The Antidote For Ativan Overdose | Flumazenil & Benzodiazepine Toxicity

Lorazepam (brand name Ativan) is absorbed into the body slowly. Nevertheless, it is a very potent drug that can be dangerous when used in high doses or when taken with other central nervous system depressants, including alcohol, opioid narcotics, and muscle relaxants.

In the event of an overdose, Ativan reversal is possible using the GABA-A receptor antagonist drug flumazenil.

Lorazepam is a benzodiazepine approved for the short-term treatment of anxiety disorders, panic disorder, insomnia, and certain seizure disorders. It is also sometimes given before anesthesia or used as a treatment for those experiencing acute alcohol withdrawal symptoms.

An Antidote For Ativan (Lorazepam)

The medication known as flumazenil (brand names Anexate, Lanexat, Mazicon, and Romazicon) is a clear, colorless solution formulated for intravenous administration.

It has two main uses:

• reversing the sedative effects of benzodiazepines after surgical operations
• acting as an antidote to reverse benzodiazepine overdoses, as well as overdoses of certain other non-benzodiazepine drugs (zolpidem, zaleplon and zopiclone)

How Flumazenil Works

In both cases, flumazenil works as a selective GABA-A receptor antagonist, binding and blocking the same receptors in the human brain that benzodiazepine drugs, like lorazepam, interact with through the gamma-aminobutyric acid (GABA) neurotransmitter.

In this way, flumazenil can rapidly remove and cancel out the effects of benzodiazepine drugs.
But because of certain serious concerns, flumazenil is only recommended for use in treating accidental benzo overdoses or severe overdoses. It is not recommended for use treating mild intentional overdoses stemming from drug abuse.

Flumazenil Length Of Effect

Flumazenil takes effect very quickly and can start reversing a benzodiazepine overdose within 1-2 minutes. Its effects peak between 6-10 minutes after administration, and a single dose lasts between 20-50 minutes.

Because many benzodiazepine drugs have substantially longer half-lives and lengths of effect than flumazenil, lorazepam included, repeated doses of flumazenil are likely needed to fully control a benzodiazepine drug overdose in an emergency setting.

Flumazenil Side-Effects

Anesthesiologists need to carefully monitor those who receive flumazenil due to the risk of potential side effects and other risks from over-administration of the drug.

Common side effects associated with use of flumazenil may include:

• headache
• dizziness
• nausea
• vomiting
• increased sweating
• flushing (warmth, redness, or tingling)
• vision problems
• injection site pain

Signs of an adverse reaction include:

• weak or shallow breathing
• prolonged drowsiness
• confusion
• agitation
• tremors
• chest pain
• rapid pulse or pounding heartbeats
• lightheadedness

Risks Of Flumazenil Use

Flumazenil has been found to be safe and effective when used in controlled situations, especially when doctors use it after surgical procedures. But there are some serious concerns that come with its use in emergency settings.

Benzodiazepine Withdrawal

By stripping away benzodiazepine drugs, flumazenil can reverse dangerous overdose effects. But it can also send those who are dependent on benzodiazepines into a very sudden and very severe state of benzodiazepine withdrawal.

This can lead to a variety of severe symptoms, including seizures or status epilepticus, a severe condition where seizures last for more than five minutes or recur within a five-minute span.

With flumazenil blocking the effects of benzodiazepines, treatment of these potentially life-threatening complications becomes more difficult, and healthcare providers may need to use barbiturates, another high-risk variety of CNS depressant, instead.

Seizures are even more likely to occur when an individual has taken high doses of antidepressant drugs in addition to benzodiazepines, or when an individual was withdrawing from benzos before their overdose occurred.

Intensive care providers may not be aware of these complications until after flumazenil is administered.

Signs & Symptoms Of Ativan Overdose

If taken in excessive amounts, likely due to substance abuse, suicide attempts, or dosing errors, lorazepam can cause a variety of potentially severe effects.

Healthcare providers can likely identify a benzodiazepine overdose by the presence of CNS depression with otherwise normal vital signs.

Classic signs of lorazepam overdose can include:

• altered mental status (confusion or stupor)
• agitation
• anxiety
• ataxia (impaired movement and bodily control)
• blurred vision
• dizziness
• drowsiness
• slurred speech
• tremors
• respiratory depression (difficulty breathing)

While overdose deaths are uncommon when lorazepam is taken alone, the drug becomes far more deadly when ingested with alcohol, opioids, or other common drugs of abuse.

This can prompt additional symptoms including hypotension (low blood pressure), hypothermia (low body temperature and blue-tinged fingertips or lips), slow heart rate, and coma.

Other Interventions For Ativan Overdose

Other treatment options that healthcare providers may use along with or as an alternative to flumazenil include:

• naloxone, an opioid overdose antidote frequently administered in case the patient also took an opioid narcotic
• life support, including breathing support and resuscitation if required
• activated charcoal, which can prevent additional absorption of lorazepam and other drugs, if required
• close observation and other palliative care

If you or a loved one struggle with prescription drug abuse or addiction, please reach out to Northeast Addictions Treatment Center today.