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Known or suspected benzodiazepine dependance.Known or suspected co-ingestion of a pro-convulsant.This decision needs to be weighed up with the ability for a ward to manage an infusion and with large adult ingestions it can be easier, quicker and potentially safer to intubate and transfer to ICU

Sometimes a flumazenil infusion is warranted.Re-sedation is likely to occur at 90 minutes whereupon further doses will be required.Paediatric dose = 0.01 – 0.02 mg/kg, repeat every minute.Adult dose = 0.1 – 0.2 mg IV and repeat every minute until there is reversal (max dose not exceeding 2mg).Only administer in an area that can manage potential seizures.The main hesitation for its use relates to dependency of benzodiazepines and mixed overdoses which if the benzodiazepine is reversed my precipitate seizures which will be difficult to control. Usually to reverse procedural sedation, accidental paediatric ingestion with compromise, and rarely to help make a diagnosis of benzodiazepine overdose or if a patient’s airway is compromised without quick access to intubation equipment. Flumazenil is a competitive benzodiazepine antagonist with a limited role in the management of benzodiazepine poisoning.