Toxicological investigations with the benzodiazepine antagonist flumazenil

The benzodiazepine antagonist ethyl 8-fluoro-5,6-dihydro-5-methyl-6-oxo-4H-imidazo[1,5-a][1,4] benzodiazepine-3-carboxylate (flumazenil, Ro 15-1788, Anexate) was investigated in a series of toxicological studies. In a single intravenous injection study in male and female mice and rats, the highest non-lethal (maximum tolerated) doses were found to be between 62.5 and 125 mg/kg (the amounts of flumazenil present in the aqueous ampoules available for intravenous injection in man are 0.5 and 1.0 mg). In intravenous studies of 4 weeks duration, 10 mg/kg/d were systemically well tolerated in dogs and rats. In 13-week oral studies, 80 mg/kg/d were very well tolerated in dogs (capsule administration) and, after 125 mg/kg/d (by feed-admix) in rats, no untoward compound-related findings apart from a 10-15% increase of the liver weights in females were made. In reproductive toxicity studies, flumazenil revealed no drug-related embryotoxic or teratogenic effect and no adverse effects upon fertility of dosed animals themselves or on the peri- and postnatal development of their offspring. There was no indication for mutagenic potential of flumazenil in vitro concerning induction of gene mutations or clastogenic effects. An in vivo DNA repair test using germ cells of male mice did not yield DNA-damaging activities. From all these toxicological investigations it can be concluded that the risk in man given therapeutic doses or even intentional or accidental overdoses of flumazenil is extremely small.