Antidote for Benzodiazepines Overdose and Treatment

Benzodiazepines, also known as “benzos,” are a class of prescription medications used to treat anxiety, seizure, and sleep disorders. They’re often prescribed in the short term because of their risk of misuse, addiction, and potentially life-threatening overdose.

Flumazenil is an antidote for benzodiazepine overdose and can reverse symptoms like severely slowed breathing (respiratory depression). Unlike antidotes for other overdoses like naloxone, flumazenil is only given by medical professionals because it can cause seizures and severe allergic reactions.

What Are Benzodiazepines?

Benzodiazepines are a class of medications that are central nervous system (CNS) depressants and sedative-hypnotics. They can help anxiety disorders, sleep disorders, and seizure disorders by calming the nervous system and relieving the associated symptoms.

Though the benzodiazepine class contains a wide range of medications that have slightly different qualities, such as Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), and Valium (diazepam), they are all CNS depressants that have a risk of overdose and addiction.[1]

What Is a Benzodiazepine Overdose?

An overdose on a benzodiazepine isn’t common, but it can happen if you take high doses. The overdose risk is also increased if you combine benzodiazepines with other CNS depressants like alcohol, opioids, or other benzos.[2]

Benzodiazepine overdose deaths are more common when you combine benzos with opioids like heroin or fentanyl. From 1999 and 2017, the number of overdose deaths with benzodiazepines and opioids increased 916%. After 2020, the number of overdose deaths increased, and of those that involved benzodiazepines, 91% involved opioids.[4]

Signs and Symptoms of a Benzodiazepine Overdose

An overdose happens if you take more of a drug than your body can process. With a benzodiazepine overdose, the signs include:[5]

• Extreme drowsiness
• Slowed breathing
• Uncoordinated movements (ataxia)
• Slurred speech
• Confusion

The severity of the overdose depends on the type of benzodiazepine involved, the dosage, and any combination of other substances. The risk is much higher with other depressants like sedative drugs, opioids, or alcohol. Though all benzos carry a risk of overdose and potential death, studies indicate that alprazolam (Xanax) may be more toxic at high doses.[6]

What to Do If Someone Is Overdosing

If you think someone is overdosing on benzodiazepines, call 911 and wait with them until help arrives. If you suspect that opioids may be involved, you can administer naloxone to reverse the opioid overdose symptoms. This won’t help the benzo overdose, but it may prevent potentially fatal symptoms like severely depressed breathing or coma.

What Is the Antidote for a Benzodiazepine Overdose?

Naloxone is widely available to regular citizens to help with the opioid epidemic and the rise of overdoses in recent years. The antidote for benzodiazepines, flumazenil, is not as well known, but it can be an effective short-term treatment for a benzo overdose and may reverse symptoms that can be deadly.[7]

Unlike naloxone, which can be given without medical training, flumazenil is given intravenously and should be administered by a medical professional. It doesn’t always completely reverse depressed breathing, so it may need to be given in repeat doses every 20 minutes while monitoring vital signs to prevent complications.[8]

There are possible side effects with flumazenil, including headache, dizziness, nausea, vomiting, sweating, flushing, vision problems, and injection site pain or reactions.[9] While these side effects can be unpleasant, they’re not as severe as the effects or complications of a benzo overdose.

Some serious side effects are possible, including shallow breathing, continued drowsiness, agitation, confusion, tremors, chest pain, rapid heart rate, lightheadedness, and a severe allergic reaction with difficulty breathing:[10]

Though less common, flumazenil may cause seizures.[11] This is more likely in people who are experiencing withdrawal from a sedative-hypnotic addiction. Seizures can also happen if you’ve taken injectable benzodiazepines or had a seizure prior to flumazenil being administered.

There are some potentially dangerous interactions between flumazenil and other drugs, including antidepressants like amitriptyline, doxepin, clomipramine, desipramine, imipramine, or nortriptyline.[12] For these reasons, flumazenil is not available to the general public and should only be given by medical professionals who can monitor the person’s vital signs after administration.

Benzodiazepine Misuse and Addiction Risk

Benzodiazepine toxicity can happen if you take too much at one time, but it’s more likely if you mix benzodiazepines with other drugs – particularly other CNS depressants – or take high doses to get high or get effects other than the way the drug is intended.

People who are addicted to benzodiazepines have a sedative, hypnotic, or anxiolytic use disorder as classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria for this disorder include:[13]

• Benzos taken in larger amounts or over longer periods than intended
• A persistent desire or unsuccessful efforts to cut down or control benzo use
• A great deal of time is spent in activities necessary to obtain, use, or recover from the benzo
• Craving, or a strong desire or urge to use benzos
• Recurrent benzo use resulting in a failure to fulfill major role obligations at work, school, or home
• Continued benzo use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of benzos
• Important social, occupational, or recreational activities given up or reduced because of benzo use

Benzodiazepine Addiction Treatment

Benzodiazepines have intense withdrawal symptoms, some of which can be life-threatening. Overcoming addiction or benzodiazepine dependence can be challenging if you struggle through the withdrawal period. You should never stop taking benzos on your own, both because of the intensity of withdrawal and the possibility of dangerous complications like seizures.

If you want to stop taking benzodiazepines after taking them for a long period, your doctor may recommend a taper schedule that gradually reduces your dose to minimize withdrawal symptoms. This should only be done under supervision by a doctor, not on your own. Your dose may need to be adjusted depending on your withdrawal symptoms.

For some people, medical detox is the best way to address withdrawal. This setting provides a medical team to manage your symptoms, adjust your taper schedule, and prevent serious complications.

Once detox is complete, you may need to enter an addiction treatment program on an inpatient or outpatient basis to address the underlying causes of addiction. This is especially important if you’re addicted to multiple drugs, such as benzos and opioids or alcohol. While your treatment plan is individualized based on your needs, it may include group counseling, talk therapy, peer support groups, holistic therapies, and behavioral therapies.

Seek Help for Benzodiazepine Addiction

Flumazenil is a beneficial option to reverse a benzodiazepine overdose and prevent serious complications, but it’s not without risks of its own. It’s not a fail-safe treatment for benzo overdose that makes misusing or abusing benzos safer, so if you’re struggling with benzodiazepine addiction, it’s important to get help before serious problems occur.

Frequently Asked Questions

Below are some of the most frequently asked questions regarding benzos and flumazenil.