Carbamazepine acute toxicity

Tidballs J. Acute toxic reaction to carbamazepine. Pediatr Pharmacol Ther 1992 121 295-299. 

STPs are found to be the major contributor of pharmaceuticals in the Ebro River water. Compounds more frequently detected in the Ebro River basin were analgesics (diclofenac, naproxen, ibuprofen), lipid regulators (gemfibrozil, bezafibrate), antibiotics (azythromycin, trimethoprim, erythromycin, sulfamethoxazole), the antiepileptic carbamazepine, the antihistaminic ranitidine, and the 6-blockers atenolol and sotalol, which are the ones of major consumption in Spain as well as the ones excreted at higher percentages as parent drugs. Concentrations detected in both waste and surface waters are from 100 to 1000 times lower than the levels reported to cause acute toxicity. However, with respect to chronic effects, for some of the most ubiquitous compounds the margin of safety is narrow. As a wide spectrum of pharmaceuticals has been detected in natural waters, effects of mixtures should also be taken into account. 

In CONCLUSION, lithium is universally accepted as a mood-stabilizing drug and an effective antimanic agent whose value is limited by its poor therapeutic index (i.e. its therapeutic to toxicity ratio). Neuroleptics are effective in attenuating the symptoms of acute mania but they too have serious adverse side effects. High potency typical neuroleptics appear to increase the likelihood of tardive dyskinesia. Of the less well-established treatments, carbamazepine would appear to have a role, particularly in the more advanced stages of the illness when lithium is less effective. 

A week later he went home on full anti-tuberculosis drugs with stable liver function tests and carbamazepine and the addition of pyridoxine. The white count does not suggest resistance has emerged during this treatment gap but should be monitored over the full treatment course. Any acute liver insult on top of this treatment would be very difficult to resolve. Compliance with the pyridoxine is very important to prevent any toxicity. 

Acute overdoses of carbamazepine are potentially lethal, and serum levels above 15 mcg/mL are associated with ataxia, choreiform movements, diplopia, nystagmus, cardiac conduction changes, seizures, and coma. Gastric lavage, hemoperfusion, and symptomatic treatment are recommended for the management of carbamazepine toxicity. 

TOXICITY Acute intoxication with carbamazepine can result in stupor or coma, hyperirritability, convulsions, and respiratory depression. During long-term therapy, untoward effects include drowsiness, vertigo, ataxia, diplopia, and blurred vision. The frequency of seizures may... 

The serum carbamazepine levels of 6 epileptic patients approximately doubled within 7 to 30 days of taking danazol 400 to 600 mg daily. Acute carbamazepine toxicity (dizziness, drowsiness, blurred vision, ataxia, nausea) was experienced by 5 out of the 6 patients. ... 

An isolated case report describes carbamazepine-induced acute renal failure, which resulted in a 3.5-fold rise in lithium levels and lithium toxicity 3 weeks after carbamazepine was started. ... 

---