Formulary
Flumazenil: Indications, Dosing, Side Effects and Interactions
Flumazenil clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Flumazenil: Indications, Dosing, Side Effects and Interactions
Flumazenil clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Reversal of sedative effects of benzodiazepines in anaesthesia and clinical procedures**
- **Adult** (By Intravenous Injection): 200 micrograms, dose to be administered over 15 seconds, then 100 micrograms every 1 minute if required; usual dose 300-600 micrograms; maximum 1 mg per course.
**Reversal of sedative effects of benzodiazepines in intensive care**
- **Adult** (By Intravenous Injection): 300 micrograms, dose to be administered over 15 seconds, then 100 micrograms every 1 minute if required; maximum 2 mg per course.
**Reversal of sedative effects of benzodiazepines for flumazenil**
- **Neonate** (By intravenous injection): 10 micrograms/kg every 1 minute if required, dose to be administered over 15 seconds.
- **Child** (By intravenous injection): 10 micrograms/kg every 1 minute (max. per dose 200 micrograms) if required, dose to be administered over 15 seconds; maximum 1 mg per course; maximum 50 micrograms/kg per course.
**Reversal of sedative effects of benzodiazepines (if drowsiness recurs after injection) for flumazenil**
- **Neonate** (By intravenous infusion): 2-10 micrograms/kg/hour, adjusted according to response.
- **Child** (By intravenous infusion): 2-10 micrograms/kg/hour (max. per dose 400 micrograms/hour), adjusted according to response.
**Reversal of sedative effects of benzodiazepines in intensive care for flumazenil**
- **Child** (By intravenous injection): 10 micrograms/kg every 1 minute (max. per dose 200 micrograms) if required, dose to be administered over 15 seconds; maximum 2 mg per course; maximum 50 micrograms/kg per course.
Cautions
Avoid rapid injection following major surgery; avoid rapid injection in high-risk or anxious patients; benzodiazepine dependence (may precipitate withdrawal symptoms); elderly; ensure neuromuscular blockade cleared before giving; head injury (rapid reversal of benzodiazepine sedation may cause convulsions); history of panic disorders (risk of recurrence); prolonged benzodiazepine therapy for epilepsy (risk of convulsions); short-acting (repeat doses may be necessary- benzodiazepine effects may persist for at least 24 hours)
Contraindications
Life-threatening condition (e.g. raised intracranial pressure, status epilepticus) controlled by benzodiazepines
Side effects
Common or very common Anxiety; diplopia; dry mouth; eye disorders; flushing; headache; hiccups; hyperhidrosis; hyperventilation; hypotension; insomnia; nausea; palpitations; paraesthesia; speech disorder; tremor; vertigo; vomiting Uncommon Abnormal hearing; arrhythmias; chest pain; chills; cough; dyspnoea; nasal congestion; seizure (more common in patients with epilepsy) Frequency not known Withdrawal syndrome
Interactions
**Other interactions (6):**
- Flumazenil reverses the central effects of benzodiazepines by means of competitive interaction at receptor level: the effects of non-benzodiazepine agonists acting via the benzodiazepine receptor,...
- However, flumazenil does not block the effect of medicines that do not operate via this route.
- Particular caution is necessary when using flumazenil in cases of accidental overdose since the toxic effects of other psychotropic medicinal products (especially tricyclic antidepressants) taken...
- No change in the pharmacokinetics of flumazenil has been observed in combination with the benzodiazepines midazolam, flunitrazepam and lormetazepam.
- Flumazenil does not affect the pharmacokinetics of these benzodiazepines.
- There is no pharmacokinetic interaction between ethanol and flumazenil.
Pregnancy
Not known to be harmful.
Breast feeding
Avoid breast-feeding for 24 hours.
Hepatic impairment
Manufacturer advises caution (risk of increased half-life). Dose adjustments Manufacturer advises cautious dose titration.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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