Acute carbamazepine intoxication: clinical spectrum and management

Carbamazepine is an anticonvulsant drug in widespread use for the treatment of tonic-clonic and temporal lobe seizure disorders. Acute intoxication with this agent results in both neurologic and cardiovascular dysfunction. Neurologic manifestations may range from mild ataxia to profound coma with respiratory failure and are correlated with the plasma drug level. Cardiovascular effects appear primarily as conduction system disturbances. Treatment of carbamazepine overdose consists of aggressive orogastric lavage followed by activated charcoal administration with catharsis. Continuous electrocardiographic monitoring and close observation are necessary until plasma carbamazepine levels fall to therapeutic anticonvulsant levels. In cases of severe intoxication with respiratory failure and prolonged intubation, charcoal hemoperfusion has been reported to result in rapid improvement.