FLUMAZENIL (Anexate)

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

Maximum cumulative dose is 3 mg. Patients with a partial response at 3 mg may require additional titration up to 5 mg. If no response 5 minutes after cumulative dose of 5 mg, the sedation is not likely due to benzodiazapines.

• 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 cumulative dose of 3 mg
• IV Infusion
  • 0.2 - 0.4 mg/hr, titrate to individual response. Indicated for rebound drowsiness.

• Contraindicated with raised ICP, seizures or tricyclic antidepression overdose
• 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 antidepressants, phenothiazines) 
• Should be used with caution with a history of cardiac arrhythmias
• In liver failure, first dose is the same as non-liver failure but subsequent doses should be reduced

• Seizures 
• Cardiac arrhythmias including bradycardia or ventricular asystole
• Hypotension or hypertension
• Nausea, vomiting
• Agitation, discomfort, tearfulness, anxiety, emotional lability
• Dry mouth
• Blurred visions
• Injection site pain
• Hot flashes
• Hiccoughs
• Sensation of cold

• IV site
• Neurological status
• Signs of seizures
• Heart rate
• Blood pressure
• Respiratory status

• May be administered IV direct or by IV infusion by a nurse in Adult Critical Care.