Sedative-Hypnotic Toxicity Medication

Updated: Dec 29, 2015
  • Author: Jeffrey S Cooper, MD, FAAEM, FACEP; Chief Editor: Asim Tarabar, MD  more...
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Medication

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.

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.

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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