Flumazenil " Anexate" : Commonly used drugs in Emergency & ICU

Flumazenil " Anexate"

Trade names: Anexate

Drug class: Benzodiazepine antagonist; reverses sedative effects of benzodiazepines used in conscious sedation and general anesthesia; treatment of benzodiazepine overdose Pregnancy: (Category C)

            Therapeutic actions

 Competitively inhibits the activity at the benzodiazepine recognition site on the GABA/benzodiazepine receptor complex. Flumazenil does not antagonize the CNS effect of drugs affecting GABA-ergic neurons by means other than the benzodiazepine receptor (ethanol, barbiturates, general anesthetics) and does not reverse the effects of opioids

              Dose:

§  By intravenous injection, 0.8–2 mg repeated at intervals of 2–3 minutes to a max. of 10 mg if respiratory function does not improve (then question diagnosis); CHILD 10 micrograms/kg; subsequent dose of

100 micrograms/kg if no response

§  By subcutaneous or intramuscular injection, as intravenous injection butonly if intravenous route not feasible (onset of action slower)

§  By continuous intravenous infusion using an infusion pump, 10 mg diluted in 50 mL intravenous infusion solution at a rate adjusted according to the response

Adverse Reactions

§  >10%

§  Gastrointestinal: Vomiting, nausea

§  1% to 10%:

§  Cardiovascular: Palpitations

§  Central nervous system: Headache, anxiety, nervousness, insomnia, abnormal crying, euphoria, depression, agitation, dizziness, emotional lability, ataxia, depersonalization, tears increased, dysphoria, paranoia, fatigue, vertigo

§  Endocrine & metabolic: Hot flashes

§  Gastrointestinal: Xerostomia

§  Local: Pain at injection site

§  Neuromuscular & skeletal: Tremor, weakness, paresthesia

§  Ocular: Abnormal vision, blurred vision

§  Respiratory: Dyspnea, hyperventilation

§  Miscellaneous: Diaphoresis

§  <1%: Abnormal hearing, altered blood pressure (increases and decreases), confusion, sensation of coldness, bradycardia, chest pain, generalized convulsions, hiccups, hypertension, junctional tachycardia, shivering, somnolence, tachycardia, thick tongue, ventricular tachycardia, withdrawal syndrome

§  Postmarketing and/or case reports: Fear, panic attacks

Overdosage/Toxicology

Excessively high doses may cause anxiety, agitation, increased muscle tone, hyperesthesia and seizures.

Nursing Implications

§  Parenteral: For I.V. use only;

§  administer via freely running I.V. infusion into larger vein to decrease chance of pain, phlebitis

Patient Education

§  Flumazenil does not consistently reverse amnesia. Do not engage in activities requiring alertness for 18-24 hours after discharge.

§  Avoid alcohol or OTC medications for 24 hours after receiving this medication, unless approved by prescriber.

§  Resedation may occur in patients on long-acting benzodiazepines (such as diazepam).

§  Pregnancy/breast-feeding precautions:  Should Inform physician if you she is or intend to become pregnant and Consult him if she is a breast-feeding.

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