What is the Flumazenil dose to reverse a Benzos Overdose?
Can you overdose on a benzodiazepine? Yes. But it is not a common occurrence. How do you treat a benzos overdose? Flumazenil is a benzos antagonist that is typically used to counteract the effect of benzos and is often administered during a benzos overdose emergency. A typical flumazenil dose administered to treat a benzos overdose is 0.2mg of an intravenous injection over a period of about 30 seconds. The dosage of medication can also be dependent on many varying factors.
Flumazenil was FDA-approved in 1992 for the treatment of benzodiazepine overdose. It can be used in the treatment of benzo overdose in adults, reversal of postoperative sedation from a benzos anesthetic, complete or partial reversal of sedative effects of benzos, and reversal of general anesthesia in adults.
What are benzodiazepines?
Benzodiazepines or benzos are central nervous system depressant drugs. They are prescription medications used in the treatment of anxiety, depression, insomnia and seizure disorders. Around 11-15% of American households have some sort of benzo medication in their medicine cabinets at home. It is one of the most commonly prescribed medications.
Benzos are a sedative-hypnotic drug that causes a slowdown in the central nervous system. It stimulates the GABA chemicals in the brain that inhibit excitability causing users to feel relaxed, sedated and calm. Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter in the central nervous system. Benzos enhance its effects by binding to its receptors leading to feelings of sedation and muscle relaxation.
Commonly prescribed benzos include clonazepam (Klonopin), alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), and triazolam (Halcion). Benzos can also become very addictive substances. Addiction can occur during recreational use when users abuse the drug in order to experience its sedative effects. Addiction can also occur unintentionally when users are prescribed the medication by a healthcare provider and take it as recommended.
Benzos Overdose
Benzos overdoses are not very common. When a person overdoses on benzos medications, they can experience intense sedation. So much so that it can cause respiratory depression and even severe motor and cognitive impairment. When this happens, flumazenil can be used to counteract the sedative effects.
Flumazenil Dose
- An average initial dose of flumazenil for reversal of sedation from the effects of benzos is 0.2mg over the course of 30 seconds. After about 30 seconds to a minute, a second dose of 0.3mg over the course of 30 seconds can be administered. A repeated dose of 0.5mg can be administered at 1-minute intervals until the patient has reached consciousness.
- A maximum dose of 1mg at any one time and a maximum dose of 3mg in total should not be exceeded.
- Research has found that doses beyond 3mg do not produce any additional effects in reversing sedation.
- The dosage of medication is also based on the individual patient and their response to the medication.
- Most patients with benzos-related sedation respond to doses between 0.6mg to 1mg.
- Most patients with benzos overdose will respond to a dose between 1-3mg.
- For benzos sedation reversal in children, the dose should not exceed 1mg.
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Flumazenil
Common brand names for flumazenil include Romazicon and Anexate. It is an Imidazobenzodiazepine derivative and potent benzodiazepine receptor antagonist that inhibits the activity of benzos on the GABA receptor. Flumazenil binds to the same GABA receptors to block the effects of benzos from pushing their influence on the central nervous system.
According to the American Society of Anesthesiologists Task Force’s guidelines for moderate to procedural sedation, flumazenil can be used for the reversal of benzos-induced sedation and respiratory depression. Flumazenil is also prescribed for off-label uses such as treating alcohol withdrawal syndrome, baclofen reversal, cannabis toxicity and benzos detox.
Flumazenil’s main form of administration is through an injection or infusion into the vein. Unlike other overdose reversal medications such as naloxone, flumazenil can only be administered in a clinical setting under the guidance of a health care provider.
The drug has an immediate onset of action within 1-2 minutes after injection. The effects begin to peak around 6-10 minutes and the total duration of effectiveness is around 19-50 minutes, depending on the dose of the injection. Flumazenil provides rapid reversal effects of sedation. Because of this, it requires careful dosing and medical observation in case of severe side effects, which can include a high risk of seizure.
Side Effects of Flumazenil
- Hypertension
- Chest pain
- Bradycardia
- Tachycardia
- Confusion
- Dizziness
- Impaired cognition
- Nausea and vomiting
- Anxiety
- Development of psychiatric disorders
- Panic attack
- Agitation and changes in mood or emotions
- Seizures
- Tremors
- Blurred vision
- Headache
The Risks and Dangers of Flumazenil
Despite being FDA-approved as a reversal agent for benzos overdose, flumazenil can cause risky side effects that can become life-threatening. The drug works to inhibit the activity of benzo substances that interact with the GABA receptors in the brain. Flumazenil works very quickly to reverse sedative side effects. Though this can be effective in treating benzos overdose, the rapid reversal can also lead to adverse effects such as seizures.
This is because the abrupt reversal of effects leads to a sudden increase in neuronal excitability. It’s almost as if there was a switch turned on right away allowing excitability and fast-move brain activity to occur at once. This is often the cause of seizures. Seizures can be serious and life-threatening if not treated properly.
Because of this risk of seizure, flumazenil is always administered under the guidance of a medical provider in a clinical setting. The medication is administered in gradual doses until the patient has achieved the desired consciousness.
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Treatment for Substance Use Disorder
Flumazenil is a benzos overdose reversal agent. It is used to help counteract the effects of sedation and respiratory depression. The drug, cannot however reverse the effects of other central nervous system depressants such as barbiturates, opioids and alcohol. Overdose from benzos is rare, but on the occasion that it does happen, flumazenil can be administered under professional care to help in the reversal of severe drug sedation. Addiction to benzos is more common than overdose. Both conditions can be treated at behavioral health treatment programs such as Hotel California by the Sea.
We offer treatment at all levels of care including detox, residential, PHP and IOP. We utilize evidence-based methods such as CBT, DBT, group therapy and family therapy. Hotel California by the Sea is dedicated to helping clients reach their goals of sobriety and overcome their substance addiction.
References:
https://poisoncontrol.utah.edu/news/2022/02/flumazenil
https://go.drugbank.com/drugs/DB01205
https://my.clevelandclinic.org/health/drugs/19798-flumazenil-injection
https://synapse.patsnap.com/article/what-is-flumazenil-used-for