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Flumazenil use in benzodiazepine overdose in the UK: a retrospective survey of NPIS data [Abstract]

Veiraiah, A., Dyas, J., Routledge, Philip Alexander and Thompson, John Paul 2010. Flumazenil use in benzodiazepine overdose in the UK: a retrospective survey of NPIS data [Abstract]. Clinical Toxicology 48 (6) , p. 648. 10.3109/15563650.2010.493290

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Flumazenil is an effective benzodiazepine (BDZ) antagonist, but its usefulness in managing BDZ overdose (OD) is limited by its potential to precipitate seizure. The approach of UK clinicians to the use of flumazenil has not been systematically studied or reported so far. Complicated cases of poisoning in the UK are referred to the National Poisons Information Service (NPIS) for advice. Details of enquiries to the NPIS are recorded in the UK poisons information database (UKPID). Using UKPID, we present data on 2 years of UK experience with the use of flumazenil in the management of BDZ OD. Between 2007 and 2009 there were 4,504 enquiries to the NPIS relating to overdoses involving BDZ. Sixty-five of these patients were definitely administered flumazenil (60 prior to enquiry and 5 others on toxicologists’ recommendation), including many patients who had also ingested proconvulsant drugs. Of 40 patients for whom information on response to flumazenil was available, 32 demonstrated rapid improvement in GCS/airway/breathing and 8 demonstrated no benefit. One patient developed brief convulsions after a second dose of flumazenil after an ineffective first dose in one mixed OD involving BDZ and a proconvulsant drug (seizure rate 1.5%). The only other adverse reaction recorded was one case of agitation following flumazenil administration. The indications for flumazenil use were not clear in a significant proportion of cases. Seizures also occurred in 0.25% of BDZ OD patients in the absence of flumazenil therapy (due to coingestion of proconvulsant drugs). There is evidence of uncertainty/disagreement about the use of flumazenil in relation to: indications for use, safety in a mixed OD or when there is a past history of seizures, dose escalation after partial response or no response, and role in lateonset compromise of airway/breathing. Further research should aim to address these issues through a systematic review of the use of flumazenil in BDZ OD, and through a well designed prospective study using standardised data collection and better follow-up for NPIS enquiries.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RS Pharmacy and materia medica
Publisher: Taylor & Francis
ISSN: 1556-3650
Last Modified: 04 Apr 2020 01:22

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