Antidotes en toxicologie d'urgence (3rd ed.). Titrate to effect.īailey, B., Blais, R., Gaudreault, P., Gosselin, S., & Laliberte, M. (2009). If adequate sedation reversal does not occur after an additional 45 seconds, further injections of 0.01 mg/kg ( up to maximum 0.2 mg) may be repeated at 1 minute intervals, as needed up to 4 times: Maximum total dose 0.05 mg/kg or 1 mg, whichever is lower.Ĭonsider IV infusion of 0.1 mg -1 mg/hour. The following data is based on published case reports.Ġ.01 mg/kg (up to maximum of 0.2 mg) over 15 seconds. Management of clinically significant CNS depression caused by overdose of zolpidem, zaleplon, or zopiclone.
Management/diagnosis of a pure benzodiazepine overdose causing clinically significant CNS or respiratory depression meeting the following criteria: no history of seizure disorder, no chronic use of benzodiazepines, and no coingestion of a toxin that can cause seizures or cardiac dysrhythmias.Reversal of sedation due to benzodiazepines used in diagnostic or therapeutic procedures.It should not be used when there is a high risk of seizures (e.g., known ingestion of a drug associated with convulsions or mixed ingestion of unknown drugs).ALERT: The use of flumazenil as a reversal agent for intentional benzodiazepine overdose is not routinely recommended due to risk of refractory seizures. It may be used with caution in patients with pure benzodiazepine poisoning who have severe respiratory depression and would otherwise require mechanical ventilation.įlumazenil should never be used as a diagnostic test and must only be administered by a clinician with expertise in its use. The risks associated with use of flumazenil, a benzodiazepine antagonist, outweigh any potential benefits for most patients. Acute management consists of maintaining airway, respiration, and haemodynamic support while excluding other diagnoses.
The effects of benzodiazepines may be potentiated if taken in combination with other central nervous system (CNS) depressants, such as alcohol and opioids.
Larger doses can cause coma, respiratory depression, and, without appropriate treatment, even death, particularly in the context of mixed ingestion with other CNS depressants. The key feature of overdose is excessive sedation. Benzodiazepine overdose can be intentional (e.g., as an act of self-harm), as part of recreational misuse, or accidental (e.g., medication error).īenzodiazepines are the most commonly prescribed medications for anxiety, sedation, and sleep.
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