Sedative-Hypnotic Toxicity Medication

  • Author: Jeffrey S Cooper, MD, FAAEM, FACEP; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 12, 2011
 

Medication Summary

The only available antidotelike drug is flumazenil for benzodiazepine intoxication. Use of flumazenil in intentional drug overdose of unknown etiology is not cost effective or particularly prudent and is not encouraged. All other therapy is supportive or designed to limit absorption or enhance elimination.

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GI decontaminant

Class Summary

Empirically used to minimize systemic absorption of the toxin. May only be of benefit if administered within 1-2 h of ingestion.

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Activated charcoal (Liqui-Char)

 

Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water.

For maximum effect, administer within 30 min of ingesting poison. The initial dose may be given with water or a cathartic (such as 70% sorbitol). Sorbitol should not be given to children < 2 y.

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Antagonist

Class Summary

Reverses benzodiazepine sedation and respiratory depression.

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Flumazenil (Romazicon)

 

Competitively and reversibly binds benzodiazepine receptors (GABA). Administer slowly; large doses cause agitation and withdrawal.

Usually effective after 0.4-1 mg. Although up to 3-5 mg in massive ingestions have been required.

In cases of resedation, IV drip at 0.01-0.05 mg/kg/h may be used. Only consider a flumazenil drip if the patient is not habituated to sedative-hypnotic agents.

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Contributor Information and Disclosures
Author

Jeffrey S Cooper, MD, FAAEM, FACEP  Attending Physician, Department of Emergency Medicine, St Joseph Medical Center, Tacoma

Jeffrey S Cooper, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Lance W Kreplick, MD, FAAEM, MMM  Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC

Lance W Kreplick, MD, FAAEM, MMM, is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

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  2. Barnett R, Grace M, Boothe P, et al. Flumazenil in drug overdose: randomized, placebo-controlled study to assess cost effectiveness. Crit Care Med. Jan 1999;27(1):78-81. [Medline].

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  11. Isbister GK, O'Regan L, Sibbritt D, Whyte IM. Alprazolam is relatively more toxic than other benzodiazepines in overdose. Br J Clin Pharmacol. Jul 2004;58(1):88-95. [Medline].

  12. Liskow B, Pikalov A. Zaleplon overdose associated with sleepwalking and complex behavior. J Am Acad Child Adolesc Psychiatry. Aug 2004;43(8):927-8. [Medline].

  13. Lovett B, Watts D, Grossman M. Prolonged coma after eszopiclone overdose. Am J Emerg Med. Jul 2007;25(6):735.e5-6. [Medline].

  14. Meyer S, Kleinschmidt S, Gottschling S, Gortner L, Strittmatter M. [Gamma-hydroxy butyric acid: neurotransmitter, sedative and party drug]. Wien Med Wochenschr. Jul 2005;155(13-14):315-22. [Medline].

  15. Riegel W. Use of continuous renal replacement therapy for detoxification?. Int J Artif Organs. Feb 1996;19(2):111-2. [Medline].

  16. Rossman PG, Knesper DJ. The early phase of hospital treatment for disruptive adolescents! The integration of behavioral and dynamic techniques. J Am Acad Child Psychiatry. 1976;15(4):693-708. [Medline].

  17. Worthley LI. Clinical toxicology: part I. Diagnosis and management of common drug overdosage. Crit Care Resusc. Sep 2002;4(3):192-215. [Medline].

 
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