- Spencer Greene, MD, MS, FACEP, FACMT
Spencer Greene, MD, MS, FACEP, FACMT
- Assistant Professor of Medicine and Pediatrics
- Baylor College of Medicine
- Director of Medical Toxicology
- Section of Emergency Medicine
- Ayrn O'Connor, MD
Ayrn O'Connor, MD
- Clinical Associate Professor of Emergency Medicine
- University of Arizona College of Medicine
- Section Editors
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
Carbamazepine has been used for many years for the treatment of both partial and generalized seizures, as well as trigeminal neuralgia. It has also been used as a mood stabilizer and for treatment of neuropathic pain syndromes.
In 2014, the American Association of Poison Control Centers reported 3734 toxic exposures to carbamazepine . Of these, 1880 were isolated ingestions. There were no deaths, and 62 patients experienced major toxicity, defined as life-threatening or resulting in significant disability .
The toxicology, diagnosis, and management of acute carbamazepine poisoning are discussed here. The clinical use of carbamazepine and chronic complications related to its use are reviewed separately. (See "Overview of the management of epilepsy in adults" and "Seizures and epilepsy in children: Initial treatment and monitoring" and "Antiseizure drugs: Mechanism of action, pharmacology, and adverse effects".)
PHARMACOLOGY AND CELLULAR TOXICOLOGY
Carbamazepine interacts with multiple receptors and ion channels. Its therapeutic effect results from binding to sodium channels in their inactivated state, which inhibits neuron depolarization and decreases glutamate release . It is also anticholinergic, a property that is more relative in overdose than the therapeutic setting . (See "Anticholinergic poisoning".)
In carbamazepine toxicity, sodium channel blockade may manifest as cardiovascular toxicity, particularly prolongation of the QRS interval. This conduction abnormality predisposes patients to ventricular arrhythmias and hypotension .
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- PHARMACOLOGY AND CELLULAR TOXICOLOGY
- CLINICAL FEATURES
- Examination and clinical manifestations
- DIFFERENTIAL DIAGNOSIS
- LABORATORY EVALUATION
- General diagnostic testing in overdose
- Serum carbamazepine concentration
- Ancillary testing
- Airway, breathing, and circulation
- QRS interval prolongation
- Gastrointestinal decontamination
- - Activated charcoal
- - Multidose activated charcoal
- - Other methods
- Extracorporeal elimination
- Other complications
- PEDIATRIC CONSIDERATIONS
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS