Cut the Confusion: Flumazenil Versus Narcan
Both Flumazenil (Romazicon) and Narcan (Naloxone) are antidotes, but why do we confuse these two drugs that don’t even sound alike? Perhaps because both are common reversal agents that nurses often use—and confuse! So take a couple of minutes to review the mechanism of action and therapeutic ranges for each, so you don’t get baffled next time you need to use one of these drugs.
Narcan (Naloxone) is used to reverse medications like Morphine, Methadone and Nalbuphine. It is a competitive opiate antagonist that binds with opiate receptors in the central nervous system (CNS) and spinal cord, and blocks out the binding of opiates to these receptor sites. The opiates are then metabolized in the liver and excreted. When therapeutic blood levels of Naloxone are maintained, opiates cannot affect the CNS. The therapeutic dose of Naloxone is 0.4 – 1 mg titrated intravenously. It has a rapid onset of action, producing reversal in less than one minute and can be repeated at half to one hour intervals, if signs of re-sedation appear (Gahart & Nazareno, 2003. PDR 2003).
Romazicon (Flumazenil) is a benzodiazepine antogonist used to reverse Versed (Midazolam) and Valium (Diazepam). It also has a rapid onset of action, producing a reversal in less than one minute. A dose of 0.2 – 1 mg is given slowly intravenously with a dose not exceeding 0.2 mg/min. Flumazenil can be repeated every 20 minutes, with a total dose not exceeding 3 mg/hour. Patients with a history of seizures need close monitoring as Flumazenil can lower seizure thresholds (Gahart & Nazareno, 2003. PDR 2003).
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