Benzodiazepine Toxicity Medication

Updated: Jun 13, 2018
  • Author: Chip Gresham, MD, FACEM; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Medication

Medication Summary

Activated charcoal not recommended in isolated benzodiazepine overdose. Decontamination with activated charcoal may be considered in a patient who ingested a life-threatening toxin that is amendable to absorption, has a secured airway, and presents within 1-2 hours after the ingestion (up to 4 h with sustained-release preperations).Flumazenil, a specific antidote for BZDs, is very controversial, and its risks appear to outweigh any benefits. It should be considered only in isolated iatrogenic BZD overdose in BZD-naive patients (eg, during conscious sedation on BZD-naive patient).

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Antidotes, Other

Class Summary

Flumazenil is a selective competitive antagonist of the gamma-aminobutyric acid (GABA) receptor and is the only available specific antidote for BZDs; it will reverse effects of BZDs but must be used with caution.

Flumazenil

Flumazenil is a competitive BZD receptor antagonist and is the only available specific antidote for BZDs, although its use in acute BZD is controversial and its risks usually outweighs any benefit.

Flumazenil does not consitantly reverse central respiratory depression due to BZDs, and over half the patients in a large multicenter study experienced re-sedation after use.

In long-term BZD users, flumazenil may precipitate withdrawal and seizures; in patients taking BZDs for a medical condition, flumenazil may result in exacerbation of the condition.

In addition to those patients on long-term BZD use, flumazenil should not be used in any patient at an increased risk of having a seizure, including those with a seizure history, head injury, coingestion of BZD and a tricyclic antidepressant or other proconvulsant, or even a possibly ingestion of a proconvulsant.

The ideal consideration for flumazenil use is isolated iatrogenic BZD overdose in BZD-naive patients (eg, during conscious sedation on BZD-naive patient).

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