Table 1. .

Summary of Reversal Agents*

Pharmacology	Flumazenil	Naloxone	Neostigmine	Sugammadex	Phentolamine
Indication for use	Complete or partial reversal of BZD-induced overdose	Complete or partial reversal of opioid-induced overdose	Reversal of nondepolarizing NMBDs	Reversal of rocuronium and vecuronium Rocuronium-induced allergy or anaphylaxis?†	Reversal of local anesthetic At risk for self-injurious behaviors or needed return of normal functions
Contraindications	Hypersensitivity Chronic/continued BZD use Head injury Alcoholism or drug dependency Signs of tricyclic antidepressants overdose	Hypersensitivity	Hypersensitivity Peritonitis Mechanical obstruction of the intestinal or urinary tract	Hypersensitivity Severe renal impairment	Hypersensitivity Severe cardiovascular disease
Pharmacologic effect	BZD receptor competitive antagonist	Opioid receptor competitive antagonist	Acetylcholinesterase inhibitor	Cyclodextrin encapsulates rocuronium or vecuronium	Nonselective α-adrenergic receptor antagonist
Onset, min	1-2	1-2	1	2 (2 mg/kg) 3 (4 mg/kg) 1.5 (16 mg/kg)	50 (maxilla) 70 (mandible)
Duration, min	19-50	5-45	20-30	—	—
Peak effect, min	6-10	5-15	9	—	—
Available formulation(s)	0.1 mg/mL IV	0.02 mg/mL IV 0.4 mg/mL IV 1 mg /mL IV 2 mg/0.1 mL IN2 4 mg/0.1 mL IN	1 mg/mL IV 0.5 mg/mL IV	200 mg/2 mL IV 500 mg/5 mL IV	0.4 mg/mL × 1.7 mL cartridge
Recommended adult dosing	0.2 mg over first 15 s, then 0.2 mg every 1 min as necessary; max dose 1 mg	0.1-0.2 mg increments	0.05 mg/kg lean body weight	2-16 mg/kg actual body weight	0.8 mg (12+ y)
Recommended pediatric dosing	0.01 mg/kg over first 15 s up to max 0.2 mg, then 0.01 mg/kg up to 0.2 mg every 1 min; max 4 additional doses or max 1 mg or 0.05 mg/kg, whichever is lower	0.01 mg/kg IV/IM/ETT	0.03-0.07 mg/kg IV; max 5 mg Add atropine 0.02 mg/kg or glycopyrrolate 0.015 mg/kg IV	Not established for ≤17 y	0.4 mg (6-11 y, ≥ 30 kg) 0.2 mg (6-11 y, 15-30 kg) 0.1 mg (≥10 kg)
Adverse events	Seizures Withdrawal Dysrhythmias Anxiety	Dysrhythmia Hypertension Tachycardia Pulmonary edema N/V Sweating Seizures Pain Dysphoria	N/V Bradycardia Dysrhythmia QT prolongation Bronchospasm Salivation Miosis GI peristalsis	Pain N/V Fever Headache Sore throat Back pain Cough Constipation	Pain Hypertension Bradycardia Headache
Precautions	Prolonged monitoring (2 h)	Prolonged monitoring (2 h)	Anticholinergic crisis	Hypersensitivity Bradycardia Prolonged blockade QT prolongation AV block Cardiac arrest	Tachycardia Dysrhythmia

^*BZD, benzodiazepine; ETT, endotracheal tube; GI, gastrointestinal; IN, intranasal; IV, intravenous; IM, intramuscular; NMBDs, neuromuscular blocking drugs; N/V, nausea and vomiting.

^†Case report finding, not indicated by product monograph.³