A question for those who have tried flumazenil

[[Buddie]]

A quick question for those who have tried low dose flumazenil. Did flumazenil initially make your symptoms worse? Did you have higher than normal anxiety? Did it cause you to be tired or out of it? Thanks in advance!

[[Buddie]]

I haven't tried Flumazenil personally. But I believe it's something that can't simply be taken like a tablet. It has to be taken intravenously in a hospital setting under careful monitoring.

From what I've read about Flumazenil. It's a selective GABAa receptor antagonist/blocker and is often administered in severe cases of Benzodiazepine overdose.

However, it has also been shown to be an effective treatment in long term benzo withdrawal symptom sufferers. By antagonising/blocking GABA's binding to these receptor sites, it allows them to up-regulate more quickly, speeding up the reversal of the down-regulation effects caused by Benzodiazepines.

This can make withdrawal symptoms temporarily more severe, which is why it's use needs to be closely monitored as it may temporarily lower the seizure threshold. NMDA and AMPA receptor antagonists may also be administered to reduce this risk.

Flumazenil will usually only be considered as a viable treatment option if a person is still suffering from moderate withdrawal symptoms beyond 6 months of having last used a Benzodiazepine or completed a taper, as this will also lower the risk of treatment complications.

[[Buddie]]

Thanks for your reply [...]. I'm 10 months post jump and actually started flumazenil treatment earlier this week. I was pretty hesitant about it for the reasons you mention, but some of my symptoms have been so persistent I decided to give it a try. I am also very fortunate to be able to have access to it. My doctor says that they have not personally had any of their patients react badly to it, which is why I figured it was worth asking here. My biggest concern is a set back.

It was much more benign than I expected to be honest. I'm now on day 3 and finally have started to have some anxiety as a result of it. The first few days were actually anxiety free, but my symptoms (dizziness, perceptual distortions and tremor mostly) did flare up somewhat and I started to get pretty bad tinnitus, which is something I have avoided so far in recovery. Surprising to me, I actually feel tired and somewhat out of it from the flumazenil. I totally expected to be fully awake, hyperaware and anxious, but the bulk of my experience has been the opposite. 

[[Buddie]]

Thanks for your reply [...]. I'm 10 months post jump and actually started flumazenil treatment earlier this week. I was pretty hesitant about it for the reasons you mention, but some of my symptoms have been so persistent I decided to give it a try. I am also very fortunate to be able to have access to it. My doctor says that they have not personally had any of their patients react badly to it, which is why I figured it was worth asking here. My biggest concern is a set back.

It was much more benign than I expected to be honest. I'm now on day 3 and finally have started to have some anxiety as a result of it. The first few days were actually anxiety free, but my symptoms (dizziness, perceptual distortions and tremor mostly) did flare up somewhat and I started to get pretty bad tinnitus, which is something I have avoided so far in recovery. Surprising to me, I actually feel tired and somewhat out of it from the flumazenil. I totally expected to be fully awake, hyperaware and anxious, but the bulk of my experience has been the opposite.

What you're experiencing is to be expected and you shouldn't be concerned by these symptoms. If the symptoms were going to be anymore severe, they would have came on very rapidly after the first administration of the treatment. Right now the GABAa receptor sites are going through a reversal process. But because GABA can't currently bind to those sites due to the antagonising effect of the Flumazenil, you will experience a temporary flair up of symptoms that you may have experienced earlier during the benzo withdrawal process.

Once the treatment has been completed and the Flumazenil has left your system, GABA will be able to bind normally to the newly formed GABA-A receptor sites and you will be feeling a whole lot better.

[[Buddie]]

Thank you so much [...]! This does help me feel a bit more at ease with the process.

[[Buddie]]

Thank you so much [...]! This does help me feel a bit more at ease with the process.

Keep us all up to date on your progress.

[[Buddie]]

Following

[[Buddie]]

Will do. Sorry for repeating some of this, but I'll include it in this post for clarity.  It has been difficult to find many subjective experiences with flumazenil, so I didn't really know what to expect when I started. I was very nervous initially, not only because of lowered seizure threshold, but also because it has been reported that flumazenil may act as an inverse agonist for those with panic disorder (which I do have). My first experience with it was strange, but not uncomfortable. Everything seemed to get brighter, colder, and I had goosebumps all over. This only happens occasionally now. Otherwise, it usually just feels like I'm tired and have a headache. I also have a bit of nausea. All of my persistent symptoms (internal tremor, dizziness, perceptual disturbances, anxiety) are worse, but not unbearably so. My eyes are dry and scratchy. I have more frequent tinnitus since starting the treatment, which was never a big issue for me. I started waking up in the middle of the night drenched in sweat again. I haven't remembered any dreams since I started the treatment, despite having vivid dreams since I jumped.

I will update if anything changes or when I stop the treatment.

[[Buddie]]

Hi [...]
May I ask where you are going for your treatment
Praying that it works for you
[...]

[[Buddie]]

Will do. Sorry for repeating some of this, but I'll include it in this post for clarity.  It has been difficult to find many subjective experiences with flumazenil, so I didn't really know what to expect when I started. I was very nervous initially, not only because of lowered seizure threshold, but also because it has been reported that flumazenil may act as an inverse agonist for those with panic disorder (which I do have). My first experience with it was strange, but not uncomfortable. Everything seemed to get brighter, colder, and I had goosebumps all over. This only happens occasionally now. Otherwise, it usually just feels like I'm tired and have a headache. I also have a bit of nausea. All of my persistent symptoms (internal tremor, dizziness, perceptual disturbances, anxiety) are worse, but not unbearably so. My eyes are dry and scratchy. I have more frequent tinnitus since starting the treatment, which was never a big issue for me. I started waking up in the middle of the night drenched in sweat again. I haven't remembered any dreams since I started the treatment, despite having vivid dreams since I jumped.

I will update if anything changes or when I stop the treatment.

I would raise these concerns you have with your doctor, but I wouldn't say anything that you're experiencing here is out of the ordinary. Flumazenil can trigger benzo withdrawal symptoms, even if you didn't experience them earlier during the withdrawal process.

GABA plays an important role in regulating neural activity and the signals sent to many different systems around the body, including your ears, your eyes and your muscles. Because Flumazenil blocks off GABA's binding effect on certain GABA receptor locations, it's only natural that some of these signals are intensified, which can lead to symptoms like tinnitus, visual sensitivity/disturbances and muscle twitching and tremors. The GABAergic system also helps to regulate body temperature, so when certain receptors are being blocked in these neurons, it can make you more sensitive to temperature changes.

Flumazenil is a challenging treatment to get through. But it really is one of those treatments where you need to deal with feeling worse before you can feel better.

This is completely normal. But please, speak to your doctor about this if you feel that it will put you mind more at ease. The anxiety mainly stems from these sensory disturbances, but just keep reminding yourself that these sensory alterations are merely temporary and a standard part of the treatment process.

You may try taking a natural NMDA receptor antagonist such as Magnesium Glycinate each day. Magnesium won't compromise your GABAergic system, but it will help to calm neural excitability in your Glutamatergic system and may help to take the edge of your anxiety by dulling Glutamate's effect on this receptor.