- Only administer in an area that can manage potential seizures
- Adult dose = 0.1 – 0.2 mg IV and repeat every minute until there is reversal (max dose not exceeding 2mg)
- Paediatric dose = 0.01 – 0.02 mg/kg, repeat every minute.
- Re-sedation is likely to occur at 90 minutes whereupon further doses will be required.
- Sometimes a flumazenil infusion is warranted. This decision needs to be weighed up with the ability for a ward to manage an infusion and with large adult ingestions it can be easier, quicker and potentially safer to intubate and transfer to ICU
- Known Seizure disorder
- Known or suspected co-ingestion of a pro-convulsant
- Known or suspected benzodiazepine dependance
- QRS prolongation on the ECG to suggest a possible co-ingestion with a sodium channel blocking drug (i.e. TCA)
- The flumazenil in benzodiazepine intoxication multicenter study group. Treatment of benzodiazepine overdose with flumazenil. Clinical Therapeutics 1992; 14:978-995.
- Ngo AS, Anthony CR, Samuel M et al. Should a benzodiazepine antagonist be used in unconscious patients presenting to the emergency department? Resuscitation 2007; 74(1):27-37.
- Seger D. Flumazenil – treatment or toxin. Journal of Toxicology-Clinical Toxicology 2004; 42(2):209-216.