PreOp Meds: Flumazenil (Reversal)

Question 1

What is flumazenil (Romazicon)?

Answer 1

• Competitive antagonist for benzodiazepine receptor. (preventative and reversal)

Question 2

What metabolizes flumazenil? What are its metabolites?

Answer 2

• CYP450’s
• No active metabolites

Question 3

What is the dosing of flumazenil?

Answer 3

• 0.2mg IV titrated to consciousness (repeat 0.1mg q1min til 1mg total)

Question 4

What is the sedation reversal dose range of flumazenil?

Answer 4

• 0.3 - 0.6 mg

Question 5

What is the complete reversal dose range of flumazenil?

Answer 5

• 0.5 - 1 mg

Question 6

If the patient is still unconscious after 0.5 - 1mg of flumazenil has been given, what should be considered?

Answer 6

• Other intoxicants (opioids, EtOH, etc)

Question 7

What is the duration of flumazenil?

Answer 7

• 30 - 60 min

Question 8

When is flumazenil contraindicated?

Answer 8

• When needed antiepileptics are being given
• If it precipitates acute EtOH withdrawal.