Use of flumazenil and naloxone in poisoned patients
4 out of 5 stars
Flumazenil, naloxone and the ‘coma cocktail’ Sivilotti MLA Br J Clin Pharmacol 2015 Aug 7 [Epub ahead of print]
Abstract
This very smart paper reviews factors affecting the clinical use of two antidotes that reliably reverse coma caused by two major classes of poisons: flumazenil for benzodiazepines, and naloxone for opiates.
Both these antidotes are specific, rapid-acting, short-lived, and titratable. However, significant adverse effects have been associated with each of them. Unwise or overly aggressive administration of flumazenil can cause acute benzodiazepine withdrawal, agitation, seizures, and fatal cardiac arrhythmias. Since many of the severe adverse effects occur in cases of mixed overdoses, use is generally discouraged in the comatose poisoned patients where detailed history is often not available.
Although naloxone is often considered safe, it can precipitate acute opiate withdrawal that, though rarely fatal, can present a risk to medical staff and other patients. The author notes:
There is a growing awareness that widely recommended initial doses [of naloxone] of 0.4 mg to 2 mg are unnecessary and that 40 μg is a more appropriate initial dose in many cases.
Actually, there is considerable controversy regarding the proper starting dose of naloxone, with some maintaining that 40 μg is a dose so low as to be almost homeopathic. Sivilotti argues (convincingly, to my mind) that in opiate-induced respiratory depression, “non-p...
Source: The Poison Review - Category: Toxicology Authors: Leon Tags: Medical antidote benzodiazepine coma cocktail flumazenil naloxone opiate Source Type: news
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