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Clinical References

Pharmacology

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Learning Center/Pharmacology/Flumazenil

reversal agent

Flumazenil

Romazicon

Route: IV
Onset: 1–2 minutes
Duration: About 1 hour — shorter than midazolam in many patients

Mechanism of action

Competitive antagonist at the benzodiazepine site of the GABA-A receptor. Reverses benzodiazepine sedation; less reliable for respiratory depression.

Dosing

Adult: 0.2 mg IV over 15–30 seconds; repeat 0.2 mg every minute as needed to a total of 1 mg
Pediatric: 0.01 mg/kg IV (max 0.2 mg), repeat every minute to a total of 0.05 mg/kg or 1 mg

Indications

Reversal of benzodiazepine sedation after procedures (e.g., midazolam for bronchoscopy)

Contraindications

Chronic benzodiazepine use or dependence (precipitates withdrawal seizures)
Seizure disorder controlled with benzodiazepines
Mixed overdose with tricyclic antidepressants or other pro-convulsants
Raised intracranial pressure

Side effects

Seizures
Agitation, anxiety
Nausea and vomiting
Arrhythmias

Monitoring parameters

Respiratory rate, SpO2 and ETCO2
Seizure activity
Re-sedation for at least 2 hours

Drug interactions

Does not reverse opioids, alcohol, propofol or barbiturates

NBRC high-yield

Benzodiazepine antagonist
Seizure risk in chronic benzodiazepine users
Re-sedation possible — monitor

Clinical pearls

Not for an unknown overdose — the seizure risk outweighs the benefit
For a procedural patient with combined midazolam and opioid, stimulation and airway support come first; naloxone addresses the opioid component

Flumazenil (Romazicon) — Respiratory Pharmacology