STRESSFUL REACTIONS AND PANIC ATTACKS INDUCED BY FLUMAZENIL IN CHRONIC BENZODIAZEPINE USERS

The acute effects of flumazenil, a benzodiazepine (BZD) receptor antag onist in long-term BZD users were used as a possible test to detect ph ysiological dependence. Thirty-four subjects (20 females, 14 males) ag ed 26-48 years (mean +/- SD, 42.4 +/- 8.5 years), all chronic users of low doses of diazepam (5-20 mg/day, 14. 2 +/- 4.8 mg/day) for 5 to 28 years (10.5 +/- 6 years), received a single 1-mg i.v. flumazenil dose or saline, infused slowly under double-blind conditions. Physiologica l dependence was suggested as all patients receiving flumazenil develo ped an anxiety reaction while the placebo group did not. Flumazenil tr iggered a qualitatively different reaction amounting to a panic attack during infusion in nine out of 15 patients. These patients had a diag nosis of panic disorder or a history of panic attacks. Caution should be exercised when giving flumazenil to panic patients who are taking B ZDs as maintenance treatment.