Carbamazepine Toxicity Guidelines

Updated: Apr 29, 2020
  • Author: Muhammad Waseem, MS, MBBS, FAAP, FACEP, FAHA; Chief Editor: Stephen L Thornton, MD  more...
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Guidelines

Guidelines Summary

The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup performed a systematic review and provided the following clinical recommendations for ECTR in carbamazepine poisoning [34] :

  • ECTR is suggested in severe carbamazepine poisoning.

  • ECTR is recommended if multiple seizures occur and are refractory to treatment, or if life-threatening dysrhythmias occur.

  • ECTR is suggested if prolonged coma or respiratory depression requiring mechanical ventilation is present or if significant toxicity persists, particularly when carbamazepine concentrations rise or remain elevated, despite using multiple-dose activated charcoal (MDAC) and supportive measures.

  • ECTR should be continued until clinical improvement is apparent or the serum carbamazepine concentration is below 10 mg/L.

  • Intermittent hemodialysis is the preferred ECTR, but both intermittent hemoperfusion or continuous renal replacement therapies are alternatives if hemodialysis is not available.

  • MDAC therapy should be continued during ECTR.