(Table.) General toxicology management in many of these cases may be safer than venturing into the unknown by using a potentially dangerous antidote. Using flumazenil to reverse known or suspected benzodiazepine overdose is contraindicated in a wide range of historical and physical findings. Suddenly reversing the drug's effects by administering flumazenil to a patient who chronically uses or abuses benzodiazepines could precipitate acute withdrawal, a life-threatening condition that, with the antagonist on board, would be difficult to treat with even high-dose benzodiazepine supplementation. Lateralizing signs on the neurological examination, for example, suggest the possibility of an intracranial lesion, and a prolonged QRS interval on ECG indicates toxicity from a tricyclic antidepressant. Peripheral findings consistent with these high-risk criteria are also red flags. Clinical seizure activity that ensued would tend to be resistant to treatment with benzodiazepines and might require going directly to a barbiturate.Įpilepsy, co-ingestion of a proconvulsant drug such as a tricyclic antidepressant or bupropion, and head injury or intracranial pathology put a patient at increased risk for developing seizure activity. Any benzodiazepine on board would be protective, and reversing its effect could bring on status epilepticus. It soon became apparent that flumazenil was safe when given to healthy research subjects, but could be theoretically hazardous in a number of clinical situations. And they were the drugs of choice for hypertension, tachycardia, and other revved-up cardiovascular manifestations of acute cocaine toxicity. Many procedures would have been impossible without the sedative and amnesic effects of midazolam. Benzos worked wonders in patients who were anxious or agitated. They were first-line treatment for seizures, especially those related to drugs, and the go-to medication for managing alcohol withdrawal. The question I couldn't put out of my mind was: Why in the world would I want to reverse the effects of benzodiazepine? Benzos were great! They were a marvelous class of drugs that we used all the time for many different indications. It is a competitive benzodiazepine antagonist, displacing many benzodiazepines at the receptor without having significant agonist activity of its own, and it was considered one of the few pure antidotes in the medical toxicologist's armamentarium. The pharmacology of flumazenil gave reason for optimism. Hopes were high that it would be a blockbuster new product that would do for benzodiazepines what naloxone does for opioids in a rapid, reliable, and safe manner. Our emergency department took part in the early premarketing studies for flumazenil many years ago. Procalcitonin: Risk Assessment in COVID-19 Bacterial Co-Infection.Current Procalcitonin Utilization and Publications.The Physician Grind EMN with Zahir Basrai, MD.Everyday Medicine for Physicians with Ryan Stanton, MD.EMN Live with Richard Pescatore, DO, & Ali Raja, MD.
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