Is Flumazenil still recommended for benzodiazepine reversal? Does the literature or guidelines support use of flumazenil?

Comment by InpharmD Researcher

Current evidence presents mixed findings regarding flumazenil’s role in benzodiazepine (BZD) reversal. While guidance from the American Society of Anesthesiologists (ASA) recommends its use to reverse BZD-induced sedation and respiratory depression, the 2023 American Heart Association/American College of Cardiology (ACC) guidelines advise caution with flumazenil in high-risk patients (e.g., chronic BZD dependence, co-ingestion of other harmful substances). While earlier trials have demonstrated flumazenil’s effectiveness in reversing the sedating and psychomotor effects of BZDs, a 2022 pilot study suggested that there was no evidence of flumazenil’s efficacy in patients taking low-dose BZDs. Due to these variable findings, further robust data is warranted to determine the optimal role of flumazenil in BZD reversal.

Background

According to the 2023 American Heart Association/American College of Cardiology guidelines, flumazenil is effective for treating respiratory depression or respiratory arrest in patients with pure benzodiazepine poisoning, defined as poisoning with benzodiazepines only, without the involvement of other medications. In patients presenting with cardiac arrest due to benzodiazepine poisoning, guidelines indicate that flumazenil offers no benefit in reversing the condition (class of recommendation [COR] 3; level of evidence [LOE] C-EO). Furthermore, flumazenil can be harmful in patients with an increased risk of seizures or dysrhythmias and may precipitate refractory withdrawal in those with benzodiazepine tolerance (COR 3; LOE B-R). Overall, the guidelines indicate that flumazenil is generally safe and effective for patients with respiratory depression/respiratory arrest, pure benzodiazepine poisoning, and low-risk presentations (COR 2a; LOE B-NR), such as pediatric exploratory ingestions and iatrogenic overdoses during procedural sedation. However, they advise caution when administering flumazenil to patients with high-risk presentations, including chronic benzodiazepine dependence or co-ingestion of other harmful substances. Of note, the guidelines suggest that the risks of flumazenil may outweigh the benefits in cases of undifferentiated coma, a history of substance abuse, or when the specific toxins involved are unknown. [1]

A 2018 guideline published by the American Society of Anesthesiologists provided recommendations for moderate sedation and analgesia, including the use of flumazenil. A meta-analysis of randomized controlled trials used to inform these guidelines found that flumazenil effectively reverses the effects of benzodiazepines within 15 minutes in patients who received these sedative drugs. Placebo-controlled studies also showed that flumazenil administration is linked to shorter recovery times from benzodiazepine sedation. Additionally, additional research indicated flumazenil can effectively antagonize the effects of benzodiazepines when combined with opioids. To develop these guidelines, a systematic review was performed where one intervention involved flumazenil for reversing benzodiazepines alone or with opioids. Outcomes examined included sedation effectiveness, improved pain management, faster recovery, and reduced frequency/severity of sedation-related complications. Results for relevant outcomes were summarized and meta-analyses were conducted when a sufficient number of RCTs were available. The literature for six evidence comparisons contained adequate well-designed and statistically reported studies to perform formal meta-analyses. Specifically, this included flumazenil versus placebo for benzodiazepine reversal and for reversing benzodiazepines combined with opioids, which showed moderate to high levels of agreement. However, these guidelines are not mandatory standards and their use does not guarantee specific outcomes, so additional research is still warranted. [2]

A 2015 meta-analysis aimed to assess the risk of adverse events (AEs) associated with the use of flumazenil in patients with impaired consciousness due to known or suspected benzodiazepine overdose. A total of 13 randomized controlled trials (RCTs) involving 994 patients were included. The findings revealed AEs ​​were significantly more common in the flumazenil group (138/498) compared to the placebo group (47/492), with a risk ratio of 2.85 (95% confidence interval [CI]: 2.11-3.84; p<0.00001). Serious adverse events (SAEs) were also more frequent in the flumazenil group (12/498) than in the placebo group (2/492), with a risk ratio of 3.81 (95% CI 1.28 to 11.39; p= 0.02). The most common AEs in the flumazenil group included agitation and gastrointestinal symptoms, while the most common SAEs were supraventricular arrhythmia and convulsions. No patients died during the blinded phase of the randomized controlled trials. Based on these findings, authors concluded that the use of flumazenil in patients with known or suspected benzodiazepine intoxication is associated with a significantly increased risk of adverse events compared to placebo. However, it is important to note that the trials included in the review exhibited heterogeneity in treatment regimens, inclusion criteria, and observation periods, which may affect the generalizability of the results. [3]

A 2018 Cochrane review aimed to assess the benefits and harms of pharmacological interventions, including flumazenil, to facilitate the discontinuation of chronic benzodiazepine use. The review included 38 RCTs with 2,543 participants who had either been treated with benzodiazepines for over 2 months or had been diagnosed with benzodiazepine dependence. Among different data comparisons, 3 studies reported positive effects of flumazenil on benzodiazepine withdrawal symptoms (standardized mean difference [SMD] ‐0.95; 95% CI ‐1.71 to ‐0.19)​​, and 1 study reported that flumazenil reduced anxiety symptoms following benzodiazepine withdrawal (mean difference [MD] ‐1.30 points; 95% CI ‐2.28 to ‐0.32). However, one of the flumazenil studies was terminated prematurely due to severe withdrawal symptoms experienced during the trial. It is also important to note that the quality of the evidence was considered to be very low due to the small number of trials including a limited number of participants for each comparison. Overall, while flumazenil shows some promise for managing benzodiazepine withdrawal, the evidence is limited, and further research is needed. [4]

References: [1] Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023;148(16):e149-e184. doi:10.1161/CIR.0000000000001161
[2] Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018;128(3):437-479. doi:10.1097/ALN.0000000000002043
[3] Penninga EI, Graudal N, Ladekarl MB, Jürgens G. Adverse Events Associated with Flumazenil Treatment for the Management of Suspected Benzodiazepine Intoxication--A Systematic Review with Meta-Analyses of Randomised Trials. Basic Clin Pharmacol Toxicol. 2016;118(1):37-44. doi:10.1111/bcpt.12434
[4] Baandrup L, Ebdrup BH, Rasmussen JØ, Lindschou J, Gluud C, Glenthøj BY. Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users. Cochrane Database Syst Rev. 2018;3(3):CD011481. Published 2018 Mar 15. doi:10.1002/14651858.CD011481.pub2
Literature Review

A search of the published medical literature revealed 3 studies investigating the researchable question:

Is Flumazenil still recommended for benzodiazepine reversal? Does the literature or guidelines support use of flumazenil?

Level of evidence

C - Multiple studies with limitations or conflicting results  Read more→



Please see Tables 1-3 for your response.


 

A Double-Blind Randomised Crossover Trial of Low-Dose Flumazenil for Benzodiazepine Withdrawal: A Proof of Concept

Design

Multi-site, double-blind, randomized, pilot, crossover trial

N= 26

Objective

To collect pilot data on the safety and efficacy of low-dose subcutaneous flumazenil to reduce BZD use, withdrawal symptoms, and craving in participants taking above and below the therapeutic maximum diazepam equivalent of 30 mg to inform on sample size for future trials

Study Groups

Flumazenil first low dose (n = 5) and high dose (n = 8) 

Placebo first low dose (n = 6) and high dose (n = 7)

Inclusion Criteria

Daily BZD use for more than three months; daily BZD use greater than 10 mg diazepam equivalent per day, (except for one participant taking 5 mg daily diazepam); individuals with a desire to stop BZDs

Exclusion Criteria

History of epilepsy or seizure; currently pregnant or breastfeeding

Methods

Participants received low-dose flumazenil (4 mg/24 h for approximately eight days) or placebo first. Diazepam use was recorded daily, and withdrawal and craving assessments were completed on specific days. Participants could request up to 10 mg diazepam on an as-needed basis.

To receive diazepam participants needed a score of two or higher on a modified six-item version of the Clinical Institute Withdrawal Assessment Scale for Benzodiazepines (CIWA-B). Participants in the flumazenil group received flumazenil on the first day after transitioning from their usual benzodiazepine to the as-needed diazepam. Participants in the placebo group received flumazenil after eight days of receiving as-needed diazepam.

Duration

Enrollment period: July 2017 to July 2019

Intervention: 16 days

Outcome Measures

Primary: Percentage reduction in daily diazepam use

Secondary: Percentage reduction in withdrawal symptoms, percentage reduction in craving scores, treatment-related adverse events, changes in BZD use across the placebo first group

Baseline Characteristics

 

Flumazenil first (low dose; n=5)

Placebo first (low dose; n=6)

Flumazenil first (high dose; n=8) Placebo first (high dose; n=7) 

Age, years (SD)

48.8 (12.5)   62.5 (12.0)  45.6 (13.2) 49.0 (5.8) 

Female

60%  67% 63% 71%

Length of BZD use in years (SD)

3.8 (1.0)   9.9 (8.2)  4.8 (5.1) 8.7 (6.3) 

Attempted to quit BZD

100% 67% 63% 57%

Diazepam equivalent

15.7 (4.8)  14.2 (7.4)  72.3 (85.0) 49.1 (26.3)

Results

Endpoint

Group

Baseline (Mean ± SD)

 % Change from Baseline (Mean ± SD)

p-Value

Participants taking less than 30mg daily diazepam equivalent at baseline

Diazepam Use

 
Flumazenil First (n=5)  15.7 mg ± 4.9  +32.0% ± 163.2  0.429
Placebo First (n=6) 14.2 mg ± 7.4 -45.6% ± 62.6  
Withdrawal Score  Flumazenil First (n=5) 42.4 ± 4.2 -35.1% ± 13.2  0.556
Placebo First (n=4) 19.2 ± 11.0 +31.6% ± 82.4  
Craving Score   Flumazenil First (n=4)  7.5 ± 5.4  -16.2% ± 20.7  0.476
Placebo First (n=6)   5.2 ± 3.4  +13.6% ± 54.8  
Participants taking 30mg daily diazepam equivalent or more at baseline    
Diazepam Use Flumazenil first (n=7) 72.3mg (85.0) -75.3 (11.4)* 0.024
Placebo first (n=7) 49.1mg (26.3) -44.9 (26.9)  

Withdrawal Scorea

Flumazenil first (n=7) 38.4 (14.1) 48.0 (194.8) 0.836
Placebo first (n=6) 34.8 (20.9) 27.1 (96.0)  

Withdrawal Scoreb

Flumazenil first (n=6)  43.3 (6.1)    -25.5 (13.5)   0.407
Placebo first (n=5) 40.0 (18.6) -9.7 (36.8)  
Craving Score Flumazenil first (n=8) 9.3 (4.5) 9.1 (74.5) 0.908

Placebo first (n=7)

8.1 (4.5) 14.5 (88.3)  

* Statistically significant compared to placebo

Withdrawala: scores at baseline mild to very severe (0 to 80)

Withdrawalb: Withdrawal scores at baseline moderate to very severe (20 to 80)

Adverse Events

The study reported 12 total adverse events, with 9 occurring during flumazenil administration. Of those, 3 adverse events were attributed to flumazenil, including 2 cases of nausea/vomiting and 1 case of itching on the hands/feet. Two additional adverse events were considered procedure-related: 1 case of pain at the infusion site and 1 instance of bleeding at the infusion site after physical exertion.

Study Author Conclusions

Low-dose flumazenil reduces diazepam use in participants aiming to cease BZDs taking doses at and above the therapeutic range (≥30 mg diazepam equivalent) prior to treatment for at least three months. While there was no evidence of flumazenil’s efficacy in participants taking low dose BZDs (<30 mg diazepam), this was a pilot study that was underpowered; therefore, findings should be interpreted with caution.

InpharmD Researcher Critique

Aside from the study population being underrepresented, the study should include a variety of BZDs. 



References:
[1] MacDonald T, Gallo AT, Basso-Hulse G, Bennett KS, Hulse GK. A double-blind randomised crossover trial of low-dose flumazenil for benzodiazepine withdrawal: A proof of concept. Drug Alcohol Depend. 2022;236:109501. doi:10.1016/j.drugalcdep.2022.109501

 

Intravenous Flumazenil Versus Oxazepam Tapering in the Treatment of Benzodiazepine Withdrawal: A Randomized, Placebo-Controlled Study

Design

Single-blind, randomized, placebo-controlled trial

N= 50

Objective

To compare the effectiveness of flumazenil with oxazepam tapering and placebo in controlling benzodiazepine (BZD) withdrawal symptoms in BZD-dependent patients

Study Groups

Group A (n= 20)

Group B (n= 20)

Group C (n= 10)

Inclusion Criteria

Aged 19 to 44 years; history of benzodiazepine dependence according to DSM-IV criteria

Exclusion Criteria

Severe chronic liver or renal diseases or other chronic physical disorders; recent onset of significant weight loss or gain; endocrinopathies, neurological disorders, immunopathologies, and HIV disease; positive family history of cardiovascular (CV) disease and hypertension

Methods

Patients were randomly assigned to three groups: Group A received intravenous flumazenil and low doses of oxazepam during the first three nights; Group B underwent oxazepam tapering; and Group C received placebo. Patients were pre-treated with high doses of oxazepam (120 mg/day) during the week before detoxification to ensure homogeneity in drug use. 

All patients participated in daily individual counseling and cognitive-behavioral therapy, and urine samples were collected regularly. Flumazenil was administered twice daily for eight days to Group A, with oxazepam tapering employed for Group B, while Group C received only placebo. Continuous medical evaluation and assessments of withdrawal symptoms, cardiovascular measures, and cravings were conducted throughout the pre-treatment and detoxification periods.

Duration

Intervention: Pre-treatment (8 days) and detoxification (8 days)

Outcome Measures

Control of BZD withdrawal symptoms; assessment of CV measures, craving scores, and occurrence of paradoxical adverse reactions

Baseline Characteristics

 

Group A (n= 20)

Group B (n= 20)

Group C (n= 10)

Age, years

35.9 38.2 35.4

Female

11 9 5

BZD use

Flunitrazepam

Lormetazepam

Bromazepam

 

12

6

2

 

10

7

3

 

5

4

1

Previous heroin dependence

4 3 2

Previous alcohol abuse

3 4 1

Anxiety disorders

7 9 2

Depression

3 2 0

Depressive trait

4 5 3

Antisocial trait

2 2 1

Results

Flumazenil led to an immediate improvement in balance performance task times (degrees of freedom [df]= 19; F= 3.4; p< 0.01), while oxazepam tapering showed significant effects only from days 6 to 8 (df= 19; F= 1.9; p< 0.05). Flumazenil also resulted in significantly lower self-reported withdrawal symptoms compared to oxazepam (df= 38; F= 2.30; p< 0.05) and placebo (df= 28; F= 4.5; p< 0.01).

Cardiovascular stability was maintained in the flumazenil group, contrasting with increased heart rate and systolic blood pressure in the oxazepam group on days 6 and 7 (df= 38; F= 3.31; p< 0.05). Flumazenil significantly reduced craving (df= 47; F= 6.4; p< 0.01) and prevented paradoxical reactions observed in the oxazepam group. 

Flumazenil not only reduced withdrawal symptoms and craving but also minimized the risk of relapse at 15, 23, and 30 days post-detoxification compared to oxazepam tapering (p<0.05). Additionally, flumazenil's ability to prevent paradoxical symptoms such as hostility, psychomotor agitation, and restlessness, which were observed in the oxazepam group, suggests its potential superiority in managing BZD withdrawal.

Adverse Events

See results

Study Author Conclusions

These preliminary data, obtained with a single-blind protocol in a small sample of subjects, need to be interpreted with great caution. However, flumazenil may be regarded as a therapeutic option in the treatment of BZD withdrawal, particularly in subjects who have developed severe dependence and tolerance with a history of prolonged BZD abuse who cannot cope with the withdrawal symptoms provoked by tapering treatment.

InpharmD Researcher Critique

The study suggests that flumazenil's ability to normalize BZD receptor function may be key in reducing withdrawal symptoms without severe reactions. Furthermore, given the paradoxical symptoms in the oxazepam group, flumazenil could be a valuable therapeutic option for severe BZD dependence.



References:
[1] Gerra G, Zaimovic A, Giusti F, Moi G, Brewer C. Intravenous flumazenil versus oxazepam tapering in the treatment of benzodiazepine withdrawal: a randomized, placebo-controlled study. Addict Biol. 2002;7(4):385-395. doi:10.1080/1355621021000005973

 

A randomized crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period

Design

Prospective, randomized, crossover trial

N= 18

Objective

To study the post-operative cognitive and psychomotor recovery from midazolam conscious sedation, after reversal with the benzodiazepine antagonist flumazenil over a prolonged recovery period

Study Groups

Study patients (N= 18)

Inclusion Criteria

ASA I or II, aged 18-60 years, requiring routine and equivalent dental treatment over two visits, access to a touch-tone telephone at home

Exclusion Criteria

Patients receiving any psychoactive medication

Methods

Participants received midazolam on two separate occasions for equivalent dental treatment. Post-treatment, they were reversed with intravenous flumazenil (0.4 mg) or saline (placebo) at alternate appointments in a cross-over fashion. Cognitive and psychomotor tests were administered prior to sedation and every hour for 6 hours post-reversal using a computerized battery of tests administered by telephone.

Duration

6 hours post-reversal

Outcome Measures

Primary: Simple Reaction Time (SRT), Choice Reaction Time (CRT), Numeric Working Memory (NWM), Word Recognition

Secondary: Self-rated mood (alertness, contentment, calmness)

Baseline Characteristics

 

Study patients (N= 18)

 

Age, years

35 ± 8  

Female

7  

Midazolam dose, mg

7 ± 1.5  
  Flumazenil Placebo

Blood pressure, mmHg

Time 0-hours (T0)

Time 1-hours (T1)

Time 2-hours (T2)

 

130/81

115/72

122/77

 

123/77

112/70

118/79

Arterial oxygen saturation, %

T0

T1

T2

 

99 ± 0.2

97 ± 0.3

97 ± 0.3

 

99 ± 0.5

97 ± 0.4

97 ± 0.4

Results

Endpoint

Study patients (N= 18)

 

Data was primarily presented as a graph.

For SRT, midazolam significantly slowed reaction times for both groups at 1 hour. By 2 hours, times began to speed up but slowed again after. Neither group reacted significantly faster than the other at any timepoint. At 6 hours, neither group returned to baseline.

Both groups saw significantly slower CRT at 1 hour. Times began to recover at 2 hours. From 3-5 hours, the flumazenil group had faster times than placebo. At 6 hours, times were equal between groups but below baseline.

Based on the combined numeric and word speed score, flumazenil was always faster than placebo, though not significantly. Neither group reached baseline speed. For combined numeric and accuracy score, flumazenil was always more accurate than placebo, though not significantly.

On self-rated alertness, both groups felt significantly less alert at 1 hour but gradually recovered. The flumazenil group rated higher than placebo at 2 and 6 hours.

Both groups rated higher contentment from baseline over time. Only at 6 hours was the flumazenil group's rating significantly higher than placebo.

Both groups rated significantly calmer over time with no differences between groups.

Adverse Events

N/A

Study Author Conclusions

The cognitive and psychomotor effects of the sedation were not fully reversed by flumazenil. Cognitive impairments were still present up to 6 hours post-reversal, despite patients appearing clinically more alert. This has important implications for treatment protocols and discharge instructions.

InpharmD Researcher Critique

Limitations included a small sample size, potential variability in patient anxiety levels affecting baseline measurements, and lack of monitoring of vital signs after discharge.



References:
[1] Girdler NM, Fairbrother KJ, Lyne JP, et al. A randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period. Br Dent J. 2002;192(6):335-331. doi:10.1038/sj.bdj.4801369