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Iminostilbene Anticonvulsants: Carbamazepine and Oxcarbazine

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Critical Care Toxicology

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Abstract

Carbamazepine (CBZ) is a carbamylated derivative of iminostilbene and is related structurally to the cyclic antidepressants [1]. It is currently considered the drug of first choice for treatment of focal epilepsy [2, 3] and is also effective in the treatment of partial seizures (simple and complex) with and without secondary generalization, generalized tonic-clonic seizures (grand mal), and combinations of these seizure types [2]. Carbamazepine is also used to treat many other medical conditions (Table 1).

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References

  1. McNamara JO. Drugs effective in the therapy of the epilepsies. In: Hardman JG, Limbird LE, Gilman AG, editors. Goodman and Gilman’s the pharmacologic basis of therapeutics. 10th ed. New York: McGraw-Hill; 2001. p. 521–47.

    Google Scholar 

  2. Carbamazepine. In Caswell A, editor. MIMS Online. Version 1.1. August 1-October 31, 2000.

    Google Scholar 

  3. Vajda FJ, Eadie MJ. The clinical pharmacology of traditional antiepileptic drugs. Epileptic Disord. 2014;16(4):395–408.

    PubMed  Google Scholar 

  4. Wiffen PJ, Derry S, Moore RA, Kalso EA. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014;4, CD005451.

    Google Scholar 

  5. Ettinger AB, Argoff CE. Use of antiepileptic drugs for nonepileptic conditions: psychiatric disorders and chronic pain. Neurotherapeutics. 2007;4(1):75–83.

    Article  CAS  PubMed  Google Scholar 

  6. Gallagher D, Herrmann N. Antiepileptic drugs for the treatment of agitation and aggression in dementia: do they have a place in therapy? Drugs. 2014;74(15):1747–55.

    Article  CAS  PubMed  Google Scholar 

  7. Targum SD. Treating psychotic symptoms in elderly patients. Prim Care Companion J Clin Psychiatry. 2001;3(4):156–63.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Findling RL, Ginsberg LD. The safety and effectiveness of open-label extended-release carbamazepine in the treatment of children and adolescents with bipolar I disorder suffering from a manic or mixed episode. Neuropsychiatr Dis Treat. 2014;10:1589–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Hikas JA, Crosby RD, Pearson VL, Graves NM. A randomised double blind study of carbamazepine in the treatment of cocaine abuse. Clin Pharmacol Ther. 1997;62:89–105.

    Article  Google Scholar 

  10. Minozzi S, Amato L, Davoli M, Farrell M, Lima Reisser AA, Pani PP, Silva de Lima M, Soares B, Vecchi S. Anticonvulsants for cocaine dependence. Cochrane Database Syst Rev. 2008;(2):CD006754.

    Google Scholar 

  11. Mowry JB, Spyker DA, Cantilena Jr LR, McMillan N, Ford M. 2013 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st annual report. Clin Toxicol. 2014;52(10):1032–283.

    Article  Google Scholar 

  12. Crawford PJ, Fisher BM. Recreational overdosage of carbamazepine in Paisley drug abusers. Scott Med J. 1997;42:44–5.

    Article  CAS  PubMed  Google Scholar 

  13. Ramsay SG, Clee MD. Comment on recreational overdosage of carbamazepine in Paisley drug abusers. Scott Med J. 1997;42:95.

    Article  CAS  PubMed  Google Scholar 

  14. Spiller HA. Management of carbamazepine overdose. Pediatr Emerg Care. 2001;17(6):452–6. Review.

    Article  CAS  PubMed  Google Scholar 

  15. Brown TR. Pharmacokinetics of antiepileptic drugs. Neurology. 1998;51 Suppl 4:S2–7.

    Article  Google Scholar 

  16. Pienimaki P, Hartikainen AL, Arvela P, et al. Carbamazepine and its metabolites in human perfused placenta and in maternal and cord blood. Epilepsia. 1995;36:241–8.

    Article  CAS  PubMed  Google Scholar 

  17. Morkunas AR, Miller MB. Anticonvulsant hypersensitivity syndrome. Crit Care Clin. 1997;13:727–39.

    Article  CAS  PubMed  Google Scholar 

  18. Hansten PD, Horn JR. The top 100 drug interactions. Edmonds: H&H Publications; 2002. p. 38–41.

    Google Scholar 

  19. Dresser GK, Spence JD, Bailey DG. Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition. Clin Pharmacokinet. 2000;38(1):41–57.

    Article  CAS  PubMed  Google Scholar 

  20. Graudins A, Peden G, Dowsett RP. Massive overdose with controlled-release carbamazepine resulting in delayed peak serum concentrations and life-threatening toxicity. Emerg Med (Fremantle). 2002;14(1):89–94.

    Article  Google Scholar 

  21. Sullivan Jr JB, Rumack BH, Peterson RG. Acute carbamazepine toxicity resulting from overdose. Neurology. 1981;31:621–4.

    Article  PubMed  Google Scholar 

  22. Spiller HA, Krenzelok EP, Cookson E. Carbamazepine overdose: a prospective study of serum levels and toxicity. J Toxicol Clin Toxicol. 1990;28:445–58.

    Article  CAS  PubMed  Google Scholar 

  23. Apfelbaum JD, Caravati EM, Kerns 2nd WP, et al. Cardiovascular effects of carbamazepine toxicity. Ann Emerg Med. 1995;25(5):631–5.

    Article  CAS  PubMed  Google Scholar 

  24. Tibballs J. Acute toxic reaction to carbamazepine: clinical effects and serum concentrations. J Pediatr. 1992;121:295–9.

    Article  CAS  PubMed  Google Scholar 

  25. Brahmi N, Kouraichi N, Abderrazek H, Thabet H, Amamou M. Clinical experience with carbamazepine overdose: relationship between serum concentration and neurological severity. J Clin Psychopharmacol. 2008;28(2):241–3.

    Article  PubMed  Google Scholar 

  26. Hojer J, Malmlund HO, Berg A. Clinical features in 28 consecutive cases of laboratory confirmed massive poisoning with carbamazepine alone. J Toxicol Clin Toxicol. 1993;31(3):449–58.

    Article  CAS  PubMed  Google Scholar 

  27. Potter JM, Donnelly A. Carbamazepine-10,11-epoxide in therapeutic drug monitoring. Ther Drug Monit. 1998;20:652–7.

    Article  CAS  PubMed  Google Scholar 

  28. Cordova S, Lee R. Fixed dilated pupils in the ICU: another recoverable cause. Anaesth Intensive Care. 2000;28:91–3.

    CAS  PubMed  Google Scholar 

  29. Salcman M, Pippenger CE. Acute carbamazepine encephalopathy. JAMA. 1975;231:915.

    Article  CAS  PubMed  Google Scholar 

  30. Gary NE, Byra WM, Eisinger RP. Carbamazepine poisoning: treatment by hemoperfusion. Nephron. 1981;27:202–20.

    Article  CAS  PubMed  Google Scholar 

  31. So EL, Ruggles KH, Cascino GD, et al. Seizure exacerbation and status epilepticus related to carbamazepine-10,11-epoxide. Ann Neurol. 1994;35:743–6.

    Article  CAS  PubMed  Google Scholar 

  32. Van Amelsvoort T, Bakshi R, Devaux CB, Schwabe S. Hyponatraemia associated with carbamazepine and oxcarbamazepine therapy: a review. Epilepsia. 1994;35:181–8.

    Article  PubMed  Google Scholar 

  33. Spiller HA, Carlyle R. Status epilepticus after carbamazepine overdose. Abstract 109, 1998 North American Congress of Clinical Toxicology Annual Meeting. J Toxicol Clin Toxicol. 1998;36:472–3.

    Google Scholar 

  34. Stremski ES, Brady WB, Prasad K, et al. Pediatric carbamazepine intoxication. Ann Emerg Med. 1995;25:624–30.

    Article  CAS  PubMed  Google Scholar 

  35. Zaidat OO, Kaminski HJ, Berenson F, Katirji B. Neuromuscular transmission defect caused by carbamazepine. Muscle Nerve. 1999;22:1293–6.

    Article  CAS  PubMed  Google Scholar 

  36. Hamilton DV. Carbamazepine and heart block (Letter). Lancet. 1978;1(8078):1365.

    Article  CAS  PubMed  Google Scholar 

  37. Mordel A, Sivlotti MLA, Linden CH. Fatal TCA-like cardiotoxicity following carbamazepine overdose. Abstract 108, 1998 North American Congress of Clinical Toxicology Annual Meeting. J Toxicol Clin Toxicol. 1998;36:472.

    Google Scholar 

  38. Doyon S, Zorc J. Electrocardiographic changes associated with carbamazepine toxicity in the pediatric population. Abstract 130, 1999 North American Congress of Clinical Toxicology Annual Meeting. J Toxicol Clin Toxicol. 1999;37:635–6.

    Google Scholar 

  39. Wilschut FA, Cobben NA, Thunnissen FB, et al. Recurrent respiratory distress associated with carbamazepine overdose. Eur Respir J. 1997;10:2163–5.

    Article  CAS  PubMed  Google Scholar 

  40. Lifshitz M, Gavrilov V, Sofer S. Signs and symptoms of CBZ toxicity. Pediatr Emerg Care. 2000;16:26–7.

    Article  CAS  PubMed  Google Scholar 

  41. Canger R, Battino D, Canevini MP, et al. Malformations in offspring with epilepsy: a prospective study. Epilepsia. 1999;40:1231–6.

    Article  CAS  PubMed  Google Scholar 

  42. Buehler BA, Delmont BS, Van Wae MS, et al. Prenatal prediction of risk of the foetal hydantoin syndrome. N Engl J Med. 1990;322:1567–72.

    Article  CAS  PubMed  Google Scholar 

  43. Jentink J, Dolk H, Loane MA, EUROCAT Antiepileptic Study Working Group, et al. Intrauterine exposure to carbamazepine and specific congenital malformations: systematic review and case–control study. BMJ. 2010;341:c6581.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Braitberg G, Miller MB, Curry SC. Anticonvulsant hypersensitivity syndrome. Emerg Med. 1995;7:170–3.

    Article  Google Scholar 

  45. Coombes BW. Stevens-Johnson syndrome associated with carbamazepine (“Tegretol”). Med J Aust. 1965;1:895–6.

    Google Scholar 

  46. Bloch KM, Sills GJ, Pirmohamed M, Alfirevic A. Pharmacogenetics of antiepileptic drug-induced hypersensitivity. Pharmacogenomics. 2014;15(6):857–68.

    Article  CAS  PubMed  Google Scholar 

  47. Hesdorffer DC, Tomson T. Sudden unexpected death in epilepsy. Potential role of antiepileptic drugs. CNS Drugs. 2013;27(2):113.

    Article  PubMed  Google Scholar 

  48. Nilsson L, Bergman U, Diwan VK, et al. Antiepileptic drug therapy and its management in sudden unexpected death in epilepsy: a case–control study. Epilepsia. 2001;42(5):667–73.

    Article  CAS  PubMed  Google Scholar 

  49. Mégarbane B, Leprince P, Deye N, et al. Extracorporeal life support in a case of acute carbamazepine poisoning with life-threatening refractory myocardial failure. Intensive Care Med. 2006;32:1409–13.

    Article  PubMed  Google Scholar 

  50. Brahmi N, Kouraichi N, Thabet H, Amamou M. Influence of activated charcoal on the pharmacokinetics and the clinical features of carbamazepine poisoning. Am J Emerg Med. 2006;24(4):440–3.

    Article  PubMed  Google Scholar 

  51. American Academy of Clinical Toxicology, European Association of Poison Centres and Clinical Toxicologists. Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. J Toxicol Clin Toxicol. 1999;37:731–51.

    Article  Google Scholar 

  52. Manoguerra AS. Gastrointestinal decontamination after poisoning: where is the science? Crit Care Clin. 1997;13:709–29.

    Article  CAS  PubMed  Google Scholar 

  53. Kielstein JT, Schwarz A, Arnavaz A, Sehlberg O, Emrich HM, Fliser D. High-flux hemodialysis–an effective alternative to hemoperfusion in the treatment of carbamazepine intoxication. Clin Nephrol. 2002;57(6):484–6.

    Article  CAS  PubMed  Google Scholar 

  54. Payette A, Ghannoum M, Madore F, Albert M, Troyanov S, Bouchard J. Carbamazepine poisoning treated by multiple extracorporeal treatments. Clin Nephrol. 2015;83(3):184–8.

    Article  CAS  PubMed  Google Scholar 

  55. Ghannoum M, Yates C, Galvao TF, Sowinski KM, Vo TH, Coogan A, Gosselin S, Lavergne V, Nolin TD, Hoffman RS, EXTRIP workgroup. Extracorporeal treatment for carbamazepine poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin Toxicol. 2014;52(10):993–1004.

    Article  CAS  Google Scholar 

  56. Ozhasenekler A, Gökhan S, Güloğlu C, et al. Benefit of hemodialysis in carbamazepine intoxications with neurological complications. Eur Rev Med Pharmacol Sci. 2012;16 Suppl 1:43–7.

    PubMed  Google Scholar 

  57. Spiller HA, Strauch J, Essing-Spiller SJ, et al. Thirteen years of oxcarbazepine exposures reported to US poison centers: 2000 to 2012. Hum Exp Toxicol. 2016;35(10):1055–9.

    Google Scholar 

  58. Pedrini M, Noguera A, Vinent J, et al. Acute oxcarbazepine overdose in an autistic boy. Br J Clin Pharmacol. 2009;67(5):579–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. van Opstal JM, Janknegt R, Cilissen J, et al. Severe overdosage with the antiepileptic drug oxcarbazepine. Br J Clin Pharmacol. 2004;58(3):329–31.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Kim YS, Kim DW, Jung KH, et al. Frequency of and risk factors for oxcarbazepine-induced severe and symptomatic hyponatremia. Seizure. 2014;23(3):208–12.

    Article  PubMed  Google Scholar 

  61. Wade JF, Dang CV, Nelson L, Wasserberger J. Emergent complications of the newer anticonvulsants. J Emerg Med. 2010;38(2):231–7.

    Article  PubMed  Google Scholar 

  62. Chong DJ, Lerman AM. Practice update: review of anticonvulsant therapy. Curr Neurol Neurosci Rep. 2016;16(4):39.

    Article  PubMed  Google Scholar 

  63. Buggy Y, Layton D, Fogg C, et al. Safety profile of oxcarbazepine: results from a prescription-event monitoring study. Epilepsia. 2010;51(5):818–29.

    Article  CAS  PubMed  Google Scholar 

  64. Keränen T, Sorri A, Moilanen E, Ylitalo P. Effects of charcoal on the absorption and elimination of the antiepileptic drugs lamotrigine and oxcarbazepine. Arzneimittelforschung. 2010;60(7):421–6.

    PubMed  Google Scholar 

  65. Christensen J, Balslev T, Villadsen J, et al. Removal of 10-hydroxycarbazepine by plasmapheresis. Ther Drug Monit. 2001;23:974–9.

    Google Scholar 

  66. Furlanut M, Franceschi L, Poz D, Silvestri L, Pecorari M. Acute oxcarbazepine, benzapril, hydrochlothiazide overdose with alcohol. Ther Drug Monit. 2006;28(2):267–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Monash Emergency Medicine, Monash Health Clinical Toxicology and Addiction Medicine Service, Melbourne, VIC, Australia

    Hwee Min Lee

  2. Clinical Toxicology and Emergency Medicine, School of Clinical Sciences at Monash Health, Monash University and Monash Health, David Street, 3175, Dandenong, VIC, Australia

    Andis Graudins

Authors
  1. Hwee Min Lee
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  2. Andis Graudins
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Correspondence to Hwee Min Lee or Andis Graudins .

Editor information

Editors and Affiliations

  1. Department of Medicine, Division of Clinical Pharmacology and Toxicology, University of Colorado, School of Medicine, Aurora, Colorado, USA

    Jeffrey Brent

  2. FDA, Office of New Drugs/Immediate Office, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas’ Hospital, Silver Spring, Maryland, USA

    Paul Dargan

  4. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Benjamin Hatten

  5. Medical Toxicological Intensive Care Unit, Lariboisiere Hospital, Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Robert Palmer

  7. Toxinology Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia

    Julian White

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Lee, H.M., Graudins, A. (2017). Iminostilbene Anticonvulsants: Carbamazepine and Oxcarbazine. In: Brent, J., et al. Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-17900-1_37

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