EFFICACY OF FLUMAZENIL IN THE MANAGEMENT OF BENZODIAZEPINE OVERDOSE

Benzodiazepine overdose is the most commonly encountered drug overdose in Iran. It has been reported by many authors that flumazenil possesses highly specific antagonistic activity on central benzodiazepine receptors. We conducted a prospective study on 150 patients brought to the toxicology emergency ward in Loghman-Hakim hospital with benzodiazepine overdose to assess the efficacy of flumazenil to counteract benzodiazepine overdose. Upon arrival, patients were examined thoroughly and their Glasgow coma scale was recorded. Afterwards flumazenil was administered in sufficient dosage, between 0.25-0.50 mg. The most commonly consumed benzodiazepine was diazepam (50%). One hundred and thirty patients responded positively to flumazenil, characterized by improved response to painful stimuli, and decreased amnesia. Twenty percent of the patients (26 cases) had an increased respiratory rate after flumazenil administration. In 86 patients, consciousness improved after 5 minutes, in 36 patients after 10 minutes and in 8 patients after 15 minutes. In 48 patients the psychomotor performance improved 5 minutes after antidote administration, while in 15 patients psychomotor performance improved after 30 minutes. Some patients developed resedation after flumazenil administration. In 25 patients resedation occurred after 15 minutes, in 59 patients after 30 minutes, and 34 patients showed this phenomenon after 45 minutes. Despite this last finding, we concluded that flumazenil effectively and rapidly antagonizes the central effects of benzodiazepines. It is also a valuable diagnostic agent with no serious side effects.