In some high-risk populations, the effects of benzodiazepines may reverse and seizures may start. Concurrent major sedative-hypnotic drug withdrawal, parenteral benzodiazepine therapy, recent therapy with repeated doses, myoclonic jerking or seizure activity prior to Flumazenil administration in overdose cases, or concurrent cyclic antidepressant poisoning are all potential risk factors for seizures. When there are motor abnormalities (twitching, stiffness, focal seizures), dysrhythmias (wide QRS, ventricular dysrhythmia, heart block), anticholinergic symptoms (mydriasis, dry mucosa, hypoperistalsis), and cardiovascular collapse at presentation, flumazenil is not advised.
Flumazenil should be avoided in these situations, and the patient should be permitted to be unconscious (with ventilatory and circulatory care if needed) until the antidepressant toxicity symptoms have passed. Treatment with flumazenil has no known benefits other than reversing sedation for the critically ill mixed-overdose patient, so it shouldn't be administered when seizures (from any cause) are expected. The majority of convulsions brought on by flumazenil injection need to be treated, and benzodiazepines, phenytoin, or barbiturates have proved effective treatments in doing so. Flumazenil means that greater benzodiazepine doses might be necessary than usual.
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