Carbamazepine Toxicity Treatment & Management

Updated: Dec 13, 2016
  • Author: Nidhi Kapoor, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Treatment

Prehospital Care

Prehospital care may include the following:

  • Obtain intravenous (IV) access
  • Place the patient on a cardiac monitor
  • Administer IV fluids, if the patient is hypotensive
  • Administer activated charcoal, if the patient has intact mental status and is able to protect the airway
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Emergency Department Care

For carbamazepine toxicity, the following ED care may be indicated:

  • Place the patient on a cardiac monitor
  • Administer intravenous fluids as needed for hypotension
  • Administer intravenous diazepam (5-10 mg, repeat q10-15min prn) or other suitable benzodiazepine to control seizures
  • Gastric lavage may be helpful if performed within 1 hour of ingestion
  • Protect the patient’s airway by placing the patient in left lateral decubitus position or by intubating
  • Induction of emesis is not recommended because of the risk of CNS depression and seizures
  • Administer activated charcoal if the patient is able to protect his or her airway
  • Multiple doses of activated charcoal (1 g/kg) can be administered every 2-4 hours to enhance total body clearance and elimination in the patient with significant toxicity
  • A saline cathartic or sorbitol may be given with the first dose of charcoal, although evidence for their effectiveness is lacking. Do not repeat activated charcoal administration if ileus is present
  • Perform whole-bowel irrigation (WBI) after ingestion of extended-release drug formulation: Adults and adolescents are treated with 1.5-2 L/h (20-30 mL/min) of polyethylene glycol electrolyte lavage solution (PEG-ELS); small children are given 0.5 L/h (25 mL/kg/h)
  • Administer sodium bicarbonate when QRS is wider than 100 msec due to carbamazepine toxicity (sodium channel blockade)

The clinician should be aware of the marginal clinical effect of extracorporal carbamazepine removal. High-efficiency hemodialysis and venovenous hemodialysis may have a similar effect as charcoal hemoperfusion. Peritoneal dialysis is not useful for carbamazepine removal.

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Consultations

Consult a medical toxicologist or a certified poison control center. Nephrology consultation is indicated if charcoal hemoperfusion is being considered.

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