Name: FLUMAZENIL (AnexateR)
Classification: benzodiazepine antagonist
  • used in reversal of benzodiazepine induced CNS depression (will not necessarily reverse sedation or respiratory depression)
  • used in diagnosis and/or management of benzodiazepine overdose
Dose:
  • Benzodiazepine associated anaesthesia/sedation:
    • 0.2 mg IV direct over 15 seconds
    • further incremental doses of 0.1 mg IV direct every 60 seconds to a maximum total dose of 1 mg
  • Benzodiazepine overdose:
    • 0.3 mg IV direct over 30 seconds
    • further incremental doses of 0.3 mg IV direct over 30 seconds repeated every 60 seconds to a maximum total dose of 2 mg
  • IV Infusion
    • 0.1 - 0.4 mg/hr, titrate to individual response
Administration: IV Infusion
1 mg/100 mL D5W or NS
Adverse Effects: Due to abrupt benzodiazepine withdrawal:
  • seizures 
  • cardiac arrhythmias
  • nausea, vomiting
  • agitation, discomfort, tearfulness, anxiety
  • Cardiovascular:
    • hypotension or hypertension
    • bradycardia, ventricular asystoles
Caution:
  • should be used with caution in epileptic patients 
  • should be used with caution in mixed overdoses where there has been co-ingestion of agents that decrease the seizure threshold (e.g. tricyclic antidepressents, phenothiazines) 
  • should be used with caution with a history of cardiac arrhythmias
Monitoring Therapy:
  • neurological status
  • respiratory status
  • BP
  • HR, ECG
NOTE: duration of benzodiazepines will exceed that of flumazenil; observe closely for recurrence of sedation or respiratory depression
CCTC Protocol:
  • Must be administered by a physician.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: August 7, 2006

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Last Updated March 24, 2009 | © 2007, LHSC, London Ontario Canada