eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Carbamazepine: Follow-up

Author: Nidhi Kapoor, MD, Emergency Physician, Clinical Assistant Professor Emergency Medicine, Brown Medical School, Department of Emergency Medicine, Brown University School of Medicine
Coauthor(s): Richard J Hamilton, MD, FAAEM, FACMT, Chairman, Department of Emergency Medicine, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Aug 14, 2008

Follow-up

Further Inpatient Care

  • Monitor carbamazepine plasma levels to make sure that they are decreasing and correlating with the clinical picture.

Transfer

  • Transfer the patient if appropriate monitoring facilities or critical care areas are not available.

Deterrence/Prevention

  • Education and communication between the primary care physician and the patient is important for prevention of carbamazepine overdose.

Complications

Prognosis

  • The patient may experience altered levels of consciousness for several days following acute overdose.
  • The patient's clinical examinations should improve as the plasma levels of the drug fall.

Patient Education

  • Carefully explain the proper method of taking anticonvulsants to avoid adverse reactions.
  • Educate to keep all medications and poisons in a locked cabinet or on high shelves to prevent pediatric accidental ingestions.
  • Instruct patients and parents to ensure that suspensions of Tegretol be agitated vigorously before administration. Otherwise, the drug settles in its container and early doses will contain less Tegretol and subsequent underdosing will occur; later doses may contain more drug and lead to toxicity.
  • For excellent patient education resources, visit eMedicine's Drug Overdose Center and Poisoning - First Aid and Emergency Center. Also, see eMedicine's patient education articles Poisoning, Drug Overdose, Activated Charcoal, and Poison Proofing Your Home.

Miscellaneous

Medicolegal Pitfalls

  • The physician should identify and diagnose carbamazepine toxicity to prevent increased morbidity and mortality of the patient.
 


More on Toxicity, Carbamazepine

Overview: Toxicity, Carbamazepine
Differential Diagnoses & Workup: Toxicity, Carbamazepine
Treatment & Medication: Toxicity, Carbamazepine
Follow-up: Toxicity, Carbamazepine
References
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References

  1. Montgomery VL, Richman BJ, Goldsmith LJ, Rodgers GC Jr. Severity and carbamazepine level at time of initial poison center contact correlate with outcome in carbamazepine poisoning. J Toxicol Clin Toxicol. 1995;33(4):311-23. [Medline].

  2. van Opstal JM, Janknegt R, Cilissen J, et al. Severe overdosage with the antiepileptic drug oxcarbazepine. Br J Clin Pharmacol. Sep 2004;58(3):329-31. [Medline].

  3. Fischer M, Hamm H, Wirbelauer J. [Severe drug-related skin reaction: toxic epidermal necrolysis caused by carbamazepine]. Klin Padiatr. Sep-Oct 2004;216(5):288-93. [Medline].

  4. Allam JP, Paus T, Reichel C, et al. DRESS syndrome associated with carbamazepine and phenytoin. Eur J Dermatol. Sep-Oct 2004;14(5):339-42. [Medline].

  5. Vander T, Odi H, Bluvstein V, Ronen J, Catz A. Carbamazepine toxicity following Oxybutynin and Dantrolene administration: a case report. Spinal Cord. Apr 2005;43(4):252-5. [Medline].

  6. Apfelbaum JD, Caravati EM, Kerns WP, et al. Cardiovascular effects of carbamazepine toxicity. Ann Emerg Med. May 1995;25(5):631-5. [Medline].

  7. Bass J, Miles MV, Tennison MB, et al. Effects of enteral tube feeding on the absorption and pharmacokinetic profile of carbamazepine suspension. Epilepsia. May-Jun 1989;30(3):364-9. [Medline].

  8. Goldfrank L, Flomenbaum NE, Lewin NA. Carbamazepine. In: Goldfrank's Toxicologic Emergencies. Appleton & Lange; 1994:594-5.

  9. Graudins A, Peden G, Dowsett RP. Massive overdose with controlled-release carbamazepine resulting in delayed peak serum concentrations and life-threatening toxicity. Emerg Med (Fremantle). Mar 2002;14(1):89-94. [Medline].

  10. Klimaszyk D, Lukasik-GLebocka M. [Cardiac toxicity of carbamazepine]. Przegl Lek. 2002;59(4-5):384-5. [Medline].

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  14. Litovitz TL, Smilkstein M, Felberg L, et al. 1996 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1997;15(5):447-500. [Medline].

  15. Micromedex. Toxicologic Managements of Carbamazepine. Healthcare Series Micromedex;95.

  16. Miles MV, Lawless ST, Tennison MB, et al. Rapid loading of critically ill patients with carbamazepine suspension. Pediatrics. Aug 1990;86(2):263-6. [Medline].

  17. Riva R, Contin M, Albani F, et al. Free and total plasma concentrations of carbamazepine and carbamazepine-10,11-epoxide in epileptic patients: diurnal fluctuations and relationship with side effects. Ther Drug Monit. 1984;6(4):408-13. [Medline].

  18. Romero Maldonado N, Sendra Tello J, Raboso Garcia-Baquero E, Harto Castano A. Anticonvulsant hypersensitivity syndrome with fatal outcome. Eur J Dermatol. Sep-Oct 2002;12(5):503-5. [Medline].

  19. Stremski ES, Brady WB, Prasad K, Hennes HA. Pediatric carbamazepine intoxication. Ann Emerg Med. May 1995;25(5):624-30. [Medline].

  20. Van Der Meyden CH, Kruger AJ, Muller FO, et al. Acute oral loading of carbamazepine-CR and phenytoin in a double-blind randomized study of patients at risk of seizures. Epilepsia. Jan-Feb 1994;35(1):189-94. [Medline].

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Further Reading

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Keywords

toxicity carbamazepine, carbamazepine toxicity, carbamazepine poisoning, 5H-dibenzazepine-5-carboxamide toxicity, antiepileptic drug toxicity, carbamazepine overdose, carbamazepine ingestion, carbamazepine exposure, antiepileptic drugs, AEDs, simple and complex partial seizures treatment, trigeminal neuralgia treatment, bipolar affective disorder treatment, iminostilbene derivative

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Contributor Information and Disclosures

Author

Nidhi Kapoor, MD, Emergency Physician, Clinical Assistant Professor Emergency Medicine, Brown Medical School, Department of Emergency Medicine, Brown University School of Medicine
Nidhi Kapoor, MD is a member of the following medical societies: American College of Emergency Physicians, Rhode Island Medical Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Richard J Hamilton, MD, FAAEM, FACMT, Chairman, Department of Emergency Medicine, Drexel University College of Medicine
Richard J Hamilton, MD, FAAEM, FACMT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

David C Lee, MD, Research Director, Department of Emergency Medicine, Assistant Professor, North Shore University Hospital and New York University Medical School
David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, ABAT, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD, ABAT is a member of the following medical societies: American Academy of Clinical Toxicology and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

John G Benitez, MD, MPH, FACMT, FACPM, FAAEM, Associate Professor, Departments of Emergency Medicine (Toxicology), Environmental Medicine, Community & Preventive Medicine and Pediatrics, University of Rochester School of Medicine; Director, Finger Lakes Regional Resource Center; Managing and Associate Medical Director, Ruth A Lawrence Poison and Drug Information Center, University of Rochester Medical Center
John G Benitez, MD, MPH, FACMT, FACPM, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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