Flumazenil Use in Benzodiazepine-Induced Delirium Reversal

Delirium is a frequent and serious complication in critically ill patients, associated with increased mortality, prolonged hospitalization, and long-term cognitive impairment. The hypoactive subtype is particularly underrecognized, missed in up to 75% of cases, and carries worse outcomes. Benzodiazepines (BZDs), though often used for sedation in the intensive care unit (ICU), can contribute to or exacerbate delirium due to their pharmacokinetics, especially in patients with renal or hepatic dysfunction. Flumazenil, a competitive benzodiazepine receptor antagonist, has been primarily utilized for acute overdose but may have an emerging role in reversing BZD-related delirium. We present a case in which flumazenil administration led to rapid neurological recovery in a critically ill patient with persistent hypoactive delirium following BZD exposure. This report highlights the importance of considering BZD-induced delirium in ICU patients and highlights flumazenil as a potential therapeutic strategy warranting further investigation.