Carbamazepine toxicity


  • Has anticholinergic, sodium-channel blockade, anti-NMDA 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: [2]
    • 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. Novartis Pharmaceuticals USA. Prescribing information for Tegretol CR400(R) tablets (Accessed on August 27, 2008).
  2. 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.