Flumazenil should be used with caution because it can precipitate seizures in chronic benzodiazepine users or in mixed overdoses.

• A. It can precipitate seizures only in acute benzodiazepine overdose
• B. It has no risk and is safe in all overdoses
• C. It should never be used in any overdose
• D. It can precipitate seizures in chronic benzodiazepine users or mixed overdoses

Answer: (D)

Flumazenil is a benzodiazepine receptor antagonist used to reverse the sedative effects of benzodiazepines. The important point is that giving it can trigger seizures in two scenarios: in people who have become chronically benzodiazepine dependent, and in mixed overdoses where other substances are still present. In chronic users, abrupt blockade of benzodiazepine receptors can cause withdrawal-type excitation of the nervous system, precipitating seizures. In mixed overdoses, reversing the benzo effect can unmask or worsen seizures if other toxins (or withdrawal from benzodiazepines) are contributing to the presentation. For these reasons, flumazenil must be used with caution rather than assumed to be safe in all overdoses or only causing seizures in acute benzodiazepine overdose.