Toxicological Controversies Series

Flumazenil: Revisited: time to resurrection or last nail in its coffin 

June 2016 | Saad Al Juma 

 

Since the introduction of Flumazenil in the market as GABAA receptors antagonists in 1987 and it approval by FDA on 1991, its use for reversal in benzodiazepine overdose or after therapeutic or diagnostic procedures was widely practiced and showed generally very good outcome. (ref)

 

However, there has been  ongoing controversy about its safety and efficacy in acute benzodiazepine overdose. There are many case reports associating the use of flumazenil with dysrhythmias, seizures and death. (ref)  

 

In this controversy series, here are outlined the pros and cons regarding the use of flumazenil in acute benzodiazepine toxicity with regard to the following categories: safety, efficacy/cost-effectiveness and practicality of use.

 

After reading our brief summary of the evidence we will present clinical scenarios for which your input is requested.

 

We will collect answers for one week and post the results on our site to reflect the clinical toxicology community’s practice patterns.

 

There is no right or wrong answers in the questions we ask. We are primarily interested in assessing potential variability in practice and underlying reasons.