Stephen Munday’s research while affiliated with King Institute of Preventive Medicine and other places

Flumazenil (Romazicon®) (US brand names are given here as examples. These may be the same or different in other countries.) is a specific benzodiazepine receptor antagonist that has generated debate regarding its clinical indications since its initial release in the USA in 1991. A major argument against the use of flumazenil in the management of benzodiazepine intoxication is the relatively high safety index (i.e., toxic-to-therapeutic dose ratio) of benzodiazepines, even in cases of overdose. In addition, the anticonvulsant effects of benzodiazepines may be advantageous in individuals simultaneously poisoned with proconvulsant substances, such as tricyclic antidepressants. Another significant concern regarding the clinical use of flumazenil in the emergent management of poisoning is the possibility of precipitating acute withdrawal in individuals with pharmacodynamic tolerance to benzodiazepine receptor agonists. Withdrawal from benzodiazepines is associated with a spectrum of effects, which can include epileptic seizures [1]. These safety concerns have prevented flumazenil from gaining widespread clinical acceptance as a component of the initial pharmacologic management of coma.

Flumazenil (Romazicon®) (US brand names are given here as examples. These may be the same or different in other countries.) is a specific benzodiazepine receptor antagonist that has generated debate regarding its clinical indications since its initial release in the USA in 1991. A major argument against the use of flumazenil in the management of benzodiazepine intoxication is the relatively high safety index (i.e., toxic-to-therapeutic dose ratio) of benzodiazepines, even in cases of overdose. In addition, the anticonvulsant effects of benzodiazepines may be advantageous in individuals simultaneously poisoned with proconvulsant substances, such as tricyclic antidepressants. Another significant concern regarding the clinical use of flumazenil in the emergent management of poisoning is the possibility of precipitating acute withdrawal in individuals with pharmacodynamic tolerance to benzodiazepine receptor agonists. Withdrawal from benzodiazepines is associated with a spectrum of effects, which can include epileptic seizures [1]. These safety concerns have prevented flumazenil from gaining widespread clinical acceptance as a component of the initial pharmacologic management of coma.