Request for documentation on the effect of flumazenil in the treatment of withdrawal reactions in b

Fråga: Request for documentation on the effect of flumazenil in the treatment of withdrawal reactions in benzodiazepine-dependent patients.

Sammanfattning: Controlled clinical studies are needed to evaluate the possible effect of flumazenil in benzodiazepine-dependent patients.

Svar: Except for the abstract of a study on benzodiazepine detoxification with flumazenil (1), no clinical studies concerning the effects of flumazenil on benzodiazepine withdrawal reactions have yet been published.<br><br>File et al (2) studied the effects of flumazenil in benzodiazepine-dependent rats. They selected rats with low and high anxiety levels and treated them with diazepam and flumazenil. They found that rats with high beginning anxiety levels had a significant reversal of withdrawal anxiety when they were treated with flumazenil, as compared with the controls, who were only treated with diazepam. On the other hand, the rats with low beginning anxiety levels experienced increased withdrawal anxiety after administration of flumazenil. The authors therefore concluded that the effect of flumazenil was dependent on the beginning anxiety level of the rat, with flumazenil functioning as either a benzodiazepine agonist (anxiolytic) or a benzodiazepine inverse agonist (anxiogenic). Furthermore, the authors speculate on similar effects of flumazenil in benzodiazepine-dependent patients (2).<div id="referenser" style="display:none;">1 Woods SW, Rosen MI, Pearsall HR, Price LH, Kosten TR: Benzodiazepine detoxification with flumazenil. CPDD (College on Problems of Drug Dependence) Meeting Toronto, June 1993<br>2 File SE, Hitchcott PK: A theory of benzodiazepine dependence that can explain whether flumazenil will enhance or reverse the phenomena. Psychopharmacology 1990; 101: 525-532</div>