title: Flumazenil, naloxone and the 'coma cocktail'.
abstract: Flumazenil and naloxone are considered to be pharmacologically ideal antidotes. By competitive binding at the molecular target receptors, they are highly specific antagonists of two important drug classes, the benzodiazepines and opioids, respectively. Both antidotes enjoy rapid onset and short duration after parenteral administration, are easily titrated and are essentially devoid of agonist effects. Yet only naloxone is widely used as a component of the 'coma cocktail', a sequence of empirical treatments to correct altered mental status, while experts discourage the use of flumazenil for such patients. This review contrasts the history, indications, published evidence and novel applications for each antidote in order to explain this disparity in the clinical use of these 'ideal' antidotes.
authors.affiliation: Emergency Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario.|Ontario Poison Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Marco L A
authors.initials: ML
authors.lastname: Sivilotti
mesh_terms: D000701:Analgesics, Opioid / Q000037:antagonists & inhibitors* / Q000506:poisoning; D000931:Antidotes / Q000627:therapeutic use; D001569:Benzodiazepines / Q000037:antagonists & inhibitors* / Q000506:poisoning; D003128:Coma / Q000139:chemically induced* / Q000188:drug therapy* / Q000517:prevention & control; D062787:Drug Overdose / Q000188:drug therapy*; D005442:Flumazenil / Q000627:therapeutic use*; D006801:Humans; D009270:Naloxone / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D000931:Antidotes; D001569:Benzodiazepines; D009270:Naloxone; D005442:Flumazenil
keywords: benzodiazepine; flumazenil; naloxone; opioid; overdose