- Benzodiazepines are used as tranquilizers and as sleeping pills.
- Poisoning is usually due to attempted suicide.
- Alprazolam (Xanax), lorazepam (Ativan), bromazipam (Lexotanil) are commonly used benzodiazepines.
CLINICAL FEATURES
Features develop within 30 min of an over-dose and include:
- Weakness, ataxia, dilated pupil, dysarthria and drowsiness.
- Nystagmus and confusion are also observed. Minor hypotension may occur.
- Coma and respiratory depression can occur with short acting benzodiazepine such as midazolam (Dormicum) or if benzodiazepines are combined with other CNS depressants such as tricyclic antidepressants.
MANAGEMENT
- Gastric lavage is not advised in pure benzodiazepine overdose.
- Activated charcoal should be given repeatedly to decontaminate GIT.
- Impaired consciousness requires particular attention to maintain airway. Pulse oximetry is needed to monitor oxygen saturation.
- Observation should be for at least 6 hours post-ingestion.
Flumazenil
(Inj. Anexate 0.1mg) a competitive benzodiazepine receptor antagonist can reverse CNS and respiratory depression. It is given IV as incremental dose of 0.2, 0.3 and 0.5 mg at 1 min intervals until the desired effect is achieved or a total dose of 3-5 mg has been given.
Flumazenil is not given routinely in mild to moderate poisoning (required when there is CNS or respiratory depression). It is expensive, costs more than Rs. 3000/injection.
Flumazenil should not be given in patients who are chronic dependent on benzodiazepine or who have taken tricyclic antidepressants with benzodiazepine; in these patients seizure may be precipitated. Removal of drug through dialysis is not possible because 85 to 99% or drug is protein bound in the plasma.
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