Flumazenil

Flumazenil Brand Name– Romazicon

What is Flumazenil

Flumazenil is a parenteral benzodiazepine antagonist. It is an imidazobenzodiazepine derivative.

Flumazenil is used to treat benzodiazepine overdose and to reverse benzodiazepine sedation during anesthesia.

Flumazenil will also antagonize the sedative actions of zolpidem and eszopiclone.

Flumazenil is administered by rapid IV injection because it is highly irritating, and care should be taken to avoid extravasation.

In pediatric patients, the intravenous formulation has also been administered intranasally and rectally; these routes of administration are not FDA-approved.

Flumazenil does not reverse the actions of barbiturates, opiate agonists, or tricyclic antidepressants and is contraindicated in patients showing signs of cyclic antidepressant toxicity

Indications

  • benzodiazepine toxicity
  • sedation reversal

For sedation reversal when sedation is secondary to benzodiazepine therapy

Side Effects

  1. agitation
  2. anxiety
  3. arrhythmia exacerbation
  4. asthenia
  5. ataxia
  6. blurred vision
  7. bradycardia
  8. chest pain (unspecified)
  9. confusion
  10. delirium
  11. depression
  12. diplopia
  13. dizziness
  14. drowsiness
  15. dysphonia
  16. dysphoria
  17. dyspnea
  18. emotional lability
  19. euphoria
  20. fatigue
  21. flushing
  22. headache
  23. hearing loss
  24. hiccups
  25. hot flashes
  26. hyperacusis
  27. hyperhidrosis
  28. hypertension
  29. hyperventilation
  30. hypoesthesia
  31. injection site reaction
  32. insomnia
  33. lacrimation
  34. malaise
  35. nausea
  36. palpitations
  37. paranoia
  38. paresthesias
  39. peripheral vasodilation
  40. phlebitis
  41. rash
  42. seizures
  43. shivering
  44. sinus tachycardia
  45. tinnitus
  46. tremor
  47. ventricular tachycardia
  48. vertigo
  49. vomiting
  50. withdrawal
  51. xerostomia

Monitoring Parameters

  • ECG
  • neurologic function

Contraindications

  • alcoholism
  • anxiety
  • benzodiazepine dependence
  • benzodiazepine hypersensitivity
  • breast-feeding
  • driving or operating machinery
  • head trauma
  • hepatic disease
  • increased intracranial pressure
  • labor
  • obstetric delivery
  • overdose
  • panic disorder
  • pregnancy
  • pulmonary disease
  • respiratory depression
  • seizure disorder
  • seizures
  • status epilepticus
  • substance abuse

Interactions

  • Alprazolam
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amoxapine
  • Benzodiazepines
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clorazepate
  • Desipramine
  • Diazepam
  • Doxepin
  • Estazolam
  • Eszopiclone
  • Flurazepam
  • Imipramine
  • Lorazepam
  • Maprotiline
  • Midazolam
  • Nalmefene
  • Nortriptyline
  • Oxazepam
  • Perphenazine; Amitriptyline
  • Protriptyline
  • Quazepam
  • Temazepam
  • Triazolam
  • Tricyclic antidepressants
  • Trimipramine
  • Zaleplon
  • Zolpidem
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