title: Slow subcutaneous infusion of flumazenil for the treatment of long-term, high-dose benzodiazepine users: a review of 214 cases.
abstract: Despite the first reports concerning benzodiazepine dependence being published in the early 1960s literature, the risk of benzodiazepine addiction is still greatly debated. The severe discomfort and life threatening complications usually experienced by long-term benzodiazepine users who suddenly interrupt benzodiazepine intake have led to the development of several detoxification protocols. A successful strategy used by our Addiction Unit is abrupt benzodiazepine cessation by administering flumazenil slow subcutaneous infusion (FLU-SSI) with an elastomeric pump. Although some studies proved the efficacy of flumazenil infusion more than 20 years ago, only a few centres in the world offer this method to their patients. This paper reports the data related to 214 subjects addicted to high doses of benzodiazepine and treated with the FLU-SSI method between 2012 and 2014. This technique is less invasive and requires less nursing intervention than intravenous infusion. Our data support FLU-SSI as a possible efficient strategy for the treatment of patients with long-term, high-dose benzodiazepine addiction, and could become a routine therapy as long as the necessary further studies on dose, duration of infusion and safety issues are carried out.
authors.affiliation: Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Faccini
authors.affiliation: Department of Diagnostics and Public Health, Pharmacology Unit, Verona University Hospital, Verona, Italy roberto.leone@univr.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Leone
authors.affiliation: Department of Diagnostics and Public Health, Pharmacology Unit, Verona University Hospital, Verona, Italy.
authors.forename: Sibilla
authors.initials: S
authors.lastname: Opri
authors.affiliation: Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona, Italy.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Casari
authors.affiliation: Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Resentera
authors.affiliation: Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Morbioli
authors.affiliation: Department of Diagnostics and Public Health, Pharmacology Unit, Verona University Hospital, Verona, Italy.
authors.forename: Anita
authors.initials: A
authors.lastname: Conforti
authors.affiliation: Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Lugoboni
mesh_terms: D000328:Adult; D000931:Antidotes / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use*; D006801:Humans; D055104:Infusions, Subcutaneous / Q000379:methods; D008297:Male; D008875:Middle Aged; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000188:drug therapy
chemical_list: D000931:Antidotes; D001569:Benzodiazepines; D005442:Flumazenil
keywords: Flumazenil; benzodiazepine addiction; benzodiazepine high doses; benzodiazepine withdrawal; subcutaneous slow infusion