Flumazanil

 Q: Can flumazenil be used as a continous intravenous (IV) infusion in severe benzodiazepines (BZD) overdose?

A) Yes

B) No

Answer: A

Although not a very desirable act but in extreme situations where the goal is to prevent intubation and a clinician is experienced - a continuous flumazenil infusion can be an option in severe BZD overdose. The rate is usually 0.25 to 1 mg per hour. This is due to the fact that the effect of flumazenil is shorter than half-lives of most BZDs. The effect of Flumazenil can last anywhere from 0.7 to 1.3 hours. A continuous infusion can be a salvage when a known BZD has a very long half-life, the quantity of overdose is high or a patient has an underlying liver insufficiency.

#toxicology

References:

1. Maxa JL, Ogu CC, Adeeko MA, Swaner TG. Continuous-infusion flumazenil in the management of chlordiazepoxide toxicity. Pharmacotherapy 2003; 23:1513. 

2. Höjer J, Baehrendtz S, Magnusson A, Gustafsson LL. A placebo-controlled trial of flumazenil given by continuous infusion in severe benzodiazepine overdosage. Acta Anaesthesiol Scand 1991; 35:584.