A young woman is brought comatose after ingesting alprazolam tablets. She is given flumazenil and wakes up promptly. Which precaution must be considered before and during administration?

• A Flumazenil precipitates ventricular arrhythmias if given faster than 5 minutes
• B It is ineffective unless co-administered with naloxone
• C It reverses respiratory depression incompletely, so intubation is always mandatory
• D In chronic benzodiazepine users it can precipitate acute withdrawal seizures ✓

Explanation

Flumazenil is a competitive antagonist at the benzodiazepine site on the GABA-A receptor. In patients physically dependent on benzodiazepines, abrupt displacement can trigger acute withdrawal with agitation and seizures, so it is avoided or used cautiously in such patients, and repeated doses may be needed because its half-life is shorter than most agonists. In pure benzodiazepine overdose it reverses sedation effectively without mandatory intubation, and naloxone is irrelevant here.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

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Written and medically reviewed by the StethoPrep medical team.