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It may therefore be used in anaesthesia and in the intensive care in the following situations: The recommended starting dose is 0.2 mg administered intravenously over 15 seconds.If the required level of consciousness is not obtained within 60 seconds, a further dose of 0.1 mg can be injected and repeated at 60-second intervals, up to a maximum dose of 1.0 mg.BECAUSE THIS FAQ IS NOT WRITTEN BY A DOCTOR, ALL ADVICE IN THIS DOCUMENT IS TO BE FOLLOWED AT YOUR OWN RISK.This FAQ is expressly placed into the public domain and may be freely disseminated by any who come into its possession. It is a gift to anyone in the world whose life has been touched by benzodiazepine dependency.
In case of other sedating benzodiazepines, the monitoring time must be adjusted according to their expected duration.- The use of the antagonist is not recommended in patients with epilepsy, who have been treated with benzodiazepines for a prolonged period of time.
If the desired level of consciousness is not obtained after waiting an additional 45 seconds, further injection of 0.01 mg/kg may be administered (up to 0.2 mg) and repeated at 60 second intervals where necessary (a maximum of 4 times) to a maximum total dose of 0.05 mg/kg or 1 mg, whichever is lower.
The dose should be individualised based on the patient's response.
Until sufficient data are available, flumazenil should only be administered to children below the age of 1 year if the risks to the patient (especially in the case of accidental overdose) have been weighed up against the benefits of the treatment.- The patient should be monitored for an adequate period of time based on the dose and duration of effect of the benzodiazepine employed (ECG, pulse, oximetry, patient alertness and other vital signs such as heart rate, respiratory rate and blood pressure).- As the action of flumazenil is usually shorter than that of benzodiazepines and sedation may possibly recur the patient should remain closely monitored, preferably in the intensive care unit, until the effect of flumazenil has presumably worn off.- In high-risk patients, the benefits of benzodiazepine-induced sedation should be weighed against the risks of rapid awakening. with cardiac problems) maintenance of a certain level of sedation may be preferable to being fully awake.- Rapid injection of flumazenil should be avoided.
In patients with high-dose and/or long-term exposure to benzodiazepines ending at any time within the weeks preceding flumazenil administration, rapid injection of doses equal to or higher than 1 mg has led to withdrawal symptoms, including palpitations, agitation, anxiety, emotional lability as well as mild confusion and sensory distortions.- In patients treated for long periods with high doses of benzodiazepines, the advantages of the use of flumazenil should be weighed against the risk of withdrawal symptoms.