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Lack of adverse effects from flumazenil administration: an ED observational study
Tammy T Nguyen1, Michelle Troendle1, Kirk Cumpston1
1Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298; Virginia Poison Center, Richmond, VA 23298; Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298.
Background:
Flumazenil is an effective benzodiazepine (BZD) antagonist. Empiric use of flumazenil in the emergency department (ED) is not widely recommended due to concerns of seizures, which are commonly associated with coingestants and BZD withdrawal.
Objective:
The objective of the study is to assess adverse events and clinical outcomes of flumazenil administration in known and suspected BZD overdose in an ED at a tertiary academic medical center.
Methods:
This is a retrospective observational study of adult patients administered flumazenil for known or suspected BZD overdose in the ED over 7 years. Outcomes included mental status improvement, the incidence of seizures, and intubation of the trachea after flumazenil administration.
Results:
Twenty-three patients were included in the analysis, of which 15 (65%) of patients experienced some type of clinically significant mental status improvement. No seizures were identified despite 7 (35%) reported proconvulsant coingestants. One patient required intubation of the trachea but was subsequently extubated in the ED.
Conclusions:
A majority of patients had improved mental status after the administration of flumazenil. No patient experienced seizures. Additional studies that clarify the role of flumazenil for ED patients with suspected BZD toxicity are warranted.
Insights
Flumazenil safely improved mental status in patients with benzodiazepine (BZD) overdose in the emergency department, with no seizures observed. Further research is needed to clarify its role in BZD toxicity management.
Area of Science:
- Emergency Medicine
- Clinical Toxicology
- Pharmacology
Background:
- Flumazenil is a known benzodiazepine (BZD) antagonist.
- Empiric flumazenil use in emergency departments (ED) is debated due to seizure risks associated with coingestants and BZD withdrawal.
Purpose of the Study:
- To evaluate adverse events and clinical outcomes of flumazenil administration.
- Focus on patients with known or suspected BZD overdose in an ED setting.
Main Methods:
- Retrospective observational study over 7 years.
- Included adult patients receiving flumazenil for BZD overdose.
- Assessed mental status improvement, seizures, and intubation rates.
Main Results:
- 15 out of 23 patients (65%) showed significant mental status improvement.
- No seizures occurred, even with 35% having proconvulsant coingestants.
- One patient required intubation but was successfully extubated in the ED.
Conclusions:
- Flumazenil administration resulted in improved mental status for most patients.
- Seizure incidence was zero in this study cohort.
- Further studies are recommended to define flumazenil's role in ED BZD toxicity.
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