Pharmaniaga Midazolam Overdosage

Symptoms: The symptoms of overdose are mainly an intensification of the therapeutics effects (sedation, muscle weakness, profound sleep) or paradoxical excitation. Confusion, tiredness, ataxia, disorders of vision, at high doses profound sleep or even loss of consciousness, respiratory depression, circulatory collapse. Extreme over-dosage may lead to coma, areflexia, cardiopulmonary depression and apnoea, requiring appropriate counter measures (ventilation. cardiovascular support).
Treatment: In case of mild symptoms of intoxication, the patient should be allowed to regain consciousness naturally, under supervision. If necessary, the circulation must be supported with peripherally acting drugs of the noradrenaline type and volume replacement. In the presence of respiratory insufficiency, which can also be caused by peripheral muscle relaxation, artificial ventilation is used. Forced diuresis, haemodialysis and peritoneal dialysis may be helpful if mixed intoxication cannot be excluded. Insufficient experience is available on the effects of haemoperfusion over activated charcoal. Prophylaxis against infection should be given.
The specific antidote is flumazenil. If mixed intoxication is suspected, for example with other centrally acting drugs, flumazenil is to be used with caution. The toxic effects of other psychotropic substances (in particular convulsions with tricyclic antidepressants) may occur due to neutralisation of the protective effect of the benzodiazepines by flumazenil.