급성 진정제 중독 추정 환자에서 플루마제닐의 투여: 위험도/이익 재평가
Flumazenil administration in suspected patients with acute hypnotics and sedatives poisoning: risk-benefit re-evaluation
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Purpose: The use of flumazenil administration in the emergency department is still controversial because of concerns about adverse effects. The present study was conducted to re-evaluate the risk-benefit ratio associated with flumazenil administration to patients suspected of having acute hypnotics and sedatives poisoning in the emergency department. Methods: A retrospective chart review study was conducted for patients whose final diagnoses were “poisoning” and “benzodiazepine” or “sedatives-hypnotics” from Mar. 2006 to Feb. 2015. The basal characteristics of the patients, including past medical history, ingredients and dose of ingested drug and co-ingested drugs were investigated. For patients administered flumazenil, responsiveness and time from admission to flumazenil administration were investigated with supplement. All collected data were analyzed in aspect terms of risk/benefit. Results: A total of 678 patients were included in our study. Benzodiazepine was the most common sedative/hypnotic drug prescribed, and the frequency of prescription continuously increased. The proportion of TCA as co-ingestion decreased from 13.1% to 3.9% in patients with acute sedative/hypnotic poisoning. Flumazenil was administered to 55 patients (8.1%), of which 29 patients (52.7%) were applied to contraindications. Fifty-three patients (96.4%) showed positive responsiveness, including partial responsiveness after flumazenil administration. No severe adverse events were identified. Conclusion: Based on the current trends in prescription patterns for sedative/hypnotic drugs, increased use of non- TCA antidepressants, and responsiveness to administration of flumazenil, benefit seemed weighted more in this study, although the observed benefits were based on limited results. Further prospective multicenter studies will be needed to optimize benefit-risk ratio.
Abstract
Purpose: The use of flumazenil administration in the emergency department is still controversial because of concerns about adverse effects. The present study was conducted to re-evaluate the risk-benefit ratio associated with flumazenil administration to patients suspected of having acute hypnotics and sedatives poisoning in the emergency department. Methods: A retrospective chart review study was conducted for patients whose final diagnoses were “poisoning” and “benzodiazepine” or “sedatives-hypnotics” from Mar. 2006 to Feb. 2015. The basal characteristics of the patients, including past medical history, ingredients and dose of ingested drug and co-ingested drugs were investigated. For patients administered flumazenil, responsiveness and time from admission to flumazenil administration were investigated with supplement. All collected data were analyzed in aspect terms of risk/benefit. Results: A total of 678 patients were included in our study. Benzodiazepine was the most common sedative/hypnotic drug prescribed, and the frequency of prescription continuously increased. The proportion of TCA as co-ingestion decreased from 13.1% to 3.9% in patients with acute sedative/hypnotic poisoning. Flumazenil was administered to 55 patients (8.1%), of which 29 patients (52.7%) were applied to contraindications. Fifty-three patients (96.4%) showed positive responsiveness, including partial responsiveness after flumazenil administration. No severe adverse events were identified. Conclusion: Based on the current trends in prescription patterns for sedative/hypnotic drugs, increased use of non- TCA antidepressants, and responsiveness to administration of flumazenil, benefit seemed weighted more in this study, although the observed benefits were based on limited results. Further prospective multicenter studies will be needed to optimize benefit-risk ratio.
참고문헌 (16)
- Votey SR, "Flumazenil:a new benzodiazepine antagonist", Ann Emerg Med, 20, pp.181~188 (1991)
- Chern T-L, "The role of flumazenil in the management of patients with acute alteration of mental status in the emergency department", Human & experimental toxicology, 13, pp.45~50 (1994)
- Spivey WH, "Flumazenil and seizures: analysis of 43 cases", Clin Ther, 14, pp.292~305 (1991)
- Ngo AS-Y, "Should a benzodiazepine antagonist be used in unconscious patients presenting to the emergency department?", Resuscitation, 74, pp.27~37 (2007)
- 김한준, "응급센터에서 플루마제닐(Flumazenil) 임상적용의 한계", 대한응급의학회지, 15(6), pp.440~445 (2004), 대한응급의학회
- Barnett R, "Flumazenil in drug overdose: randomized, placebo-controlled study to assess cost effectiveness", Crit care med, 27, pp.78~81 (1999)
- Spivey WH, "A clinical trial of escalating doses of flumazenil for reversal of suspected benzodiazepine overdose in the emergency department", Ann Emerg Med, 22, pp.1813~1821 (1993)
- Bayer M, "Treatment of benzodiazepine overdose withflumazenil", Clin Ther, 14, pp.978~995 (1992)
- Weinbroum A, "Use of flumazenil in the treatment of drug overdose: a double-blind and open clinical study in 110patients", Crit care med, 24, pp.199~206 (1996)
- Kim DM, "Comparison of Prescription Patterns and Clinical Features according to Clinical Departments in Sedativehypnotic Intoxication", Journal of the Korean Society of Clinical Toxicology, 12, pp.54~62 (2014)
- 송민규, "주요 우울장애 입원환자에서 약물 사용의 변화: 일 대학병원에서 2001년, 2006년과 2010년의 비교", 대한정신약물학회지, 23(4), pp.166~175 (2012), 대한정신약물학회
- Oh S-H, "In-depth investigation for prescribing trends of benzodiazepines in South Korea", Int J Clin Pharmacol Ther, 52, pp.460~470 (2014)
- Veiraiah A, "Flumazenil use in benzodiazepine overdose in the UK:a retrospective survey of NPIS data", Emerg Med J, 29, pp.565~569 (2012)
- Mathieu-Nolf M, "Flumazenil use in an emergency department: a survey", Journal of Toxicology: J Toxicol Clin Toxicol, 39, pp.15~20 (2001)
- Nguyen TT, "Lack of adverse effects from flumazenil administration:an ED observational study", Am J Emerg Med, 33, pp.1677~1679 (2015)
- "Korea institute of drug safety & risk management" (2012)[URL]