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FLUMAZENIL · by MARTIN DOW

OTHER NERVOUS SYSTEM DRUGS Benzodiazepine antagonist MARTIN DOW

Composition

Inj: Per ml: Flumazenil 1000 mcg; 10 ml (1 mg), 5 ml (0.5 mg) amp

Indications & Dosage

Reversal of sedative effects of benzodiazepines in anaesthesia and clinical procedures: BY IV INJ: Adult: 200 mcg, dose to be administered over15 seconds, then 100 mcg every 1 minute if required; usual dose 300-600 mcg; max.1 mg per course Children: 10 mcg/kg (max 200 mcg), repeated at 1-minute intervals if required, max total dose of 50 mcg/kg (1 mg). Reversal of sedative effects of benzodiazepines in intensive care: BY IV INJ: Adult: 300 mcg, dose to be administered over 15 seconds, then 100 mcg every 1 minute if required; max. 2 mg per course. Children: 10 mcg/kg (max 200 mcg), repeated at 1-minute intervals if required, max total dose of 50 mcg/kg (2 mg). Reversal of sedative effects of benzodiazepines in intensive care (if drowsiness recurs after injection): BY IV INF: Adult: 100-400 mcg/hour, adjusted according to response, alternatively (by IV injection) 300 mcg, adjusted according to response. Children: 2-10mcg/kg/hr, adjusted according to response, max 400 mcg/hr.

Administration

Administered IV over 15 to 30 seconds. To minimize pain at the injection site, Flumazenil should be ad-ministered through a freely running IV infusion line into a large vein. Extravasation should be avoided.

Compatibility

Dextrose 5%, NS, LR.

Stability

Stored at controlled room temperature.

Contraindications

Life-threatening condition (e.g. raised intracranial pressure, status epileptic us) controlled by benzodiazepines

Precautions

Head injury, avoid rapid injection following major surgery or in high-risk or anxious patients, benzodiazepine dependence (may precipitate withdrawal symptoms), elderly, ensure neuromuscular blockade cleared before administering, history of panic disorders, prolonged benzodiazepine therapy for epilepsy, short-acting (repeat doses may be necessary)

Pregnancy

Caution advised

Lactation

Caution advised

Side Effects

Nausea, vomiting, anxiety, fear, palpitation, agitation, chills, convulsions, dizziness, flushing, if wakening too rapid, transient increase in blood pressure and heart-rate in intensive care patients; very rarely convulsions (particularly in epileptics).