flumazenil intravenous / Generic mfg. - LARVOL DELTA

Anesthetic Management for Laparoscopic Gynecological Surgery in a Rare Adult-Onset Case of Alexander's Disease: A Case Report (IARS-SOCCA 2025) - "Labs revealed a hemoglobin of 9.5 g/dL, hematocrit of 31.9%, and stable coagulation parameters.The anesthesia plan involved midazolam 5 mg IV premedication, followed by induction with propofol 120 mg IV and rocuronium 30 mg IV...Anesthesia was maintained with sevoflurane at 2%, reduced to 0.6% after fentanyl 50 mcg administration to manage mild blood pressure elevation. Intraoperatively, vital signs remained stable, with end-tidal CO₂ between 34-45 mmHg.Reversal of neuromuscular blockade was achieved with sugammadex 200 mg at, confirmed by a TOF response of 4/4. Flumazenil 0.2 mg IV reversed midazolam, restoring spontaneous ventilation...This case of a 34-year-old female with adult-onset Alexander's disease underscores the importance of individualized anesthetic approaches for patients with rare genetic disorders undergoing elective surgery. The successful management using standard anesthetic agents, including midazolam and fentanyl, highlights that safe, effective..."

Case report • Clinical • Surgery • Anesthesia • Ataxia • Beta-Thalassemia • CNS Disorders • Epilepsy • Genetic Disorders • Gynecology • Long-acting Reversible Contraceptives • Movement Disorders • Pain • Pediatrics • Rare Diseases • Vascular Neurology

Failure of intravenous flumazenil to antagonize alfaxalone anesthesia in cats. (PubMed, J Feline Med Surg) - "Pulse rate was significantly higher in the flumazenil group than the saline group (mean 176.01 vs 169.57; P = 0.0067).Conclusions and relevanceFlumazenil administered at 0.1 mg/kg intravenously over 1 min did not antagonize the effects of alfaxalone in cats. Further investigations are required to investigate an appropriate dose or other drug to antagonize alfaxalone and its judicious use in clinical settings."

Clinical • Journal • Anesthesia

Could Flumazenil Be Used Pre-hospital by Intramuscular Injection for Coma due to Mixed Drug Overdose Not Responding to Naloxone?: A Systematic Review of the Evidence. (PubMed, Basic Clin Pharmacol Toxicol) - "IM flumazenil data are sparse, but it may be effective and safe. Clinical research is urgently needed to determine whether pre-hospital IM flumazenil can prevent benzodiazepine-involved overdose deaths."

Journal • Review • Anesthesia • CNS Disorders • Epilepsy

Effects of remazolam combined with propofol anesthesia on quality of recovery and hemodynamics after partial hepatic resection: a prospective randomized controlled trial (ChiCTR) - P4 | N=50 | Recruiting | Sponsor: Affiliated Hospital of North Sichuan Medical College; Affiliated Hospital of North Sichuan Medical College

New P4 trial • Anesthesia

Breaking the Spell: A Rare Case of Prolonged Benzodiazepine Elimination (ATS 2024) - "He was treated for presumed severe AWS with escalating doses of intravenous benzodiazepines and barbiturates, receiving a cumulative dose of 660mg of intravenous diazepam and 130mg of phenobarbital in the next 27 hours...Twenty-two days after last diazepam administration, a trial of intravenous flumazenil was given... This patient's persistent encephalopathy was likely due to the prolonged elimination of diazepam. Cirrhosis and age are known to prolong diazepam elimination. Despite normal enzyme activity of CYP2C19 and CYP3A4, it may have been impaired due to cirrhosis even though it was not present on admission."

Clinical • Addiction (Opioid and Alcohol) • CNS Disorders • Fibrosis • Hepatology • Immunology • Movement Disorders • CYP2C19 • CYP3A4

Impact of Flumazenil on the Emergence Delirium (clinicaltrials.gov) - P4 | N=68 | Completed | Sponsor: Korea University Guro Hospital | Recruiting ➔ Completed | Trial completion date: Dec 2023 ➔ Aug 2023 | Trial primary completion date: Nov 2023 ➔ Aug 2023

Trial completion • Trial completion date • Trial primary completion date • Anesthesia • CNS Disorders

Re-audit of the use of flumazenil following midazolam-induced conscious sedation. (PubMed, BDJ Open) - "This re-audit highlighted the need for administrating flumazenil in certain patient groups, and/or circumstances (not emergency). The importance of maintaining high-quality record keeping is discussed."

Journal • Anesthesia

Impact of Flumazenil on the Emergence Delirium (clinicaltrials.gov) - P4 | N=68 | Recruiting | Sponsor: Korea University Guro Hospital | Not yet recruiting ➔ Recruiting

Enrollment open • Anesthesia • CNS Disorders

Immobilization of Captive Kulans (Equus hemionus kulan) Without Using Ultrapotent Opioids. (PubMed, Front Vet Sci) - "Kulans were darted using a ketamine-medetomidine-midazolam-butorphanol (KMMB) protocol (n = 8, treatment group (TG) 1), a tiletamine-zolazepam-medetomidine-butorphanol (TZMB) protocol (n = 7, treatment group (TG) 2), or an etorphine-acepromazine-detomidine-butorphanol (EADB) protocol (n = 6, control group)...At 60 min following induction, medetomidine and detomidine were antagonized with atipamezole IM (5 mg/mg medetomidine or 2 mg/mg detomidine), etorphine and butorphanol with naltrexone IV (2 mg/mg butorphanol or 50 mg/mg etorphine), and midazolam and zolazepam with flumazenil IV (0.3 mg per animal)...However, the control group (EADB) showed faster recoveries. Therefore, EADB is recommended for ultra-short immobilizations (e.g., microchipping and collaring), especially with free-ranging kulans where individual recovery is uncertain, whereas the investigated treatment protocols are recommended for prolonged medical procedures on captive kulans."

Journal • Anesthesia • Cardiovascular • Hypertension • Pulmonary Arterial Hypertension

Alprazolam and lorazepam overdose and the absence of brainstem reflexes. (PubMed, BMJ Case Rep) - "Her consciousness and brainstem reflexes improved dramatically after 0.25 mg of intravenous flumazenil. The blood for BZDs concentration showed alprazolam 268 ng/mL (20-40 ng/mL), lorazepam 861 ng/mL (20-250 ng/mL) and their metabolites."

Journal • Anesthesia • CNS Disorders • Depression • Psychiatry

Gaba A receptors containing the α4 subunit modulate emergence/recovery following anesthesia with different general anesthetics in mice (Neuroscience 2021) - "Also, we reported that intravenous flumazenil could hasten EEG and behavioral correlates of emergence from isoflurane anesthesia in rats. Objective: As the GABA A R mediates the clinical effects of many common general anesthetics, we aimed to evaluate the role of GABA A Rs containing the alpha-4 subunit (GABRA-4) in emergence and recovery from three different anesthesia regimens: inhaled isoflurane, injected ketamine/xylazine and injected ketamine in mice...Pharmacologic studies with a gaboxadol (a preferred GABRA-4 agonist) confirm these specific effects occur during emergence from anesthesia via α4-containing GABA A receptors without an associated change in recovery and/or cognitive performance. We conclude that there are important differences in the neural substrates mediating emergence and recovery. These findings confirm that α4-containing GABA A receptors are involved in hastening wakefulness.; Grant Support: Departmental grant from Anesthesiology Department at..."

Preclinical • CNS Disorders • Sleep Disorder

Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. (PubMed, J Clin Sleep Med) - "Evidence for the following interventions is presented: armodafinil, clarithromycin, clomipramine, dextroamphetamine, flumazenil, intravenous immune globulin (IVIG), light therapy, lithium, l-carnitine, liraglutide, methylphenidate, methylprednisolone, modafinil, naps, pitolisant, selegiline, sodium oxybate, solriamfetol, and triazolam. J Clin Sleep Med. 2021;17(9):1895-1945."

Journal • Retrospective data • Review • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Dementia • Genetic Disorders • Lewy Body Disease • Movement Disorders • Multiple Sclerosis • Muscular Dystrophy • Myotonic Dystrophy • Narcolepsy • Parkinson's Disease • Sleep Disorder • Vascular Neurology

Rapid Reversal of CNS-Depressant Drug Effect Prior to Brain Death Determination (clinicaltrials.gov) - P1; N=0; Withdrawn; Sponsor: Prisma Health-Midlands; N=40 ➔ 0; Trial completion date: Jun 2020 ➔ Jul 2021; Recruiting ➔ Withdrawn; Trial primary completion date: Dec 2019 ➔ Jul 2021

Enrollment change • Trial completion date • Trial primary completion date • Trial withdrawal • Cardiovascular • CNS Disorders • Vascular Neurology

Modulation of GABA-A Receptors in Parkinson Disease-Flumazenil Arm (clinicaltrials.gov) - P1/2; N=26; Completed; Sponsor: University of Michigan; Recruiting ➔ Completed; Trial completion date: Nov 2021 ➔ Jun 2021; Trial primary completion date: Nov 2021 ➔ Jun 2021

Trial completion • Trial completion date • Trial primary completion date • CNS Disorders • Movement Disorders • Parkinson's Disease

[VIRTUAL] Results of Double-blind, Placebo-controlled, Dose Range Finding, Crossover Study of Single Day Administration of ERX-963 (IV Flumazenil) in Adults with Myotonic Dystrophy Type 1 (AAN 2021) - "While ERX-963 at 1 mg and 2 mg was safe, there was no evidence of efficacy in measures of sleepiness or vigilance with this dose and administration regimen."

Clinical • CNS Disorders • Excessive Daytime Sleepiness • Myotonic Dystrophy • Obstructive Sleep Apnea • Sleep Apnea • Sleep Disorder

A Pharmacokinetic-Pharmacodynamic Study of Intravenous Midazolam and Flumazenil in Adult New Zealand White-Californian Rabbits (Oryctolagus cuniculus). (PubMed, J Am Assoc Lab Anim Sci) - "In a prospective, randomized, blinded, crossover study design,the efficacy of IV flumazenil (FLU; 0.05 mg/kg) or saline control (SAL; equal volume) to reverse the loss of righting reflex(LORR) induced by IV midazolam (1.2 mg/kg) was investigated in 15 New Zealand white rabbits (2.73 to 4.65 kg, 1 y old). Return of sedation(lateral recumbency) occurred in both groups (7/13 in FLU; 12/13 in SAL) with return of LORR in a few animals (4/13 in FLU; 7/13 in SAL) at 1540 [858 to 2328] s. In the population and anesthesia protocol studied, flumazenil quickly and reliably reversed sedation induced by midazolam injection. However, the potential return of sedation after flumazenil administration warrants careful monitoring in the recovery period."

Clinical • Journal • PK/PD data • Anesthesia

ANESTHESIA AND SURGERY PROTOCOLS FOR INTRA-ABDOMINAL TRANSMITTER PLACEMENT IN FOUR SPECIES OF WILD ARMADILLO. (PubMed, J Zoo Wildl Med) - "Anesthetic combination BDM was applied: butorphanol tartrate, detomidine hydrochloride, and midazolam hydrochloride, each at 0.1 mg/kg. In group 2, 43 armadillos received ketamine hydrochloride at 10 mg/kg 20 min after BDM injection, and intra-abdominal radio transmitters were surgically implanted...Both groups received the antagonist combination NYF: naloxone hydrochloride (0.02 mg/kg), yohimbine hydrochloride (0.125 mg/kg), and flumazenil (0.01 mg/kg)...The surgical procedure technique chosen did not appear to have a negative impact on armadillos studied. Implantable transmitters provide a cost-effective method for long-term monitoring of wild individuals."

Clinical • Journal • Aesthetic Medicine • Anesthesia

DEXMEDETOMIDINE, BUTORPHANOL, AND MIDAZOLAM AS A REVERSIBLE INDUCTION PROTOCOL IN NORTH AMERICAN RIVER OTTERS (LONTRA CANADENSIS). (PubMed, J Zoo Wildl Med) - "The otters were maintained on isoflurane during the surgical procedure...The otters were reversed with atipamezole (0.3-2 mg/kg, IM), naltrexone (0.6 mg/kg, IM), and flumazenil (0.05 mg/kg, IM)...Two fatal complications occurred secondary to suspected respiratory arrest during recovery. This drug protocol provided a smooth and rapid induction in free-ranging river otters, but further research is required to determine the safety of this protocol for river otters in both zoo and free-ranging situations."

Clinical • Journal • Anesthesia

EVALUATION OF TWO DOSES OF BUTORPHANOL-MEDETOMIDINE-MIDAZOLAM FOR THE IMMOBILIZATION OF WILD VERSUS CAPTIVE BLACK-FOOTED CATS (FELIS NIGRIPES). (PubMed, J Zoo Wildl Med) - "Intramuscular administration of naltrexone, atipamezole, and flumazenil resulted in rapid, uncomplicated recoveries. The capture methods exerted a greater influence on the physiology of the immobilized animals than did the doses of the drugs used. Although this drug combination can be used safely to immobilize black-footed cats, supplemental oxygen should always be available for use, especially in pursued animals due to hypoxia."

Journal • Metabolic Disorders

Αlpha 5 subunit-containing GABA receptors in temporal lobe epilepsy with normal MRI. (PubMed, Brain Commun) - "The less selective PET ligand [C]flumazenil has revealed reductions in GABA receptors...We found increased tonic inhibitory neurotransmission in our cohort of MRI-negative temporal lobe epilepsy who also had co-morbid memory impairments. Our findings are consistent with a subunit shift from α1/2/3 to α5 in MRI-negative temporal lobe epilepsy."

Journal • Alzheimer's Disease • CNS Disorders • Epilepsy • Immunology • MRI

An In Vivo Study of a Rat Fluid-Percussion-Induced Traumatic Brain Injury Model with [C]PBR28 and [F]flumazenil PET Imaging. (PubMed, Int J Mol Sci) - "Our results demonstrate a potential way to measure the molecular alterations in a rodent-based TBI model using PET imaging with [C]PBR28 and [F]flumazenil. These radioligands are promising options that can be eventually used in exploring the complex in vivo pharmacokinetics and delivery mechanisms of nanoparticles in TBI treatment."

Journal • Preclinical • CNS Disorders • Immunology • Inflammation • Vascular Neurology

The conundrum of polysubstance overdose. (PubMed, J Clin Pharm Ther) - "A new approach to treating opioid-induced respiratory depression due to drug overdose focuses on agents that stimulate respiratory drive rather than competing for opioid receptors. Such an approach is "agnostic" to the cause of the respiratory depression, so might be a potential way to treat polysubstance overdose."

Journal • Addiction (Opioid and Alcohol) • CNS Disorders • Depression • Epilepsy • Psychiatry

Design, synthesis, and preliminary pharmacological evaluation of novel thiazolidinone derivatives as potential benzodiazepine agonists. (PubMed, Mol Divers) - "The pharmacological effects of the designed compounds were antagonized by flumazenil, which confirmed the benzodiazepine receptors' involvement in their biological effects...In this study, we designed novel structures by the hybridization of thiazolidinone moiety with scaffold which has necessary pharmacophores for binding to the benzodiazepine receptors. The results are very promising for developing new lead compounds as benzodiazepine agonists possess anticonvulsant effects."

Journal • Alzheimer's Disease • CNS Disorders

Excitatory-inhibitory balance within EEG microstates and resting-state fMRI networks: assessed via simultaneous trimodal PET-MR-EEG imaging. (PubMed, Transl Psychiatry) - "The trimodal data were acquired from three studies using different radio-tracers such as, [C]ABP688 (ABP) (N = 9), [C]Flumazenil (FMZ) (N = 10) and 2-[F]fluoro-2-deoxy-D-glucose (FDG) (N = 10) targeted to study the mGluR5, GABA receptors and glucose metabolism respectively...Changes in the neuroreceptors leading to an altered coupling with glucose metabolism may render the RSNs vulnerable to psychiatric conditions. The paradigm employed here will likely help identify the precise neurobiological mechanisms behind these alterations in fMRI functional connectivity and EEG oscillations, potentially benefitting individualised healthcare treatment measures."

Journal • CNS Disorders • Psychiatry • MRI

Potential modulating effect of the Ascaris suum nicotinic acetylcholine receptor (nAChR) by compounds GSK575594A, diazepam and flumazenil discovered by structure-based virtual screening approach. (PubMed, Mol Biochem Parasitol) - "We constructed the homology model using the ACR-16 subunit sequence. The selected hit compounds displayed potential for further optimization as lead compounds. Therefore, such compounds may be useful in neutralizing the growing resistance of parasites to drugs, either alone or in combination with existing conventional anthelmintics."

Journal