Flumazenil (Romazicon)

Anesthesia reversal - administration of 0.3 mg at the end of surgery (in patients that did NOT receive benzodiazepines) has resulted in earlier emergence and higher BIS values. This suggest possible antagonism of inhaled anesthetics or even restorative affects of the drug itself. Expiration - Flumazenil is only stable for 24 hours if drawn into a syringe or mixed with LR, NS, or D5W Seizure risk - reversal of benzodiazepines can result in seizures, especially in those who use benzodiazepines to manage seizures. Those receiving Romazicon should be monitored for at least 2 hours. Overdose/Toxicity - overdose of flumazenil is extremely rare and wouldn't be expected in a patient that does NOT have a benzodiazepine dependence. Toxicity would most likely manifest as seizures, dysrhythmias, and hypotension

Reversal of benzodiazepines may provoke convulsions/seizures in: Patients exhibiting signs of tricyclic antidepressants overdose Benzodiazepine dependence Alcohol dependence Mixed overdose Head injuries or altered cerebral blood flow Benzodiazepine reversal can provoke panic attacks in those with panic disorders

Adult: Initial dose: 0.2 mg IV over 15 seconds Followed by: 0.2 mg IV every 1 minute If sedation reoccurs: 0.2 mg IV may be given at 20-minute intervals MAX cumulative: 1.0 mg Pediatric greater than or equal to 1 year old: Initial dose: 0.01 mg/kg (MAX 0.2 mg) given over 15 seconds Followed by: Same dose every 1 minute for up to 4 additional doses. Reassess sedation before each dose. MAX cumulative: The LOWEST of 1 mg or 0.05 mg/kg

Flumazenil is a benzodiazepine antagonist. However, flumazenil also works to reverse non-benzodiazepine substances that interact with GABA/benzodiazepine receptor complex. For this reason, there are several non-FDA approved uses (eg. baclofen drug reversal, alcohol withdrawal syndrome treatment, hepatic encephalopathy, cannabis toxicity, etc.)