Podcast 866: Carbamazepine (Tegretol) Overdose

<p dir="ltr"><strong>Contributor: Aaron Lessen MD</strong></p> <p dir="ltr"><strong>Educational Pearls:</strong></p> <p dir="ltr">What is Carbamazepine (Tegretol)?</p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Carbamazepine is an anti-epileptic drug with mood-stabilizing properties that is used to treat bipolar disorder, epilepsy, and neuropathic pain.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">It functions primarily by blocking sodium channels which can prevent repetitive action potential firing.</p> </li> </ul> <p dir="ltr">What are the symptoms of an overdose?</p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Common initial signs include diminished conscious state, nystagmus, ataxia, hyperreflexia, CNS depression, dystonia, and tachycardia</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Severe toxicity can cause seizures, respiratory depression, decreased myocardial contractility, pulmonary edema, hypotension, and dysrhythmias.</p> </li> </ul> <p dir="ltr">How is an overdose treated?</p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">An overdose is treated with large doses of activated charcoal and correction of electrolyte disturbances.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Be ready to intubate given the potential for respiratory depression.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Carbamazepine is moderately dialyzable and dialysis is recommended in severe overdoses.</p> </li> </ul> <p dir="ltr">Additional educational pearl: Individuals in correctional facilities can occasionally self-administer medications which means that medication overdose should still be on the differential for any of these individuals.</p> <p dir="ltr"><strong>References</strong></p> <ol> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Epilepsies in children, Young People and adults: NICE guideline [NG217]. National Institute for Hea