1 A case report on a 13-year-old girl with idiopathic grand mal epilepsy who ingested 34 g carbamazepine (CBZ) and 80 mg clonazepam is presented.
2 The patient survived but suffered severe temporary neurological toxicity characteristic of CBZ.
3 CBZ was 79.6 ± 2.8% bound to serum protein and carbamazepine-10,11-epoxide (CBZ-E) binding was essentially concentration dependent.
4 CBZ and CBZ-E elimination half-lives were 26 and 16.5 h respectively. An inhibitory metabolic interaction with the co-ingested clonazepam is suggested.
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References
1.
Beerman B., Edhag O. & Vallin H.Advanced heart block aggravated by carbamazepine. British Heart Journal1975; 37: 668-71.
2.
Hamilton DNCarbamazepine and heart block. Lancet1977 ; i: 1365.
3.
Zucker P., Daum F. & Cohen MJFatal carbamazepine hepatitis. Journal of Paediatrics1977; 91: 667-8.
4.
Smoot CA & Wood DLCarbamazepine toxicity: report of a case. Journal of the American Osteopathic Association1977; 76: 758-60.
5.
De Zeeuw RA, Westenberg GM, Van Der Klijn E. & Gimbrere Jsf.An unusual case of carbamazepine poisoning with a near fatal relapse after two days. Clinical Toxicology1979; 14: 263-9.
Leslie PJ, Heyworth R. & Prescott LFCardiac complications of carbamazepine intoxication: treatment by haemoperfusion . British Medical Journal1983; 286: 1018.
8.
Baselt RCDisposition of Toxic Drugs and Chemicals in Man, 2nd ed, pp. 113-7. Davis, California: Biochemical Publications, 1982.
9.
Denning DW, Matherson L., Bryson SM, Streete J., Berry DJ & Henry JADeath due to carbamazepine self-poisoning: Remedies reviewed. Human Toxicology1985; 4: 255-66.
10.
Elyas AA, Ratnaraj N., Goldberg VD & Lascelles PTRoutine monitoring of carbamazepine and carbamazepine-10,11-epoxide by high performance liquid chromatography using 10-methoxycarbamazepine as internal standard. Journal of Chromatography1982; 231: 93-101.
11.
Lehrman SN & Bauman MDCarbamazepine overdose. American Journal of Diseases of Children1981; 135: 768-9.
12.
Bertilsson L.Clinical pharmacokinetics of carbamazepine . Clinical Pharmacokinetics1978; 3: 128-43.
13.
Agbato OA, Elyas AA, Patsalos PN, Brett EM & Lascelles PTTotal and free serum concentrations of carbamazepine and carbamazepine-10,11-epoxide in children with epilepsy. Archives ofNeurology1986; 43: 1111-6.
14.
Bertilsson L. & Tomson T.Clinical pharmacokinetics and pharmacological effects of carbamazepine and carbamazepine-10,11-epoxide. An update. Clinical Pharmacokinetics1986; 11: 177-98.
15.
Mackichan JJ , Duffner PK & Cohen MESalivary concentrations and plasma protein binding of carbamazepine and carbamazepine-10,11-epoxide in epileptic patients . British Journal of Clinical Pharmacology1981; 12: 31-7.
16.
Riva R., Albani F., Ambrossetto G. et al. Diurnal fluctuations in free and total steady state plasma levels of carbamazepine and correlation with intermittent side-effects. Epilepsia1984; 25: 476-81.
17.
Elyas AA, Patsalos PN, Agbato OA, Brett EM & Lascelles PTFactors influencing simultaneous concentrations of total and free carbamazepine and carbamazepine-10,11-epoxide in serum of children with epilepsy. Therapeutic Drug Monitoring1986; 8: 288-92.
18.
Bourgeois Bfd & Wad N.Individual and combined antiepileptic and neurotoxic activity of carbamazepine and carbamazepine-10,11-epoxide in mice . Journal of Pharmacology and Experimental Therapeutics1984; 231: 411-5.
