Flumazenil interactions

Conditions

Conditions in which Flumazenil needs care, as documented in this source.

• Seizures

  Major

  Flumazenil has been associated with seizure activity, particularly in patients receiving repeated doses of benzodiazepines for long term sedation, acute overdose involving concurrent cyclic antidepressants, or head injury where it may alter cerebral blood flow in patients receiving benzodiazepines. Therapy with flumazenil should be administered cautiously in patients with a history of or predisposition to seizures.

  5 sources

  1. Marchant B, Wray R, Leach A, Nama M "Flumazenil causing convulsions and ventricular tachycardia." BMJ 299 (1989): 860
  2. Mordel A, Winkler E, Almog S, Tirosh M, Ezra D "Seizures after flumazenil administration in a case of combined benzodiazepine and tricyclic antidepressant overdose." Crit Care Med 20 (1992): 1733-4
  3. Thomas P, Lebrun C, Chatel M "De novo absence status epilepticus as a benzodiazepine withdrawal syndrome." Epilepsia 34 (1993): 355-8
  4. "Product Information. Romazicon (flumazenil)." Roche Laboratories (2001):
  5. Chern TL, Kwan A "Flumazenil-induced seizure accompanying benzodiazepine and baclofen intoxication." Am J Emerg Med 14 (1996): 231-2

• Alcoholism

  Moderate

  Flumazenil should be used with caution in patients with alcoholism and other drug dependencies due to the increased frequency of benzodiazepine tolerance and dependence observed in these patient populations.

  1 source

  1. "Product Information. Romazicon (flumazenil)." Roche Laboratories (2001):

• Liver Diseases

  Moderate

  Flumazenil is a highly extracted drug, dependent on blood flow, and primarily metabolized by the liver. Hepatic clearance is decreased 40% to 60 % in patients with moderate hepatic dysfunction and 75% in patients with severe hepatic dysfunction. Care should be exercised as the metabolic and therapeutic activity of flumazenil may be altered in patients with compromised hepatic function or conditions that decrease systemic blood flow. Following the initial dose, subsequent doses or the frequency of administration should be reduced.

  6 sources

  1. Klotz U "Drug interactions and clinical pharmacokinetics of flumazenil." Eur J Anaesthesiol Suppl 2 (1988): 103-8
  2. Janssen U, Walker S, Maier K, von Gaisberg U, Klotz U "Flumazenil disposition and elimination in cirrhosis." Clin Pharmacol Ther 46 (1989): 317-23
  3. Pomier-Layrargues G, Giguere JF, Lavoie J, Willems B, Butterworth RF "Pharmacokinetics of benzodiazepine antagonist Ro 15-1788 in cirrhotic patients with moderate or severe liver dysfunction." Hepatology 10 (1989): 969-72
  4. Roncari G, Ziegler WH, Guentert TW "Pharmacokinetics of the new benzodiazepine antagonist Ro 15-1788 in man following intravenous and oral administration." Br J Clin Pharmacol 22 (1986): 421-8
  5. van der Rijt CC, Drost RH, Schalm SW, Schramel M "Pharmacokinetics of flumazenil in fulminant hepatic failure." Eur J Clin Pharmacol 41 (1991): 501
  6. "Product Information. Romazicon (flumazenil)." Roche Laboratories (2001):

• Psychotic Disorders

  Moderate

  Panic attacks have been induced by flumazenil in patients with a history of panic attacks. Emotional lability, including crying, depersonalization, euphoria, depression, dysphoria and paranoia have also been reported. Therapy with flumazenil should be administered cautiously in patients with or predisposed to psychosis, particularly panic attacks.

  4 sources

  1. Seebach J, Jost R "Flumazenil-induced psychotic disorder in hepatic encephalopathy." Lancet 339 (1992): 488-9
  2. "Flumazenil." Med Lett Drugs Ther 34 (1992): 66-8
  3. Griffiths RR, Evans SM, Guarino JJ, Roache JD, Furman WR, Liebson I, Schwam EM "Intravenous flumazenil following acute and repeated exposure to lorazepam in healthy volunteers: antagonism and precipitated withdrawal." J Pharmacol Exp Ther 265 (1993): 1163-74
  4. "Product Information. Romazicon (flumazenil)." Roche Laboratories (2001):