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Flumazenil, naloxone and the 'coma cocktail'
1Emergency Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario.
British Journal of Clinical Pharmacology
|October 16, 2015
Summary
Naloxone, an opioid antagonist, is widely used for altered mental status, unlike the benzodiazepine antagonist flumazenil. This review explains the disparity in their clinical application despite both being ideal antidotes.
Area of Science:
- Pharmacology
- Toxicology
- Emergency Medicine
Background:
- Flumazenil and naloxone are pharmacologically ideal antidotes for benzodiazepines and opioids, respectively.
- Both exhibit rapid onset, short duration, easy titration, and lack agonist effects.
- Despite ideal properties, their clinical usage differs significantly.
Purpose of the Study:
- To explain the disparity in clinical use between flumazenil and naloxone.
- To contrast their history, indications, evidence, and novel applications.
- To understand why naloxone is favored in empirical 'coma cocktails' while flumazenil use is discouraged.
Main Methods:
- Comparative review of flumazenil and naloxone.
- Analysis of historical data and clinical indications.
- Evaluation of published evidence and emerging applications.
Main Results:
- Naloxone is a standard component of empirical altered mental status treatment ('coma cocktail').
- Flumazenil's use in similar settings is generally discouraged by experts.
- The review highlights differences in their clinical acceptance and application.
Conclusions:
- The disparity in clinical use is not due to pharmacological properties but likely other factors.
- Understanding these differences is crucial for appropriate antidote selection in emergency settings.
- Further research may clarify optimal roles for both antidotes.