From the Department of Pharmacology and Toxicology, Tehran University of Medical Sciences, and the Toxicology Ward of Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
Abstract: (5394 Views)
Benzodiazepine overdose is the most commonly encountered drug overdose
in Iran. It has been reported by many authors that flumazenil possesses highly
specific antagonistic activity on central benzodiazepine receptors. We conducted
a prospective study on 150 patients brought to the toxicology emergency ward in
Loghman-Hakim hospital with benzodiazepine overdose to assess the efficacy of
flumazenil to counteract benzodiazepine overdose. Upon arrival, patients were
examined thoroughly and their Glasgow coma scale was recorded. Afterwards
flumazenil was administered in sufficient dosage, between 0.25-0.50 mg. The
most commonly consumed benzodiazepine was diazepam (50%). One hundred
and thirty patients responded positively to flumazenil, characterized by improved
response to painful stimuli, and decreased amnesia.
Twenty percent of the patients (26 cases) had an increased respiratory rate
after flumazenil administration. In 86 patients, consciousness improved after 5
minutes, in 36 patients after 10 minutes and in 8 patients after 15 minutes. In 48
patients the psychomotor performance improved 5 minutes after antidote
administration, while in 15 patients psychomotor performance improved after 30
minutes. Some patients developed resedation after flumazenil administration. In
25 patients resedation occurred after 15 minutes, in 59 patients after 30 minutes,
and 34 patients showed this phenomenon after 45 minutes. Despite this last
finding, we concluded that flumazenil effectively and rapidly antagonizes the
central effects of benzodiazepines. It is also a valuable diagnostic agent with no
serious side effects.