Brand Name:

Generic Name:

Classification: BENZODIAZEPINE ANTAGONIST

Recommended Dosage, Route, and Frequency:

Reversal of Sedation
Adult: IV 0.2 mg over 15 sec, may repeat 0.2 mg q60sec for 4 additional doses or a cumulative dose of 1
mg
Benzodiazepine Overdose
Adult: IV 0.2 mg over 30 sec, if no response after 30 sec, then 0.3 mg over 30 sec, may repeat with 0.5
mg q60sec (max: cumulative dose of 3 mg)
Drug Action: ADME, Onset, Peak, Duration

Antagonizes the effects of benzodiazepine on the CNS, including sedation, impairment of recall, and
psychomotor impairment. Does not reverse the effects of opioids.

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.
Metabolism and Excretion: Metabolism of flumazenil occurs primarily in the liver

Drug-Drug and Drug-Food Interactions:

Drug: May antagonize effects of zaleplon, zolpidem; may cause convulsions or arrhythmias
with TRICYCLIC ANTIDEPRESSANTS.
Indications:

Complete/partial reversal of effects of benzodiazepines used as general anesthetics, or during diagnostic

or therapeutic procedures. Management of intentional or accidental overdose of benzodiazepines.
Contraindications:

Hypersensitivity to flumazenil or to benzodiazepines; patients given a benzodiazepine for control of a

life-threatening condition; patients showing signs of cyclic antidepressant overdose; seizure-prone
individuals during labor and delivery. Effects on children are not established.
Side Effects: By system

CNS: dizziness, agitation, drowsiness, headache EENT: blurred vision GI: nausea, vomiting,

Adverse Reaction: By system

CNS: SEIZURES, dizziness, agitation, confusion, drowsiness, emotional lability, fatigue, headache, sleep
disorders. EENT: abnormal hearing, abnormal vision, blurred vision. CV: arrhythmias, chest pain,
hypertension. GI: nausea, vomiting, hiccups. Derm: flushing, sweating. Local: pain/injection-site
reactions, phlebitis. Neuro: paresthesia.Misc:rigors, shivering

Nursing Responsibilities: (ADPIE Format)

Assessment

● Assess level of consciousness and respiratory status before and during therapy. Observe patient for at
least 2 hr after administration for the appearance of resedation. Hypoventilation may occur. ●
Overdose: Attempt to determine time of ingestion and amount and type of benzodiazepine taken.
Knowledge of agent ingested allows an estimate of duration of CNS depression.
Potential Nursing Diagnoses

Risk for injury (Indications)

Risk for poisoning (Indications)

Implementation

● Do not confuse flumazenil with influenza virus vaccine ● Institute seizure precautions. Seizures are
more likely to occur in patients who are experiencing sedative/hypnotic withdrawal, patients who have
recently received repeated doses of benzodiazepines, or those who have a previous history of seizure
activity. Seizures may be treated with benzodiazepines, barbiturates, or phenytoin. Larger than normal
doses of benzodiazepines may be required.

Patient/Family Teaching

● Flumazenil does not consistently reverse the amnestic effects of benzodiazepines. Provide patient and
family with written instructions for postprocedure care. Inform family that patient may appear alert at
the time of discharge but the sedative effects of the benzodiazepine may recur. Instruct patient to avoid
driving or other activities requiring alertness for at least 24 hr after discharge.

Evaluation/Desired Outcomes

● Improved level of consciousness. ● Decrease in respiratory depression caused by benzodiazepines