To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products [see Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS):

Assess each patient’s risk prior to prescribing acetaminophen and codeine phosphate tablets, and monitor all patients regularly for the development of these behaviors and conditions (see

It should not be used when there is a high risk of seizures (e.g., known ingestion of a drug associated with convulsions or mixed ingestion of unknown drugs).WARNING: ADDICTION, ABUSE, AND MISUSE RISK EVALUATION AND MITIGATION STRATEGY (REMS) LIFE-THREATENING RESPIRATORY DEPRESSION ACCIDENTAL INGESTION ULTRA-RAPID METABOLISM OF CODEINE AND OTHER RISK FACTORS FOR LIFE-THREATENING RESPIRATORY DEPRESSION IN CHILDREN NEONATAL OPIOID WITHDRAWAL SYNDROME INTERACTIONS WITH DRUGS AFFECTING CYTOCHROME P450 ISOENZYMES HEPATOTOXICITY and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTSĪcetaminophen and codeine phosphate tablets expose patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. It may be used with caution in patients with pure benzodiazepine poisoning who have severe respiratory depression and would otherwise require mechanical ventilation.įlumazenil should never be used as a diagnostic test and must only be administered by a clinician with expertise in its use. The risks associated with use of flumazenil, a benzodiazepine antagonist, outweigh any potential benefits for most patients. Acute management consists of maintaining airway, respiration, and haemodynamic support while excluding other diagnoses. The effects of benzodiazepines may be potentiated if taken in combination with other central nervous system (CNS) depressants, such as alcohol and opioids. Larger doses can cause coma, respiratory depression, and, without appropriate treatment, even death, particularly in the context of mixed ingestion with other CNS depressants. The key feature of overdose is excessive sedation. Benzodiazepine overdose can be intentional (e.g., as an act of self-harm), as part of recreational misuse, or accidental (e.g., medication error).īenzodiazepines are the most commonly prescribed medications for anxiety, sedation, and sleep.

Antidote for benzodiazepine toxicity