Indications: reversal of sedative effects of benzodiazepines in anaesthetic, intensive care, and diagnostic procedures

Cautions: short-acting (repeat doses may be necessary benzodiazepine effects may persist for at least 24 hours); benzodiazepine dependence (may precipitate withdrawal symptoms); prolonged benzodiazepine therapy for epilepsy (risk of convulsions); history of panic disorders (risk of recurrence); ensure neuromuscular blockade cleared before giving; avoid rapid injection in high-risk or anxious patients and following major surgery; hepatic impairment; head injury (rapid reversal of benzodiazepine sedation may cause convulsions); elderly, children.

Contra-indications: life-threatening condition (e.g. raised intracranial pressure, status epilepticus) controlled by benzodiazepines.

Side Effects: nausea, vomiting, and flushing; if wakening too rapid, agitation, anxiety, and fear; transient increase in blood pressure and heart-rate in intensive care patients; very rarely convulsions (particularly in those with epilepsy), hypersensitivity reactions including anaphylaxis.

Dose: By intravenous injection, 200 mcg over 15 seconds, then 100 mcg at 60-second intervals if required; usual dose range, 300–600 mcg; max. total dose 1 mg (2 mg in intensive care); question aetiology if no response to repeated doses. By intravenous infusion, if drowsiness recurs after injection, 100–400 mcg/hour, adjusted according to level of arousal.