Which medication is used to reverse Midazolam (Versed)?

• A. Romazicon
• B. Naloxone
• C. Flumazenil
• D. Protamine

Answer: (A)

Reversing midazolam relies on blocking the benzodiazepine effects at the GABA-A receptor. The antidote is flumazenil, available as the generic drug or under the brand name Romazicon. It works by competitively inhibiting the benzodiazepine binding site, rapidly reversing the sedative, amnestic, anxiolytic, and respiratory depressant effects of midazolam. Because flumazenil has a short duration of action, symptoms can recur as the benzo effect wears off, so patients need close observation and sometimes repeat dosing. This reversal is specific to benzodiazepines; naloxone is used for opioid overdoses, and protamine reverses heparin. Flumazenil can provoke seizures in patients with benzodiazepine dependence or in those with mixed overdoses containing proconvulsants, so use with caution and ensure airway and monitoring are in place.