Flumazenil
Benzodiazepine overdose reversal, Reversal of procedural sedation benzodiazepines
Indications
- Benzodiazepine overdose reversal
- Reversal of procedural sedation benzodiazepines
Adult dosing
- reversal: dose: 0.2; unit: mg; route: IV; interval: q1min, max 3mg total; fixed: true
Pediatric dosing
- reversal: dose: 0.01; unit: mg/kg; maxDose: 0.2; maxDoseAbsolute: true; route: IV; interval: q1min, max 1mg total; weightBased: true; pedNote: Limited data in children <1 year
Contraindications
- Known chronic benzodiazepine use (seizure risk)
- Co-ingestion with seizure-causing agents (TCAs, cocaine)
- Known seizure disorder controlled with benzodiazepines
Clinical pearls
- Duration shorter than most benzos — re-sedation can occur; observe 2+ hours
- DANGEROUS in chronic benzo users — can precipitate life-threatening seizures
- Safe in iatrogenic oversedation (procedural sedation) in benzo-naive patients
- Give 0.2mg IV over 30 sec, repeat q1min to max 3mg
Source and review
- Goldfrank's Toxicologic Emergencies; ACEP Clinical Policies. Last reviewed: 2024-11-01