Abstract
Clinical features—carbamazepine is structurally related to the tricyclic antidepressants and has similar anticholinergic features in overdose (dry mouth, coma and convulsions). In addition, drowsiness, nystagmus, ataxia and incoordination are often seen, the pupils are often dilated and divergent strabismus may be present. Complete external ophthalmoplegia has been reported. Hallucinations may occur, particularly in the recovery phase.Management—a single dose of charcoal within 1 hour of ingestion substantially reduces absorption. Multiple-dose activated charcoal (MDAC) has been shown to significantly increase elimination of carbamazepine (Boldy et al., 1987, Montoya-Cabrera, 1996). Activated charcoal should therefore be given in severe cases of carbamazepine poisoning in an initial dose of 50-100 g for adults, with repeated doses of 12.5 g/hour (or the equivalent).
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