Flumazenil in self-induced benzodiazepine poisoning

In Sweden the pattern of consumption of hypnotics has changed over the last two decades in favour of benzodiazepines (BZ), at the expense, mainly, of barbiturates. The agents chosen in cases of self-induced poisoning relfect this altered pattern of consumption. The frequency of BZ poisoning alone or in combinations at the Intensive Care Unit (ICU) of one of the largest hospitals in Stockholm increased by an average of 13% per year between 1972 and 1986. Today BZ poisoning constitutes 57% of all self-induced poisonings with hypnotics and sedatives. The mortality is negligible, but the cost of ICU treatment is substantial. The discovery of the BZ antidote flumazenil therefore opens up interesting diagnostic and therapeutic possibilities. The drug's efficacy in reversing iatrogenic BZ overdose has been well documented. Its use in cases of self-induced poisoning has also been advocated. Various authors have reported independently successful use of flumazenil in series of patients admitted because of self-induced hypnotic-drug overdose. The results clearly demonstrate that flumazenil is a potent, quick-acting antidote to BZ. However, the duration of its action is short.