Stressful reactions and panic attacks induced by flumazenil in chronic benzodiazepine users

• Published in: Journal of psychopharmacology (Oxford) 1998, Vol.12 (2), p.146-150
• Main Authors: Bernik, M.A., Gorenstein, C., Vieira Filho, A.H.G.
• Format: Article
• Language: English
• Subjects: Adult; Anti-Anxiety Agents - adverse effects; Arousal - drug effects; Biological and medical sciences; Diazepam - adverse effects; Double-Blind Method; Drug toxicity and drugs side effects treatment; Female; Flumazenil; GABA Modulators; Humans; Infusions, Intravenous; Male; Medical sciences; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Panic - drug effects; Panic Disorder - diagnosis; Pharmacology. Drug treatments; Substance-Related Disorders - diagnosis
• ISSN: 0269-8811; 1461-7285
• DOI: 10.1177/026988119801200205

The acute effects of flumazenil, a benzodiazepine (BZD) receptor antagonist in long-term BZD users were used as a possible test to detect physiological dependence. Thirty-four subjects (20 females, 14 males) aged 26-48 years (mean ± SD, 42.4 ± 8.5 years), all chronic users of low doses of diazepam (5-20 mg/day,14.2 ± 4.8 mg/day) for 5 to 28 years (10.5 ± 6 years), received a single 1-mg i.v. flumazenil dose or saline, infused slowly under double-blind conditions. Physiological dependence was suggested as all patients receiving flumazenil developed an anxiety reaction while the placebo group did not. Flumazenil triggered a qualitatively different reaction amounting to a panic attack during infusion in nine out of 15 patients. These patients had a diagnosis of panic disorder or a history of panic attacks. Caution should be exercised when giving flumazenil to panic patients who are taking BZDs as maintenance treatment.