Midazolam drug overdose

B. Convulsions. All three drugs can be used for the treatment of acute seizure activity or status epilepticus resulting from idiopathic epilepsy or convulsant drug overdose. Midazolam and lorazepam have the advantage of rapid absorption after intramuscular injection. Lorazepam also has a longer duration of anticonvulsant action than the other two agents. 

Drug overdose Between November 2004 and November 2008, UK health-care staff reported 498 dosing errors for midazolam to the National Patient Safety Agency (NPSA) there were three deaths [35 ]. The following problems were reported ... 

Flumazenil is a benzodiazepine antagonist used to reverse the effects of benzodiazepines in the treatment of poisoning or in anesthesia [46 , 47, 48, 49 ]. It reduces the risks of complications from drug overdose, obviating the need for invasive interventions such as mechanical ventilation and invasive hemodynamic monitoring [5(E]. However, it is not effective in reversing the amnesic effects of midazolam [51 ]. It has also been used to reverse the effects of zaleplon [52 J, zolpidem [53, 54, 55 ], zopiclone [56", 57" ], antihistamines such as promethazine [58, 59 ], baclofen... 

II. Toxic dose. In general, the toxic therapeutic ratio for benzodiazepines is very high. For example, oral overdoses of diazepam have been reported in excess of 15-20 times the therapeutic dose without serious depression of consciousness. On the other hand, respiratory arrest has been report after ingestion of 5 mg of triazolam and after rapid Intravenous injection of diazepam, midazolam, and many other benzodiazepines. Also, ingestion of another drug with CNS-depres-sant properties (eg, ethanol, barbiturates, opioids, etc) will likely produce additive effects. 

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