impaired psychomotor and cognitive functioning) and the potential to develop addiction. 10,11 Even though levels of benzodiazepine consumption and abuse are increasing in Europe, 12 somewhat surprisingly scientific research seems to overlook this issue. 13 It is crucial to ensure that sleep medications are properly managed, taking into account issues such as addiction; it is also important to consider the use of benzodiazepines to treat pain.…”

Therapie der Benzodiazepinabhängigkeit

“…Inwieweit neuere Ansätze, wie z. B. die subkutane Gabe des Benzodiazepinantagonisten Flumazenil, die verschiedentlich propagiert wurde, unter antiepileptischem Schutz [55] oder umgekehrt eine "Benzodiazepinsubstitution" [56] gute Strategien darstellen könnten, sei dahingestellt; der Autor ist diesbezüglich skeptisch. Vordringlich scheint zu sein, die psychotherapeutischen Behandlungsstrategien im Benzodiazepinentzug und zur Rückfallprophylaxe zu verbessern und mehr Langzeitdaten zum Behandlungserfolg zu generieren.…”