THE USUAL INITIAL DOSE FOR THE REVERSAL OF BENZODIAZEPINE-INDUCED SEDATION IS 200 MICROGRAMS, FOLLOWED AT INTERVALS OF 60 SECONDS BY FURTHER DOSES OF 100 TO 200 MICROGRAMS IF REQUIRED, TO A MAXIMUM TOTAL DOSE OF 1 MG OR OCCASIONALLY 2 MG (USUAL RANGE, 0.3 TO 1 MG); EACH DOSE SHOULD BE GIVEN OVER 15 SECONDS, AND FURTHER DOSES SHOULD ONLY BE GIVEN IF AN ADEQUATE RESPONSE HAS NOT OCCURRED 45 SECONDS AFTER COMPLETION OF THE INJECTION. IF DROWSINESS RECURS AN INTRAVENOUS INFUSION MAY BE USED, AT A RATE OF 100 TO 400 MICROGRAMS/HOUR, ADJUSTED ACCORDING TO RESPONSE. ALTERNATIVELY, FURTHER DOSES OF UP TO 1 MG, IN BOLUSES OF 200 MICROGRAMS AS ABOVE, MAY BE GIVEN AT 20-MINUTE INTERVALS TO A MAXIMUM OF 3 MG IN ONE HOUR. PATIENTS AT RISK FROM THE EFFECTS OF BENZODIAZEPINE REVERSAL, SUCH AS THOSE DEPENDENT ON BENZODIAZEPINES, SHOULD RECEIVE SMALLER BOLUS INJECTIONS OF 100 MICROGRAMS. THE DOSE FOR CHILDREN IS 10 MICROGRAMS/KG, REPEATED AT 60-SECOND INTERVALS UP TO A MAXIMUM OF 50 MICROGRAMS/KG OR 1 MG, WHICHEVER IS LOWER; DOSES ARE GIVEN INTRAVENOUSLY OVER 15 SECONDS, WITH FURTHER DOSES IF AN ADEQUATE RESPONSE HAS NOT OCCURRED 45 SECONDS AFTER COMPLETION OF THE INJECTION, AS FOR ADULTS.
THE USUAL INITIAL DOSE FOR THE MANAGEMENT OF BENZODIAZEPINE OVERDOSE IS 200 MICROGRAMS GIVEN INTRAVENOUSLY OVER 30 SECONDS. A FURTHER DOSE OF 300 MICROGRAMS CAN BE GIVEN AFTER ANOTHER 30 SECONDS AND CAN BE FOLLOWED BY DOSES OF 500 MICROGRAMS AT ONE-MINUTE INTERVALS IF REQUIRED, TO A TOTAL DOSE OF 3 MG OR OCCASIONALLY 5 MG. IF A DOSE OF UP TO 5 MG PRODUCES NO RESPONSE THEN FURTHER DOSES ARE UNLIKELY TO BE EFFECTIVE. IF SYMPTOMS OF INTOXICATION RECUR, REPEATED DOSES MAY BE GIVEN AT 20-MINUTE INTERVALS; NOT MORE THAN 1 MG SHOULD BE GIVEN AT ANY ONE TIME AND NOT MORE THAN 3 MG IN ONE HOUR. AS BEFORE A SLOWER RATE OF ADMINISTRATION MAY BE USED FOR 'AT RISK' PATIENTS.