Flumazenil-induced seizures

July 26, 2012, 12:15 am

 


★★½☆☆

A Poison Center’s Ten-Year Experience with Flumazenil Administration to Acutely Poisoned Adults. Kreshak AA et al. J Emerg Med 2012 Jul 4 [Epub ahead of print]

Abstract

The use of flumazenil for diagnosis and treatment of poisoned patients with suspected benzodiazepine poisoning is controversial.

This historical case series searched the computerized database of the California Poison Control System to identify adults (> 18 years) who were treated with flumazenil over the 10-year period from 1999 through 2008. The authors’ objective was to determine the incidence of seizures in patients reported to the database who received flumazenil, and to specify clinical factors associated with these seizures.

The authors found 904 cases that met eligibility criteria. The incidence of seizures in these patients was relatively low (1.4%), but increased over 3-fold if there was a history of ingesting a pro-convulsant drug such as a tricyclic antidepressant.

In their discussion, the authors state many of the limitations of this study, including the lack of laboratory testing that could confirm or refute recorded drug histories, the inability establish a time frame for occurrence of seizures in relation to administration of flumazenil, and the limited information contained in the electronic database. Unfortunately, given these limitations (and others). it is impossible to derive useful clinical information from the data. I do agree with the authors, however, that giving flumazenil to patients with known exposure to pro-convulsant drugs is ill-advised. Since benzodiazepine overdose itself usually responds well to supportive care, I also would not use the antidote in any tox patient with an unknown ingestion or history.

There was one death in a 67-year-old patient who developed intractable seizures after receiving flumazenil. The fact that this patient is described as male in the discussion section but female in Table 1 does not inspire confidence in the rigor of either the authors or the editors.

Related posts:

Is use of flumazenil in poisoned pediatric patients safe?

The problem with observational studies

 

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