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Protective effect of flumazenil infusion in severe acute benzodiazepine toxicity: a pilot randomized trial

  • Clinical Trial
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European Journal of Clinical Pharmacology Aims and scope Submit manuscript

A Correction to this article was published on 26 February 2021

This article has been updated

Abstract

Objective

We aimed to investigate the efficacy of flumazenil infusion in the maintenance of arousal and prevention of development of complications in severe benzodiazepine poisoning.

Materials and method

Sixty severely poisoned patients (intubated due to loss of consciousness) intoxicated by sole benzodiazepines referred to Loghman Hakim hospital between May 2018 and August 2019 were considered to be included in the current study. All were evaluated for possible contraindications of flumazenil administration. If there were no contraindications, we continued supportive care in one group and supportive care plus flumazenil infusion in the second group. Following response to the stat dose of flumazenil, complications, hospital stay, and outcome were compared between these two groups.

Results

A total of 60 benzodiazepine-poisoned patients aged between 16 and 84 years old (37 males and 23 females) were enrolled. There was no statistically significant difference between these two groups regarding the period of hospital stay. Need for intubation significantly decreased in the infusion group. None of the patients experienced seizure or dysrhythmia. One patient died in the control group which received only a stat dose of flumazenil.

Conclusions

Administration of flumazenil is safe in benzodiazepine-poisoned patients with appropriate indications. Flumazenil infusion can significantly decrease the need for intubation and subsequent ICU admission. Even though flumazenil is an expensive antidote, its administration may decrease the need for ICU beds in the setting of acute poisoning.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request

Change history

Abbreviations

BZD:

benzodiazepine

COPD:

chronic obstructive pulmonary disease

CT:

computed tomography

DM:

diabetes mellitus

ED:

emergency department

GCS:

Glasgow coma scale

HTN:

hypertension

ICU:

intensive care unit

IHD:

ischemic heart disease

IQR:

interquartile range

LOC:

loss of consciousness

TCAs:

tricyclic antidepressants

UDT:

urine drug testing

VBG:

venous blood gas

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Funding

All necessary funds of this study were provided by National Institute for Medical Research Development (NIMAD).

Author information

Authors and Affiliations

  1. Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran

    Akram Sadat Razavizadeh

  2. Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Nasim Zamani & Hossein Hassanian-Moghaddam

  3. Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, Iran

    Nasim Zamani & Hossein Hassanian-Moghaddam

  4. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Pardis Ziaeefar & Sara Ebrahimi

Authors
  1. Akram Sadat Razavizadeh
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  2. Nasim Zamani
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  3. Pardis Ziaeefar
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  4. Sara Ebrahimi
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  5. Hossein Hassanian-Moghaddam
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Contributions

HHM conceived of and designed the study and data collection tools. ASR, HHM, and NZ collected data. HHM analyzed the data. PZ and SE drafted the manuscript. NZ and HHM revised the manuscript for important intellectual contribution. All authors read the final manuscript and approved submission.

Corresponding author

Correspondence to Hossein Hassanian-Moghaddam.

Ethics declarations

Conflict of interests

The authors declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.

Ethical approval

The study was approved by the ethics committee in National Institute for Medical Research Development (IR.NIMAD.REC.1397.305) and registered in Iranian Clinical Trial Registry (IRCT20120629010133N3).

Consent to participate and publication

Patients’ relatives accompanying them to ED were explained about the process of the study and written informed consents were taken from them all before patient enrollment. Patients that were awake after the initial flumazenil administration give consent for themselves as well. All data are de-identified in this database to remove patients’ information. Ethic committee waived consent for publication with this conditional issue.

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Key points

Benzodiazepine toxicity is a common poisoning all over the world, and it is not life-threatening with treatment in most cases. Still there are reports of 3.2% severe toxicity and 0.1% death in these groups that make considerable numbers of morbidity and mortality.

Flumazenil is a competitive benzodiazepine receptor antagonist that is used as a diagnostic antidote to obviate the need for further diagnostic and therapeutic interventions in case of unknown loss of consciousness.

After evaluation for possible contraindications of flumazenil administration, we run a pilot randomized trial and found that flumazenil infusion can significantly decrease the need for intubation and subsequent ICU admission in those poisoned by this popular CNS drug.

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Razavizadeh, A.S., Zamani, N., Ziaeefar, P. et al. Protective effect of flumazenil infusion in severe acute benzodiazepine toxicity: a pilot randomized trial. Eur J Clin Pharmacol 77, 547–554 (2021). https://doi.org/10.1007/s00228-020-03031-7

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  • DOI: https://doi.org/10.1007/s00228-020-03031-7

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