Carbamazepine toxicity

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  • Has anticholinergic and antiepileptic effects
  • Therapeutic concentration: 4-12 mg/L

Clinical Features

May be delayed and follow crescendo-decrescendo course (due to delayed GI motility)

Differential Diagnosis


  • Levels do not accurately correlate with clinical severity


  • GI decontamination
  • Dialysis for severe cases. Indications: [1]
    • Intractable seizures or life threatening dysrhythmia (level 1D recommendation)
    • Respiratory depression requiring mechanical ventilation or prolonged coma (level 2D suggestion)
    • Significant toxicity or rising/persistent carbamazepine level despite activated charcoal and supportive care (level 2D suggestion)


  • Consider discharge for patient with decreasing levels (measured few hrs apart) and is asymptomatic

See Also


  1. Ghannoum M, Yates C, Galvao TF et al. Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup. Clin Tox 2016. 52(10):993-1004.