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Clinical effects of overdose: Confusion, continuing; decreased reflexes; drowsiness, severe; shakiness; slow heartbeat, shortness of breath, or troubled breathing; slurred speech, continuing; staggering; weakness, severe.
Treatment of overdose: For benzodiazepine intoxication, treatment consists of general supportive therapy and includes the following: To decrease absorption: If the patient is conscious (and not at risk of becoming obtunded, comatose, or convulsing based on ingestion), emesis should be induced mechanically or with emetics; also, activated charcoal may be administered orally to increase clearance as well as decrease absorption of the benzodiazepine.
If the patient is unconscious, gastric lavage may be performed with a cuffed endotracheal tube in place to prevent aspiration of vomitus.
To enhance elimination: Intravenous fluids may be administered to promote diuresis.
Specific treatment: Oxygen should be administered if respiration is depressed.
Hypotension may be controlled, if necessary, by intravenous administration of vasopressors such as dopamine, norepinephrine, or metaraminol.
Flumazenil is now available, and other agents are currently under investigation to determine the usefulness as antagonists to reverse the effects of the benzodiazepines.
Monitoring: Respiration, pulse, and blood pressure should be monitored.
Supportive care: An adequate airway should be maintained.
Patients in whom intentional overdose is known or suspected should be referred for psychiatric consultation.
