Carbamazepine Toxicity Medication

Updated: Oct 15, 2021
  • Author: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA; Chief Editor: Stephen L Thornton, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Other than activated charcoal, no antidotes are available.

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Antidote, Adsorbent

Activated charcoal

Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water.

For maximum effect, administer within 30 min of ingestion of poison. May administer as aqueous suspension or combine with cathartic (usually sorbitol 70%) in the presence of active bowel sounds.

Repeat dose, if necessary (without cathartic), to adsorb large pill masses or drug packages.

With superactivated forms, use of doses of 0.5 g/kg PO may be possible.

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Benzodiazepines

Lorazepam (Ativan)

DOC for treatment of status epilepticus because persists in the CNS longer than diazepam. Rate of injection should not exceed 2 mg/min. May be administered IM if unable to obtain vascular access.

Monitoring patient's blood pressure after administering dose is important. Adjust prn.

Diazepam (Valium, Diastat, Diazepam Intensol)

Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA. Third-line agent for agitation or seizures because of shorter duration of anticonvulsive effects and accumulation of active metabolites that may prolong sedation.

Midazolam

Used as alternative in termination of refractory status epilepticus. Because water soluble, takes approximately 3 times longer than diazepam to peak EEG effects. Thus, clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose. Has twice the affinity for benzodiazepine receptors than diazepam. May be administered IM if unable to obtain vascular access.

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Alkalinizing Agent

Sodium bicarbonate

Used to correct arrhythmias if patient is diagnosed with bicarbonate-responsive acidosis, hyperkalemia, or overdose resulting in an acidotic state. Routine use for arrhythmia is not recommended.

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Cathartic

Polyethylene glycol-electrolyte solution (Colyte, GoLytely, MoviPrep, NuLytely)

Laxative with strong electrolyte and osmotic effects that has cathartic actions in GI tract.

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