Drug Interaction Report

GENERALLY AVOID: The administration of flumazenil can result in convulsions in patients who have been receiving long-term treatment with benzodiazepines for epilepsy or sedation or who have recently received repeated doses of parenteral benzodiazepines. The mechanism is abrupt reversal of the benzodiazepine's anticonvulsive effects. In addition, withdrawal seizures may occur in patients who are physically dependent on benzodiazepines.

MANAGEMENT: The use of flumazenil is not recommended in patients with epilepsy who have been receiving long-term treatment with benzodiazepines. In addition, flumazenil is contraindicated in patients who have received a benzodiazepine to control potentially life-threatening conditions such as status epilepticus or increased intracranial pressure. Extreme caution, dose individualization, and close monitoring is recommended for other patients. Clinicians should be prepared to manage convulsions. Most seizures have been successfully managed with benzodiazepines, phenytoin, or barbiturates.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.