In a chronic benzodiazepine user with acute overdose, what is the recommended management?

• A. Flumazenil
• B. Benzo taper
• C. Naloxone
• D. Haloperidol

Answer: (B)

The important idea is that reversing benzodiazepines abruptly in someone who is chronically dependent can cause serious harm. In a chronic user, blocking the benzodiazepine effect with an antagonist often precipitates withdrawal symptoms, including seizures, and can lead to dangerous agitation or arrhythmias, especially if other depressants are involved. So the acute management centers on supportive care rather than reversal.

Focus on securing the airway and breathing, ensuring adequate circulation, monitoring vitals, and providing ongoing supportive care until the drug effect wears off. If needed, provide respiratory support or intubation and admission to a monitored setting. After the patient has stabilized, the long-term plan is to address dependence with a slow, supervised taper of benzodiazepines to minimize withdrawal symptoms.

Naloxone would not reverse a benzodiazepine overdose unless there’s an opioid co-ingestion, and haloperidol has no role in treating benzodiazepine overdose and could worsen the outcome. The key takeaway is that reversal is generally avoided in chronic benzodiazepine overdose, with emphasis on supportive care and careful tapering once stabilization is achieved.