Reversal for Benzodiazepines: Flumazenil (Romazicon)
|
Route |
Onset of Action |
Peak Effect |
Duration of Action |
|---|---|---|---|
|
IV (bolus or infusion) |
1-2 minutes |
6-10 minutes (but 80% of the maximum response is seen within 3 minutes.) Call anesthesia if there is no desired clinical response with the administration of the initial 1 mg. |
45-90 minutes |
Specific benzodiazepine antagonist, used for complete or partial reversal of the sedative effects of benzodiazepines; management of benzodiazepine overdose
Administration Technique
IV bolus:
1) Phase One: Initially 0.2 mg IV over 15 seconds to one minute. If patient does not reach desired level of consciousness after 45 seconds…
2) Phase Two: Repeat dose at one minute intervals until a cumulative dose of 1 mg has been administered (includes initial dose in phase one). If no response to treatment is noted, call anesthesia for assistance.
IV infusion:
30-60 ug/minute (0.5-1 ug/kg/min). Total dose not to exceed 3 mg/hour.
Special considerations
- Individualized dosage is required, manufacturer does not recommend the administration of flumazenil to patients under the age of 18.
- Flumazenil– induced seizures have been reported in patients with chronic physical dependence to benzodiazepines or patients recently undergoing multiple procedures requiring multiple large doses of benzodiazepines.
- Patients who have responded to flumazenil should be carefully monitored (up to 120 minutes) for resedation.
- To avoid pain and inflammation at the site of injection, administration of flumazenil via a large vein is recommended.
- Overdose: Excessive doses result in anxiety, agitation, increased muscle tone, and possible convulsions.
Adverse effects
- Respiratory – return of respiratory depression which has exceeded the therapeutic effects of flumazenil.
- Cardiovascular – cutaneous vasodilation, sweating, and flushing, dysrhythmias, bradycardia, tachycardia, hypertension.
- CNS – dizziness, headache, abnormal or blurred vision, confusion, and convulsions.
Educational reference for sedation providers, relocated from the previous version of this site — not a substitute for the current package insert, your facility protocols, or clinical judgment. Verify all doses against current references before clinical use.