What is the appropriate treatment for acute benzodiazepine toxicity in a patient without chronic use?

• A. Flumazenil
• B. Supportive care
• C. Activated charcoal
• D. Naloxone

Answer: (A)

Flumazenil is the reversal agent for benzodiazepine toxicity. It works by blocking the benzodiazepine binding site on the GABA-A receptor, displacing the benzodiazepine and restoring normal GABAergic inhibition. In someone who has acutely overdosed but does not have chronic benzodiazepine use, this reversal can rapidly wake a sedated patient and improve airway protection and mental status.

Keep in mind that flumazenil has a short duration of action compared with many benzodiazepines, so re-sedation can occur and the patient must be monitored for potential return of symptoms, sometimes requiring additional dosing. It should be used with caution in people who may be benzodiazepine dependent, because it can precipitate withdrawal symptoms or seizures. In contrast, if the overdose involves opioids, naloxone would address that component, and activated charcoal is only supportive if ingestion was recent and the patient can safely protect their airway.