Carbamazepine Toxicity in Emergency Medicine Follow-up
- Author: Nidhi Kapoor, MD; Chief Editor: Asim Tarabar, MD more...
Further Inpatient Care
- Monitor carbamazepine plasma levels to make sure that they are decreasing and correlating with the clinical picture.
- Admit the patient to the monitored setting with cardiac telemetry.
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
Complications of carbamazepine toxicity may include the following:
- Coma
- Elevated liver function test results
- Pulmonary edema
- Pancytopenia
- Anuria
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 carbamazepine should be shaken vigorously before administration. Otherwise, the drug settles in its container and early doses will contain less carbamazepine 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.
Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2008 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 26th Annual Report. Clin Toxicol (Phila). Dec 2009;47(10):911-1084. [Medline].
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].
van Opstal JM, Janknegt R, Cilissen J, L'Ortije WH, Nel JE, De Heer F. Severe overdosage with the antiepileptic drug oxcarbazepine. Br J Clin Pharmacol. Sep 2004;58(3):329-31. [Medline]. [Full Text].
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].
Allam JP, Paus T, Reichel C, Bieber T, Novak N. DRESS syndrome associated with carbamazepine and phenytoin. Eur J Dermatol. Sep-Oct 2004;14(5):339-42. [Medline].
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].
Apfelbaum JD, Caravati EM, Kerns WP 2nd, Bossart PJ, Larsen G. Cardiovascular effects of carbamazepine toxicity. Ann Emerg Med. May 1995;25(5):631-5. [Medline].
Bass J, Miles MV, Tennison MB, Holcombe BJ, Thorn MD. Effects of enteral tube feeding on the absorption and pharmacokinetic profile of carbamazepine suspension. Epilepsia. May-Jun 1989;30(3):364-9. [Medline].
Goldfrank L, Flomenbaum NE, Lewin NA. Carbamazepine. In: Goldfrank's Toxicologic Emergencies. Appleton & Lange; 1994:594-5.
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].
Klimaszyk D, Lukasik-GLebocka M. [Cardiac toxicity of carbamazepine]. Przegl Lek. 2002;59(4-5):384-5. [Medline].
Micromedex. Toxicologic Managements of Carbamazepine. Healthcare Series Micromedex. 95.
Miles MV, Lawless ST, Tennison MB, Zaritsky AL, Greenwood RS. Rapid loading of critically ill patients with carbamazepine suspension. Pediatrics. Aug 1990;86(2):263-6. [Medline].
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].
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].
Stremski ES, Brady WB, Prasad K, Hennes HA. Pediatric carbamazepine intoxication. Ann Emerg Med. May 1995;25(5):624-30. [Medline].
Van Der Meyden CH, Kruger AJ, Muller FO, Rabie W, Schall R. 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].
Wada JA, Troupin AS, Friel P, Remick R, Leal K, Pearmain J. Pharmacokinetic comparison of tablet and suspension dosage forms of carbamazepine. Epilepsia. Jun 1978;19(3):251-5. [Medline].
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