Seizures flumazenil

Although rare, benzodiazepine toxicity may occur from an overdose of the drug. Benzodiazepine toxicity causes sedation, respiratory depression, and coma. Flumazenil (Romazicon) is an antidote (antagonist) for benzodiazepine toxicity and acts to reverse die sedation, respiratory depression, and coma within 6 to 10 minutes after intravenous administration. The dosage is individualized based on the patient s response, widi most patients responding to doses of 0.6 to 1 mg. However, die drug s action is short, and additional doses may be needed. Adverse reactions of flumazenil include agitation, confusion, seizures, and in some cases, symptoms of benzodiazepine withdrawal. Adverse reactions of flumazenil related to the symptoms of benzodiazepine withdrawal are relieved by die administration of die benzodiazepine. 

Flumazenil s one problematic side effect is that it can trigger benzodiazepine withdrawal including increased pulse, increased blood pressure, shakiness, anxiety, and seizures. Because it is only used in the hospital, supportive medical care is, by definition, available if this occurs. 

Flumazenil Flumazenil and nalmefene can induce seizures in animals. Remain aware of the potential risk of seizures from agents in these classes. 

Seizures The use of flumazenil has been associated with the occurrence of seizures. These are most frequent in patients who have been on benzodiazepines for long-term sedation or in overdose cases where patients are showing signs of serious cyclic antidepressant overdose. Individualize the dosage of flumazenil and be prepared to manage seizures. 

Physical dependence on benzodiazepines Flumazenil is known to precipitate withdrawal seizures in patients who are physically dependent on benzodiazepines, even if such dependence was established in a relatively few days of high-dose sedation in ICU environments. The risk of either seizures or resedation in such cases is high and patients have experienced seizures before regaining consciousness. Use flumazenil in such settings with extreme caution, because use of flumazenil in this situation has not been studied and no information as to dose and rate of titration is available. 

Monitor for seizures, sedation, respiratory depression, or other residual benzodiazepine effects for an appropriate period (up to 120 min) based on dose and duration of effect of the benzodiazepine employed pharmacokinetics of benzodiazepines are not altered in the presence of flumazenil... 

In an emergency setting, the benzodiazepine antagonist fluma-zenil may be given intravenously to reverse the effects of a potential overdose of a benzodiazepine. Caution in use of flumazenil in a mixed overdose with tricychc antidepressants (TCAs) is warranted, however. Its use may precipitate TCA-induced arrhythmias and seizures that were suppressed by benzodiazepines. 

Adverse effects of flumazenil include agitation, confusion, dizziness, and nausea. Flumazenil may cause a severe precipitated abstinence syndrome in patients who have developed physiologic benzodiazepine dependence. In patients who have ingested benzodiazepines with tricyclic antidepressants, seizures and cardiac arrhythmias may follow flumazenil administration. 

Flumazenil Benzodiazepines Adult dose is 0.2 mg IV, repeated as necessary to a maximum of 3 mg. Do not give to patients with seizures, benzodiazepine dependence, or tricyclic overdose. 

Flumazenll [floo MAZ eh nill] is a GABA receptor antagonist that can rapidly reverse the effects of benzodiazepines. The drug is available by IV administration only. Onset is rapid but duration is short, with a half-life of about one hour. Frequent administration may be necessary to maintain reversal of a long-acting benzodiazepine. Administration of flumazenil may precipitate withdrawal in dependent patients or may cause seizures if a benzodiazepine is used to control seizure activity. Dizziness, nausea, vomiting, and agitation are the most common side effects. 

Flumazenil is used as a benzodiazepine antagonist in the treatment of poisoning or the reversal of benzodiazepine effects in anesthesia 1,2) or in neonates (3). Guidelines for its use have been summarized (4). The problems in its use are those of dose adjustment, the risks of panic anxiety, seizures, or other signs of excessively rapid benzodiazepine withdrawal, and pharmacokinetic problems due to the short half-life of flumazenil (about 1 hour) compared with the longer half-lives of most benzodiazepines (5). Its use is also commonly associated with vomiting and headache, and rarely with psychosis or sudden cardiac death (SEDA-17,... 

Similar reports have appeared in the past in patients with seizure disorders. It is recommended that flumazenil not be used in patients predisposed to seizures. 

Flumazenil is not indicated in all cases of suspected BZ overdose, and it is contraindicated when cyclic antidepressant involvement is known or suspected because of the risk of seizures. It should be used with caution when BZ physical dependence is suspected, as it may precipitate BZ withdrawal. 

Flumazenil (used to reverse the effects of benzodiazepines) may precipitate seizures and should not be used in patients treated for seizure disorders with clonazepam... 

Flumazenil may induce seizures, particularly in patients tolerant to or dependent on benzodiazepines, or who have overdosed on cyclic antidepressants, received recent/repeated doses of parenteral benzodiazepines, or have jerking or convulsion during overdose... 

Patients dependent on benzodiazepines or receiving benzodiazepines to suppress seizures in cyclic antidepressant overdose should receive the minimally effective dose of flumazenil... 

Flumazenil (used fo reverse fhe effecfs of benzodiazepines) may precipifafe seizures and should nof be used In pafienfs freated for seizure disorders wifh lorazepam... 

Adverse effects of flumazenil can include brief anxiety, seizures in epileptics treated with a benzodiazepine and precipitation of withdrawal syndrome in dependent subjects. Rarely, vomiting is induced. 

Zolpidem and a newer agent, zaleplon, are nonbenzodiazepines used in sleep disorders. They activate BZt receptors (reversed by flumazenil) and are more selective hypnotics because they are not effective in chronic anxiety, for seizure disorders, or for muscle relaxation. Possibly less tolerance and lower abuse liability and dependence than BZs. 

The BZD site is the most thoroughly studied of the three modulatory sites and numerous drugs have been identified that bind to it. About a dozen of these are currently marketed for treating disorders such as generalized anxiety, panic disorders, depression, some forms of epilepsy (e.g. absence seizures), febrile seizures, some sleep disorders (e.g. insomnia), and muscle spasms and cramps and for use as anaesthetics. Flumazenil (11), a BZD antagonist, is currently marketed for treating BZD agonist overdose. 

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