Alternate Name(s):
ANEXATE®
Classification:
Benzodiazepine antagonist
Original Date:
August 2005
Revised Date:
September 2011
Indications:
- Reversal of central sedative effects of benzodiazepines
- NOT indicated for ethanol, barbiturate, general anesthetic or narcotic overdose
Reconstitution and Stability:
- Available as 0.1 mg/mL vials
- Store at room temperature
- Stable for 24 hours at room temperature after removing it from its original vial
- Stable for 24 hours in D5W, NS and ringer's lactate at room temperature
Compatibility:
- Solutions Compatible: D5W, NS, ringer's lactate
- Additives/Above Cassette Compatible: no information
- Y-site Compatible: no information
Incompatible: no information
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct | YES, into freely running IV infusion in large vein Usual dilution: 0.1 mg/mL Infusion time: 15-30 seconds |
| IV Intermittent Infusion | YES Usual dilution: 0.1 mg/mL |
| IV Continuous Infusion | YES, Usual dilution: 0.1 mg/mL Infusion rate: depends on dose needed by patient |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- IV Direct: 10-20 mcg/kg/dose IV (Max: 0.2 mg), repeated as required at 1 minute intervals, Maximum: 5 total doses or a total dose of 1 mg
- IV Continuous: 5-10 mcg/kg/hour IV
Adolescent/Adult:
- 0.2 mg IV over 30 seconds, if no response within 30 seconds, may give an additional dose of 0.3 mg IV.
- May repeat at 1 minute intervals.
- Maximum: total dose of 3 mg.
Potential hazards of parenteral administration:
- Thrombophlebitis
- Seizures and/or cardiac arrhythmias may occur in patients maintained on benzodiazepine therapy
- May precipitate a benzodiazepine withdrawal syndrome
- In patients with suspected concomitant tricyclic antidepressant overdose, ECG analysis for QRS prolongation should be performed prior to administration of flumazenil; reversal of benzodiazepine activity may precipitate cardiac arrhythmias and/or seizures
- Nausea, vomiting, dizziness have been reported
Notes:
- Flumazenil has a short duration of action, thus patients should be closely monitored until all central benzodiazepine effects have subsided, repeat doses may be required (the initial dosing regimen may be repeated no more frequently than every 20 minutes)
- Flumazenil effectively reverses CNS sedation due to benzodiazepines, but does not reliably reverse the respiratory depressant effects
- Flumazenil is a benzodiazepine antagonist only and has no effect on reversing the sedative effects of other CNS depressants
- Elimination may be delayed in patients with severe hepatic impairment
- Monitor level of consciousness, blood pressure, heart rate, respiratory rate