If absence seizures increase in patients receiving these medications, an alternative anticonvulsant should be instituted. Rifampin is a potent hepatic enzyme inducer and can accelerate the hepatic metabolism of diazepam. Patients should be monitored closely for signs of reduced diazepam effects if given rifampin concomitantly. Ten patients receiving diazepam and epinephrine survived compared to one patient in a retrospective control group. Diazepam is reported to antagonize the toxic effects of chloroquine, although the mechanism is unclear.
Further study is needed to confirm the usefulness of diazepam in chloroquine poisoning.
Flumazenil and benzodiazepines are pharmacological opposites. Flumazenil is specifically used to reverse the actions of benzodiazepines. Clinicians should note that the duration of action for some benzodiazepines may be much longer than that of flumazenil and repeat doses of flumazenil may be necessary. This paradoxical effect is possibly due to release of previously inhibited responses. Symptoms of CNS stimulation include nightmares, talkativeness, excitement, mania, tremor, insomnia, anxiety, restlessness, euphoria, acute rage reactions, and hyperactivity.