When treating a patient with flumazenil for suspected benzodiazepine intoxication, certain adverse effects may be observed. The patient should be monitored during therapy, and any adverse effects treated promptly.
Patient selection: flumazenil therapy for suspected benzodiazepine intoxication
Serious adverse effects include:
(1) seizures
(2) cardiac arrhythmias (supraventricular arrhythmias, multiple ventricular beats)
(3) hypotension
Other adverse effects may include:
(1) tachycardia
(2) agitation or aggressive behavior
(3) nausea, vomiting or abdominal cramps
(4) sweating, shivering, malaise, shakes, and/or chills
(5) headache
(6) dizziness
(7) anxiety or distress
(8) depressed mood or dysphoria
(9) abnormal crying
(10) aspiration pneumonia
Some of the findings can be explained by reversal of the effects of the benzodiazepine or signs of withdrawal. The presence of other drugs could also explain some of the findings. It is uncertain which findings could be due to the effects of flumazenil alone. Simply using a placebo alone may not be the best control since flumazenil is an antagonist and is able to trigger withdrawal.
It would be prudent not to use large doses indiscriminately, but rather to use the lowest dose to achieve the therapeutic goals.
