flumazenil can't be used in benzodiazepine ove - usmle68

[ArchivalUser]

Under what situation can't flumazenil be used in benzodiazepine overdose?

[ArchivalUser]

caution should be exercised when using this agent in patients who have co-ingested chloral hydrate to carbamazepine or whose ECG shows abnormalities typical to those seen after overdose with tricyclic antidepressants (TCAs); the use of flumazenil in the presence of these drugs can sometimes induce treatable cardiac dysrrhythmia. It is manily used when benzo is the only drug overdose.

hope this help ur question, input are welcome

[ArchivalUser]

chronic benzo use+overdose, we can not use flumazenil. I forgot why. Maybe cause siezure?

[ArchivalUser]

Yes. they preclude to seizures. Should be used cautiously in those with history of epilepsy

[ArchivalUser]

What should we use for chronic benzo+benzo overdose then?

[ArchivalUser]

Its symptomatic Mm as givin flumazenil in chronic benzo use can elicit withdrawal seizures...

[ArchivalUser]

What should we use for chronic benzo+benzo overdose then?

[ArchivalUser]

Symtomatic management. Supportive measures include observation of vital signs, especially Glasgow Coma Scale and airway patency. IV access with fluid administration and maintenance of the airway with intubation and artificial ventilation may be required if respiratory depression or pulmonary aspiration occurs.
Supportive measures should be put in place prior to administration of any benzodiazepine antagonist in order to protect the patient from both the withdrawal effects and possible complications arising from the benzodiazepine.

[ArchivalUser]

Flumazenil (Anexate) is a competitive benzodiazepine receptor antagonist that can be used as an antidote for benzodiazepine overdose. Its use, however, is controversial as it has numerous contraindications.[3][45] It is contraindicated in patients who are on long-term benzodiazepines, those who have ingested a substance that lowers the seizure threshold, or in patients who have tachycardia, widened QRS complex on ECG, anticholinergic signs, or a history of seizures.[46] Due to these contraindications and the possibility of it causing severe adverse effects including seizures, adverse cardiac effects, and death,[47][48] in the majority of cases there is no indication for the use of flumazenil in the management of benzodiazepine overdose as the risks generally outweigh any potential benefit of administration(source wiki)

[ArchivalUser]

Thank you, caps. excellent explanation.
However, it seems that we are hammered with flumazenil being the antidote for benzo. overdose.
If the Q asks: benzo. overdose, what should be used as antidote? Then we can answer flumazenil.
If in a case senario, pt came to ER, unconsious, suspect benzo. overdose, asks management: I guess may be intubate+mechanical ventilation, iv fluid, other supportive Rx, not flumazenil. unless they mention there is no long term use of benzo...