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Br J Clin Pharmacol. 2016 Mar;81(3):428-36. doi: 10.1111/bcp.12731. Epub 2015 Sep 21.

Flumazenil, naloxone and the 'coma cocktail'.

Author information

1
Emergency Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario.
2
Ontario Poison Centre, Hospital for Sick Children, Toronto, Ontario, Canada.

Abstract

Flumazenil and naloxone are considered to be pharmacologically ideal antidotes. By competitive binding at the molecular target receptors, they are highly specific antagonists of two important drug classes, the benzodiazepines and opioids, respectively. Both antidotes enjoy rapid onset and short duration after parenteral administration, are easily titrated and are essentially devoid of agonist effects. Yet only naloxone is widely used as a component of the 'coma cocktail', a sequence of empirical treatments to correct altered mental status, while experts discourage the use of flumazenil for such patients. This review contrasts the history, indications, published evidence and novel applications for each antidote in order to explain this disparity in the clinical use of these 'ideal' antidotes.

KEYWORDS:

benzodiazepine; flumazenil; naloxone; opioid; overdose

PMID:
26469689
PMCID:
PMC4767210
[Available on 2017-03-01]
DOI:
10.1111/bcp.12731
[Indexed for MEDLINE]
Free PMC Article

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