Drugs that interact with CYP enzymes may prolong the half-lives of most Benzodiazepines They are rapidly absorbed in the gastrointestinal tract, with peak plasma concentrations occurring 30 to 90 minutes after ingestion.Short-acting (half-life 24 h) eg Diazepam, these generally have pharmacologically active metabolites, accumulate in tissues after multiple doses, and demonstrate impaired clearance in children with liver disease.Benzodiazepines can be short, intermediate or long acting:.Sedation can be prolonged and last up to 36 hours.All intentional overdoses require a Mental Health Assessment.įor 24 hour advice, contact Victorian Poisons Information Centre 13 11 26 Background.Close observation and supportive care are the mainstay of management.Pure benzodiazepine overdoses usually induce a mild to moderate central nervous system depression deep coma requiring assisted ventilation is rare, and should prompt a search for other toxic substances.Emergency Medicine Journal, 29, 565-569.Poisoning – Acute guidelines for initial management Coma Afebrile Seizures Resuscitation Key points Flumazenil use in benzodiazepine overdose in the UK: A restrospective survey of NPIS data. Veiraiah, A., Dyas, J., Cooper, G., Routledge, P.
Bethesda, Maryland: American Society of Health-System Pharmacists Pediatric zolpidem ingestion demonstrating zero-order kinetics treated with flumazenil. Haddad and Winchester's clinical management of poisoning and drug overdose (Fourth ed.). Flumazenil administration in poisoned pediatric patients. Journal of Medical Toxicology, 9, 155-162. Review article: The clinical and forensic toxicology of Z-drugs. Goldfrank's toxicologic emergencies (Tenth ed.). Quebec, Canada: Centre antipoison du Quebec. Antidotes en toxicologie d'urgence (3rd ed.). Titrate to effect.īailey, B., Blais, R., Gaudreault, P., Gosselin, S., & Laliberte, M. (2009). If adequate sedation reversal does not occur after an additional 45 seconds, further injections of 0.01 mg/kg ( up to maximum 0.2 mg) may be repeated at 1 minute intervals, as needed up to 4 times: Maximum total dose 0.05 mg/kg or 1 mg, whichever is lower.Ĭonsider IV infusion of 0.1 mg -1 mg/hour. The following data is based on published case reports.Ġ.01 mg/kg (up to maximum of 0.2 mg) over 15 seconds. Management of clinically significant CNS depression caused by overdose of zolpidem, zaleplon, or zopiclone.Management/diagnosis of a pure benzodiazepine overdose causing clinically significant CNS or respiratory depression meeting the following criteria: no history of seizure disorder, no chronic use of benzodiazepines, and no coingestion of a toxin that can cause seizures or cardiac dysrhythmias.Reversal of sedation due to benzodiazepines used in diagnostic or therapeutic procedures.ALERT: The use of flumazenil as a reversal agent for intentional benzodiazepine overdose is not routinely recommended due to risk of refractory seizures.
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